Market event facts
Pharmaceutical manufacturers will often take advantage of market dynamics such as drug patent expirations to bring about outrageous price increases or unwarranted price discrepancies.
With unexpected drivers of drug spend, your plan and your members may be vulnerable to increased drug costs, which can affect therapy adherence and effectiveness.
What is the Market Events Protection Program?
The Market Events Protection Program®, part of the SafeGuardRx® platform, makes things simpler and more affordable by preauthorizing Evernorth® to act on your behalf when a dramatic market event occurs. We will shield your plan from extreme price increases by driving your members to the most clinically appropriate, cost-effective therapies or dispensing channels.
Plan Benefits
Avoid price increases
When a drug price has more than doubled in a single year and a safe, effective and lower-cost alternative exists, we will step in to quickly make it available to plans and members.
Reduce waste
If an unwarranted price discrepancy arises as a result of, for example, different dosage forms of the same medication (tablet vs. capsule) or drug manufacturers offering incentives on brand drugs, we will swiftly address it to help you avoid wasteful spending.
Leverage generics
Track patent expirations and new generics entering the market to keep costs in check while also providing members with effective medication alternatives.
Frequently Asked Questions
-
How much time will it take to implement a solution once an event is identified?
This timing varies per event scenario and the appropriate corresponding action. For some actions, such as preferring one chemically equivalent drug over another, we may be able to act as quickly as two to three weeks, because there is no member impact and therefore no need to notify members.
Member impact events will require more time due to member notifications in advance of the change to ensure a positive member experience and continuation of therapy.
-
Who is evaluating strategy for each event and determining which action to take?
The Market Events Protection Program has a product governance process that involves engaging cross-functional partners and leadership to ensure we make the best decision for our clients and members.
Action taken is based on opportunities as they arise by monitoring pricing and the generic pipeline. Other factors which are taken into consideration include:
- Pricing differential between products—we only take action on opportunities if there is a large price discrepancy across our book of business which sometimes happens slowly and can also differ by client.
- Pricing and utilization can differ by client, so we look at this holistically when determining which drugs to target.
- Utilization is also considered when determining which opportunities to go after. This is another item we continue to monitor.
-
What therapy classes could be impacted through this program?
Our Therapeutic Assessment Committee will review all medications targeted by the Market Events Protection Program to ensure the action is clinically appropriate and adheres to our strict clinical standards. We will not take action on clinically sensitive drug classes (antipsychotics, HIV, transplant, oncology medications) except for very rare circumstances, such as when a clinically appropriate alternative exists and there is very little to no member disruption.