Pharmacy benefit managers love generics, of course, and what better way to boost usage than to scour prescription claims for illuminating data? And so Express Scripts has come up with another angle to boost its business - the Medicare drug plan and the ‘donut hole.’

After examining the claims of 220,000 seniors - not the low-income variety - the PBM found that 23 percent who fell into the $2,250 donut hole coverage gap could’ve avoided that fate had they used generics. A senior in the donut hole typically paid considerably more of the cost of medication until $3,600 of his or her own money was spent.

Among seniors, 22 percent hit the donut hole and more than half of these did so by August. Despite numbering less than a quarter of the seniors served by plans in the analysis, the ‘donut hole’ crowed accounted for 60 percent of the total cost. Seniors who fell into the donut hole also lagged in overall generic use compared to seniors who didn’t (53 percent versus 67 percent).

“Since the total cost of the drug, including the amount spent by the federal government and the patient’s out-of-pocket expenses is calculated towards the $2,250, using just two branded chronic medications instead of generic alternatives can put a senior in the donut hole,” says Rebecca Rabbitt, Express Scripts senior director for Medicare.

Savings were calculated by examining the individual claims histories of each senior in the study to identify where substitution of a generic for a brand drug would have been clinically indicated.

A link will be provided as soon as one becomes available.[tags]Express Scripts, Medicare Part D, PBMs[/tags]