If you examine your claims data, you’ll likely discover that among your “Top 50 Most Expensive Drugs” is a line item for generic “metformin HCL ER”.
Metformin HCL is a longstanding, very inexpensive diabetes treatment. And ER stands for “extended release”.
There are metformin HCL ER treatments that are very inexpensive. So the question is: Why would this line item be among your “Top 50” most expensive drugs?
The answer: There are certain generic forms of metformin HCL ER that are absurdly expensive, while others bear the low-costs that you’d expect. But it’s reasonably likely that many (if not most) of your beneficiaries are unknowingly using the high-cost forms of this drug.
To help you understand what is taking place, we provide you with the following Chart, reflecting, first, the “immediate release” version of metformin, and then the 3 “extended release” generic versions of this drug. Our 3 columns for each drug identify each of the dosage strengths, the GSN identifiers, and the per ‘unit’ cost based on current retail Average Acquisition Costs (AACs). Focus in particular on the far right column, reflecting the per unit AACs (reported average retail acquisition costs):
Metformin (immediate release): The reference drug is Glucophage:
· 500 mg 13318 $0.0141
· 850 mg 16441 $0.023
· 1,000 mg 40974 $0.0234
(i) Metformin ER: The reference drug is Glucophage XR:
· 500 mg 46754 $0.0395
· 750 mg 52080 $0.0526
(ii) Metformin OSM: The reference drug is Fortamet:
· 500 mg 54019 $5.2278
· 1,000 mg 54018 $10.9621
(iii) Metformin ER: The reference drug is Glumetza:
· 500 mg 61267 $36.2147
· 1,000 mg 61273 $83.3821
As you can see, there are big differences in cost – per unit – for the generic versions of Fortamet and Glumetza!
Thus, it’s hard to imagine why any entity would cover generic Fortamet and Glumetza products (without at least a very strict letter of medical necessity). Both are examples of generic drugs with grossly inflated costs.
Note too: It also makes no sense for plans to cover the brand versions of those two drugs since they are even more expensive. In fact, if you search your claims data for those products, you’ll likely find you’ve been spending at least $2,000 and perhaps more than $3,000 per 30 day script for brand Glumetza!
What’s the Bottom Line?
It’s important for every plan to review its claims data continuously to identify inappropriate costs and use.
For your first effort: Look at metformin HCL ER, and make sure you (i) analyze your claims data and “Top 50 Drug Lists”; (ii) determine how much you are spending on each version of these drugs; and (iii) consider blocking all high-cost generic and brand versions.
You’ll likely save considerable sums if you do.
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