Yet, it is important to note that this PMPM figure represents an average. The Vigilant Drug Program is both optional and modular. Therefore, clients can choose different modules in various combinations based on the unique needs of their members. As a result, clients that opt to exclude more drugs will benefit from more savings. For example, clients electing each component of the Vigilant Drug Program saved $5.75 on a PMPM basis in 2020.5
The Vigilant Drug Program in action
Since drug makers continue to produce high-cost, low-value medicines, the list of products covered by the Vigilant Drug Program continues to expand.
Of the many drugs excluded by the OptumRx Vigilant Drug Program few demonstrate the potential for savings more clearly than Pennsaid®. An anti-inflammatory drug applied topically to treat the pain of osteoarthritis of the knee, it costs 60 times more than a clinically appropriate generic alternative. Vigilant Drug Program savings on this drug alone totaled $13 million in 2020.
Another prime example of the drugs targeted by the program is Vimovo®. A brand oral medication used to treat symptoms of osteoarthritis and rheumatoid arthritis, Vimovo contains a combination of a nonsteroidal anti-inflammatory drug (NSAID) and a proton pump inhibitor (PPI) and has an ingredient cost of $2,377 per prescription. In comparison, clinically appropriate alternative NSAID drug naproxen costs $15 per prescription. Complementary alternative PPIs such as omeprazole and pantoprazole, commonly cost approximately $15. As a result, Vigilant Drug Program savings on Vimovo totaled $11 million in 2020.
Often, several high-cost, low-value drugs will flood a single drug class. This is the case with prescription prenatal vitamins that include similar combinations of vitamins and minerals as clinically comparable generic alternatives. The Vigilant Drug Program has identified low-cost replacements for several drugs in this class including Azesco®, Trinaz®, Genicin Vita-S®and Lorid®. These products can as much as $5,600 per prescription, compared with $44 for alternativities. This helps not only clients but also pregnant women who may have chosen to forego these products altogether due to cost concerns.
Likewise, the Vigilant Drug Program has identified a similar trend of high-priced prescription wound dressings. These products are used to manage wounds and scars resulting from burns, surgical procedures or other trauma. Consider SIL-K PAD® Silicone pads. Despite having similar ingredients as over the counter (OTC) and lower-cost generic products, this product can cost up to 125 times as much as alternatives.