Adding Over-the-Counter Omeprazole to Drug Benefit Coverage Saves State Money

Researchers at the University of Arkansas for Medical Sciences College of Pharmacy evaluated the financial effects of adding drug coverage for over-the counter (OTC) omeprazole to the state employee health plan. The new plan utilized 3 tiers and placed OTC omeprazole in a $5 co-payment tier. It also increased pharmacy reimbursement to a $13 dispensing fee for each omeprazole prescription to compensate pharmacists for the extra work in switching patients and to keep the gross margin income-neutral for the pharmacy provider. The investigators used the prescription claims database to examine utilization and cost data for beneficiaries who received prescriptions for a proton pump inhibitor (PPI) during the 2-month period preceding the change in policy compared with the 2-month period following the policy change. Results reported indicated that use of OTC omeprazole increased from 47 percent of all PPI claims during the first week of the new policy to 60 percent of PPI claims during the remaining study period. Employees saved an average of $4.20 per PPI claim; the average reimbursement to pharmacies rose by 118 percent, yet the state saved an average of $40.86 per PPI claim. There was a reported increase in utilization of 17.2 percent in the post period as measured by days of PPI therapy per member per month. The investigators concluded that the policy change produced a savings to the state of as much as 50 percent of the total cost of PPI drugs despite a small increase in utilization coupled with increased reimbursement to pharmacies. For more information refer to: J Manag Care Pharm. 2004; 10(5):449-55. Return to Top