$3.6K topical gel? Optum report warns of potential for wasteful spending on pricey, branded wound care products

generic drugs
A new Optum report examines the rising costs of prescription wound care products. (The Photographer/CC BY-SA 4.0)

Pharmaceutical manufacturers are bringing a number of new, high-cost branded wound care products to market, which could lead to significant wasteful spending, according to a new report from OptumRx.

These products include similar combinations of ingredients to generic and over-the-counter products, according to the report, but come with far higher price tags. For example, Sil-K PAD silicone pads come in at a $5,499 price, while the over-the-counter version is priced at $44.

That's a difference of 125 times, according to the report.

Savitha Vivian, senior vice president of clinical and formulary services at OptumRx, said the pharmacy benefit manager has been tracking such "pricing misconducts" from drugmakers for some time.

"The existence of these products is not new," she told Fierce Healthcare. "I think what's new is that there's more and more of these coming to market."

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A similar prescription silicone pad, ScarCare Gel Pad, comes in at a $3,811 price compared to a $44 over-the-counter product, according to the report.

Foraxa and Lidotrex, both topical gels, are prescriptions that compete with a $21 generic alternative, Regenecare. Foraxa costs $3,615 and Lidotrex costs $2,991, according to the report. Another topical gel, Solox, costs $2,661, when an over-the-counter alternative, Silvermed Gel, costs $25, according to the report.

Payers and plan sponsors should be aware of these products, Optum said, as addressing them can cut back on wasteful spending, especially as healthcare costs rise and affordability becomes a greater challenge.

Optum offers its clients, for instance, the Vigilant Drug Program, which uses analytics to flag these potentially low-value products and develop strategies to mitigate them. Plans can choose to cull them from the formulary entirely, where clinically appropriate, Vivian said, or use other methods like prior authorization or step therapy to ensure patients are trying lower-cost alternatives when possible.

Vivian said that since the program's 2017 launch, 78% of commercial clients have adopted at least one component of the program.

"It’s really shining a light on where there are affordability issues or this growing trend of increased prices," she said.