Webinar: Clinically Equivalent Therapeutic Alternatives for Health Plans

Health plans can optimize plan design with evidence-based, clinically equivalent therapeutic alternatives.

The medication is too expensive. Or it’s not covered. What now?

The prescribing doctor may see a few “therapeutic alternatives” in the electronic health record (EHR) and then choose one of these other medications as an alternative to the original.

But to truly enable the doctor to choose an alternative, the alternative must be clinically equivalent.

The Challenge for Health Plans

Some health plans outsource the work of creating and maintaining lists of therapeutic alternatives to pharmacy benefit managers (PBMs). Other health plans do this work entirely in-house. Still others take a hybrid approach. But no matter what approach health plans choose to perform this work, it can take significant time and effort to create and maintain lists of therapeutic alternatives.

On this AHIP webinar, my colleagues Leticia Salinas, Pharm.D., and John Vonhof, J.D., explain why.

Listen to the episode

Reduce Medication Costs & Optimize Plan Design

For example, consider a medication that was originally prescribed: a nasal spray for the treatment of allergies. As the doctor and patient consider their options, the EHR provides an alternative that isn’t “equivalent”: an oral solution. The oral solution is offered as an alternative because it’s less costly. Yes, both medications are for allergies. But the formulations are so different that they’re not clinically interchangeable.

What ‘100% Clinical’ Means

“Our program is purely, 100% clinical,” Dr. Salinas says on the webinar.

This program takes all factors into account, including the medically accepted indication, any secondary indications, equipotency, dosing schedule, route of administration, changing drug codes and evolving guidelines. This adds up to therapeutic alternatives that are clinically equivalent.

“It’s not about what makes sense in theory,” Dr. Salinas says, “but what makes sense in practice.” And what makes sense in practice is that the original and alternative medications are interchangeable from a clinical standpoint.

That’s how a therapeutic alternative becomes a viable choice for the doctor at the point of prescribing.