A couple weeks ago the good folks at PMSI sent a copy of their excellent Drug Trends Report over for a preview before the ‘official’ release at RIMS. There’s some interesting stuff in the Report, lots of good info about cost drivers, the impact of re-branding OxyContin; the effects of price and utilization on total drug costs, and other wondrously fascinating material (I know, get a life…)
A few days ago the fine people at ExpressComp (the workers comp PBM unit of PBM giant Express Scripts) published their Drug Trend Report – and while it is noticeably shorter than their friendly competitor’s, it is nonetheless packed with insights and information.
But don’t make the mistake of trying to compare the two PBMs’ reports, as their client bases, analytical methods, data definitions, and analytical methodologies tend to be different – in some ways, quite different.
Here’s a couple ways the Express Scripts business may show different results from PMSI’s.
1. ESI services some of the largest state funds – including California and New York. With significant variation in prescribing and dispensing patterns across the country, it would be surprising if their data did NOT show differently than PMSI’s (which has some significant market share in the southeast as well as extensive national coverage).
2. PMSI doesn’t include out of network transactions; others do. Neither methodology is good or bad, they just reflect a different approach. Yet this can skew the data significantly, and make a PBM look ‘better’ or ‘worse’ depending on how you view the data.
3. Some payer clients are more sophisticated, employing strong prior auth and clinical drug management programs, and thereby reducing utilization for expensive drugs. Other payers are lazy and/or indifferent. PBMs don’t control payer behavior, rather they have to adapt to that behavior. I’m NOT saying ESI’s customers or PMSI’s are more or less savvy, just that they are undoubtedly different. And that difference is reflected in the results delivered by each PBM.
On the positive side, both companies use the same title for their publication…”Drug Trend Report” – demonstrating that consistency can actually lead to more confusion!
What does this mean for you?
When comparing two programs, or two vendors, dig deep into the data to make sure you really understand the methodologies and definitions. Otherwise you’ll not have the right info to make the correct decision.
PostScript
CompPharma LLC has been asked to help develop standardized data definitions and methodologies to enable PBMs to produce reports that will allow inter-company comparisons. If the PBM members agree to pursue this, expect the standards will be out in time for next year’s Reports.
(note I am affiliated with CompPharma)
May
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