Combination drugs are an important category to understand in the overall scope of what your company is paying for prescription benefits. Combination drugs can quickly increase your healthcare costs, and there are often other less expensive options available.
For certain medical conditions, a combination of two medications may be prescribed to treat the issue. When that happens, drug manufacturers may choose to put those two medications together as a new combination drug or market it as a bundled compound kit. On the surface, it makes sense: the doctor only has to write one prescription and the patient only has to pay for and keep track of one prescription.
The issue with combination drugs is that some of them are priced higher than they would be if the two (or more) components were purchased separately. That means the company and sometimes even the employee are paying more for the convenience of one product instead of two, and they may not realize it’s happening.
Because of how these products are billed, they may not look like a combination drug, even to electronic claims review software programs. Many are also priced to stay under cost-per-claim thresholds that might trigger further review.
Our SmartBlock program is designed to identify these high-cost products and recommend alternative options. In some cases, it’s as simple as prescribing two separate medications to be used together rather than the single combination drug. In other cases, it might mean using a compound drug available at a much lower cost from a local community pharmacy instead of the combination drug through the manufacturer.
The pharmacy world is constantly changing, and our clinical services team stays on top of new combination drugs to help identify cost savings for our clients. We can help you analyze which combination drugs your plan is paying for and what the cost savings could be to switch to individual components or compound medications.
If you want to better understand your overall pharmacy costs as part of your self-funded healthcare plan, contact us today to learn more about how MaxCare can help analyze your current plan and create a customized plan to help you control costs while still ensuring your employees receive the care they need.