Avoiding the "Donut Hole"

Even if you are not interested in geriatrics, still take Dr. Remington’s class….

As the summer goes on, I continue making my MTM calls. But the more calls I do, the more I realize that a comment complaint among the members is hitting the “donut-hole”. It is inevitable though, as your age increases so do the number of your prescriptions. Even though more and more generic drugs are coming to market, medication costs are still on the rise. But this is where pharmacists can play a crucial role to members (or “patients” for the rest of you).

As a student it’s hard to believe that we can really impact a patient’s drug therapy or reduce the overall costs of their medications. But we can! This is why I say take Dr. Remington’s class – even if you don’t have any interest in geriatrics. I can honestly say I am a peds person all the way and still benefited greatly from her class.

In Dr. Remington’s class, she gives an assignment which requires you do reduce a patient’s medication. Now, avoiding the donut-hole has nothing to do with what the patient actually pays at the pharmacy but with the actual drug cost. For example a member is receiving pantoprazole and pays the lowest copay since this is a generic medication ($10 for 90-day supply). So is there a reason to switch this patient to another PPI? Yes! If you look at the actual cost of the medication (wholesale cost) a 90-day supply of pantoprazole is $319.95, where a 90-day supply of omeprazole is $149.98. As a result, switching the member to omeprazole would save $679.88 per year. And that’s just ONE medication!

As you can see, modifying a member’s drug therapy - even just one medication - can make a huge difference. Think about how much we as pharmacists can do for a member in cutting their prescription costs to help them avoid the donut hole.