CSS Responds: Sources of Regional Variation in Medicare Part D Drug Spending, The New England Journal of Medicine

A recent NEJM study indicated nearly a two-fold difference between brand name drug use in low cost versus high cost regions (Donohue, et al, NEJM 366; 6). The Donohue study calculated that if all Medicare regions used brand name drugs in a manner similar to the lowest cost regions, the Medicare program could save approximately $4.5 billion in drug spend (~$11 million per Part D plan).

The Problem: The problem, as Donohue notes, is that using typical formulary tactics to eliminate brand drug use “…would deprive some patients of needed treatment options”.

The Solution: CSS’s iDeal Therapy is a focused medication management program that uses patients’ clinical features to identify and eliminate inappropriate brand drug use.

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