Patching up wounds is one of the more basic services provided by healthcare, and the need for wound dressings is increasing.
The problem, according to a new OptumRx report, is that manufacturers have launched new brand-name prescription wound dressings that have similar ingredients when compared to over-the-counter and generic products – and the brand-name options are priced far higher than the alternatives. In some cases, they cost up to 125 times more.
This is significant, since chronic wounds affect about 6.5 million people, resulting in annual treatment costs of up to $25 billion. Depending on plan design, wound dressing formulations are often considered medical devices, not medications.
Several factors are driving the increased need for wound care, including: the rising incidence of chronic diseases such as diabetes, cancer and autoimmune disorders; the number of surgical procedures expected to rise over time; and an increased focus on reducing hospital stays.
WHAT'S THE IMPACT?
Currently, there are hundreds of different prescription and over-the-counter wound dressing options on the market. These can contain multiple combinations of antiseptic, antimicrobial and protective barrier compounds.
What's notable is that high-cost prescription wound dressings have not demonstrated consistent clinical benefit compared to those with similar active ingredients available in low-cost-prescription or over-the-counter form.
The data uncovered some particularly egregious offenders. ScarAway brand silicone pads, for example, cost about $44, while prescription SIL-K PAD products, made from similar materials, cost a whopping $5,499.
The Scarcare Gel Pad silicone pad alternatives didn't fare much better, costing roughly $3,811.
Gels also saw significant price disparities. Foraxa brand gel costs about $3,615, while Lidotrex gel costs $2,991 and Solox gel costs $2,661. The Regencare alternative, which is a prescription product, costs only $21. The over-the-counter option, Silvermed gel, costs just $25.
Physicians targeted by pharmaceutical companies may often be unaware of the ultra-high costs of these products, the report noted, and this can affect patients in tangible ways. These products, and others like them, result in significant, unnecessary out-of-pocket expenses for consumers.
Patients managing active wounds may delay use or forgo these products altogether due to their high price, particularly those in high-deductible health plans. This may put them at higher risk for infections, scarring and increased recovery time.
Plan sponsors are affected as well. High-cost wound care products are a subset of a broader financial exposure to high-cost, low-value products in the market. Collectively, unnecessary drugs and devices can add more than 6% in undue added cost to a plan sponsor's annual overall drug expenditures.
THE LARGER TREND
Medications and treatments that are more expensive than generic and off-brand items have become a pervasive issue in healthcare. This is exemplified by prescription medications: According to a recent study, the Medicare Part D program would have saved $977 million in a single year if all branded prescription drugs requested by prescribing clinicians had been substituted with a generic option.
And if Medicare patients had requested generic drugs instead of brand-name drugs, the Medicare Part D program would have saved an additional $673 million in one year, for a total savings of $1.7 billion.