If you examine your Heath Plan’s claims data, it’s extremely likely you’ll discover that Crestor is costing your Plan a small fortune.

Typically, Crestor represents more than 1% of a Plan’s total annual drug costs. As a result, Crestor almost always appears on a Plan’s list of “Top Twenty Most Expensive Drugs.” Frequently, Crestor is among the “Top Ten” – jockeying to collect even more money from Plans than many high-cost specialty drugs.

But as if manna has fallen from heaven, there is now a means to reduce your Health Plan’s costs: Crestor has finally lost its patent protection, several chemically identical generics have just entered the market, and available prices for all generics have plunged as a result.

Accordingly, every Health Plan should now be asking two critical questions:

• How much is my PBM charging my Plan for Crestor and for the generic version of Crestor – rosuvastatin?
• Assuming my Plan can obtain low rosuvastatin costs from my PBM, what can I do to ensure my Plan avoids the high costs of Crestor, and only pays for the far lower-costs of rosuvastatin?

The Prices of Crestor and Rosuvastatin

Our consulting firm – and National Prescription Coverage Coalition – have been tracking Crestor developments for many months, waiting for the day when we could ensure low costs for rosuvastatin for all our firm’s clients, as well as for all Coalition Members.

In so doing, we have observed that Crestor’s manufacturer – AstraZeneca – has acted as virtually all brand manufacturers act before their drugs lose patent protection: As reflected below, AstraZeneca continuously increased Crestor’s price!

We also observed that as so often occurs, the first generic manufacturer that entered the market priced its product lower – but not much lower – than the brand manufacturer’s cost. Thus, in May 2016 when Actavis entered the market with rosuvastatin, its per pill (per unit) AWP was about $8.95.

However, in July 2016, when several other generic manufacturers entered the market, the per pill AWPs for different dosage levels for all generic manufacturers were far lower – varying from $6.30 to $6.50. Far more important, the available prices for all generic manufacturers’ products plummeted far below those numbers, and they are now less than $1.00 per pill.

Thus, it’s critically important for you to determine the prices your PBM is invoicing your Plan for Crestor and rosuvastatin. And it’s equally important for your Plan to try to ensure that your PBM is providing competitive pricing for both retail and mail dispensed rosuvastatin.

The PBM contracts that our firm has put in place for our clients – as well as for the National Prescription Coverage Coalition – require the relevant PBM to negotiate improved pricing whenever new generics enter the market. Thus, our Coalition staff has already contacted the Coalition’s PBM – Envision – which immediately responded to our request. While we cannot disclose our actual prices, we can say that they are well below the above cited numbers.

From our work in the marketplace, we also know that rosuvastatin can be obtained for costs as low as $25 to $50 for a 30 day retail pharmacy script (depending on the pharmacy from which it’s dispensed) – and about $60 to $90 for a 90 day mail order script.

Compare those costs to Crestor’s, with a typical total tab at retail and mail, respectively, of approximately $250 and $750, and you’ll understand why your Plan should act immediately to stop paying for Crestor’s costs: For every retail script dispensed, you’re likely losing about $200. For every mail script – more than $600.

Accordingly, even if your current PBM contract does not explicitly give you the right to negotiate new-to-market generic drug costs, we urge you to contact your PBM and try to lock in low rosuvastatin pricing of $1.00 per pill, or less.

Assuming you are successful, we also urge you to monitor your claims data thereafter to ensure that your PBM does not suddenly increase other drugs’ costs. After all, you’ll not save a dime if your PBM surreptitiously raises other drugs’ costs and thus “takes back” the rosuvastatin profits it has agreed to relinquish!

How To Incentivize Your Beneficiaries To Use Rosuvastatin

Last year, Crestor was prescribed 20.3 million times in the United States, making it the second most prescribed brand drug in our country. (1) Therefore, your Plan faces a major hurdle in decreasing Crestor use.

That’s especially true given AstraZeneca’s Crestor coupon program, which essentially eliminates Plans’ copay incentives for beneficiaries to use generic drugs. If you search for “Crestor.com” on your computer, you can easily discover the terms of AstraZeneca’s Crestor coupon program.

Below is a replica of the picture and text that will greet you, making clear that regardless of most plan beneficiaries’ copays, AstraZeneca will provide Crestor for as little as $3 per 30 day or 90 day fill:

Reading further on AstraZeneca’s website, you’ll discover that AstraZeneca is subsidizing users’ copayment costs up to $130 for a 30-day supply, $260 for a 60-day supply, and $390 for a 90-day supply. Moreover, plan beneficiaries can easily access those price reductions via simple text messages on their cell phones! (2)

Thus, unless your Plan drastically increases your copay requirements for Crestor, your plan beneficiaries are likely to continue to use Crestor. After all, by using coupons they can purchase Crestor for almost nothing, and most individuals act in their own economic interests (not their Plan’s).

Accordingly, if you want to take advantage of rosuvastatin’s lower costs, you must take other steps to decrease – or end – Crestor use. There are three alternative approaches to do so:

The first – and easiest – is simply to stop covering Crestor, while making clear you will continue to provide coverage for chemically identical rosuvastatin.

Alternatively, you can continue to cover both Crestor and rosuvastatin, but tell your beneficiaries that if they choose to use Crestor, they will be required to pay the difference between Crestor’s cost and whatever rosuvastatins’ costs happen to be on the day of dispensing.

A third approach is to implement “reference pricing”: Make clear that the most that your Plan will pay for Crestor – or its generic equivalent – is a “reference price” that you establish based on the generic drugs’ available costs. If a Plan beneficiary chooses to use brand Crestor, the beneficiary will need to pay for all costs above your “reference price.”

It’s worth noting that for those Plans that currently obtain coverage from Caremark or Express Scripts, both PBMs just announced the drugs they’ll be excluding from their “standard” 2017 Formularies. Caremark included Crestor on its list of excluded drugs, but Express Scripts did not. Therefore, if your Plan is relying on Express Scripts and its standard Formulary, you’ll need to take action on your own. Moreover, as other PBMs announce their standard Formularies for next year, they may also continue to include Crestor, meaning all Plans obtaining coverage from those PBMs will have to act on their own as well.

Most important of all, even if your coverage is with Caremark (or another PBM that decides to exclude Crestor from its standard Formulary in 2017), if you don’t act now, you’ll likely continue to incur high Crestor use for the rest of the year. And since Crestor is undoubtedly among your largest drug costs, that will mean you are losing the opportunity to obtain considerable drug savings.

Educate Your Beneficiaries

Whichever approach you implement, we believe it’s critically important that you tell your plan beneficiaries why you’re doing so.

Explain that Crestor and rosuvastatin are chemically identical, therapeutically equivalent drugs.

Identify just how much Crestor is costing your Plan, and just how much will be saved if your Plan is only required to incur the costs of rosuvastatin.

Articulate that everyone must band together to end manufacturers’ outrageous pricing.

And finally, make clear to your beneficiaries that they can have an enormous impact on the entire marketplace, if they’ll just do their part by paying attention to drugs’ costs and actively choosing to use lower-cost drugs.

If all Plans take steps to educate their beneficiaries, we will together change our entire country’s approach to medical care.

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