The RegenceRx Formulary: Based on scientific evidence for effectiveness, safety and cost-savings

Have you ever wondered why some drugs make the RegenceRx formulary and others don’t? If a medication you’re taking isn’t on our formulary, we bet you have wondered.

We don’t just draw medications out of a hat. In fact, our process is quite scientific–-evidence based. Our unique formulary review is specifically designed with our members top of mind–in terms of a medication’s safety, effectiveness and overall cost savings.

Other Pharmacy Benefit Management (PBM) companies like RegenceRx create formularies (or Preferred Medication Lists). While these medication lists provide the highest coverage, they do not always offer more effective or safer medications.

The role of pharmaceutical companies

Many PBMs are influenced by drug manufacturers offering financial incentives to be on their formulary lists. This can result in expensive medications on the formulary, even if the medications are not more effective or safer than other options. Few PBMs require the rigorous clinical study applied by RegenceRx.

When a new medication hits the market, the manufacturer typically supplies us with a detailed description of the drug’s ingredients, how it works, and what clinical studies have been done to demonstrate its safety and effectiveness. Our specially trained pharmacists take a critical look at this potentially biased information and research additional objective sources.

RegenceRx asks the tough questions:

• How thorough and unbiased were the manufacturer’s trials? (The most reliable study is called a “double-blind” in which neither the patient nor the physician knows who is using a placebo and who is using the new medication.)
• Were these trials extensive enough to reveal any negative side effects from extended use?
• Are the results of all clinical trials available—not just promotional materials that support the manufacturer’s claims?
• Is this new medication demonstrably better than ones already existing for the same condition? What are the risks? What are the costs?

The FDA plays a role, too

The U.S. Food and Drug Administration (FDA) is a useful source of information about new medications. A drug must have FDA approval before it can be legally sold in the U.S. But there are those who question the FDA’s policies and methods, believing that even the FDA is not immune from drug manufacturer influence.

The recent recall of high-profile medications like Vioxx ® has raised concerns about FDA policies. Consider this fact:

The FDA generally only requires the manufacturer of a new medication to show that it supplies more benefit than a placebo—not more benefit than existing medications.

Last year, three out of every four FDA-approved medications were classified as similar to existing drugs in chemical makeup or therapeutic value. It’s a game the pharmaceutical companies play to keep their profits up.

For example, when a popular drug’s patent nears expiration, equivalent generics could become available. Pharmaceutical companies sometimes take this strategy:

• tinker slightly with the drug’s chemical makeup
• promote it with a new name and snappy ad campaign
• convince the public they’ve created a better product.

Often there is little scientific evidence that the new drug is any better than existing medications, but it’s likely more expensive.

This is why the heartburn medication, Nexium ® is not on our formulary. Nexium was touted as a new-and-improved version of the popular purple pill, Prilosec ® . In fact, studies have shown that Nexium is similar to Prilosec in effectiveness. Still, Nexium is more than five times the cost ($148 for a month’s supply vs. $27 for Prilosec-OTC ™ ).

At RegenceRx, we strive to keep prescription costs down and health coverage affordable. That’s why we can’t justify paying so much for medications that simply aren’t more effective.

Nexium is not an isolated case. Many heavily advertised “new” medications don't show a significant benefit to justify their high cost. Lexapro ® , Wellbutrin XL ® , and many others have lower priced equivalents, clinically just as effective.

Save money with generics

One of the easiest and most significant things we can all do to help lower medical costs is to ask for generic medications. Every time Regence members increase their generic usage by 1%, they help save nearly $10 million.

How medications make the cut

RegenceRx pharmacists make recommendations to an independent committee of active physicians and pharmacists who make the formulary decisions they think make the most sense for their patients. We respect and abide by their advice.

We update our formulary as soon as new medications, brand-name and generic, become available. Our pharmacists look beyond a manufacturer’s claims, press releases, news reports, and even beyond FDA recommendations, for information that is truly scientific and evidence based.

Our pharmacists explore:

• What does the data say?
• Are the new drugs really more effective than existing drugs?
• What is their relative cost?

The efficiency of our process has received national recognition from well-respected organizations like Consumer Reports.

No decision-making system is perfect. But we think we have the best, most in-depth and fair process in the business based on the evidence. We believe that medications on our formulary are likely to provide our members with the most benefit—improving health, saving money, and keeping health coverage affordable.