HEALTH PLANS–Using OTC as a lever for pushing costs onto members

Health plans and their PBMs failed in their mission to control drug costs in the 1990s. One option that has proved somewhat successful is to get members to use OTC versions of previously popular prescription drugs.  Wellpoint in particular waged a successful campaign to get Claritin (and other non-sedating anti-allergy drugs) reclassified as OTC by the FDA. They then gave away (initially) free coupons to Claritin users to persuade them to try the OTC variety and at the same time made it very expensive for members to get the prescription anti-allergy drugs, Zyrtec and Allegra, by essentially kicking them off the formulary. Now other plans including Aetna are doing something similar by promoting free use of Prilosec now it’s OTC.  Of course this means that Aetna members will probably have to pay much, much more if they want Prilosec’s replacement, Nexium, instead of OTC Prilosec.

While this is good business for the plans and obviously not so for the pharmas, it’s just one more indicator that costs are being pushed directly onto consumers.

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