Big Data Aiming to Lower Big Prescription Bills

While Washington D.C. bickers with itself over healthcare reform, there are real thing happening in the private sector to help bring down the costs of prescription drugs, and if you didn’t guess, the big data technology trend is playing a central role in making it happen.

The company is Express Scripts, who say they are dedicated to making the use of prescription drugs safer and more affordable. Founded in 1986, a chief focus for the company is reducing waste in the prescription drug system, while helping to improve health outcomes.

It’s a big job. In a recent CIO.com article, it was reported that as the largest prescription benefits manager in the United States, Express Scripts manages 1.4 billion prescriptions, producing up to 14 petabytes of data annually. According to the report, the company is using three of those petabytes fed into a Teradata analytics engine to help doctors make data-driven prescription choices for their patients.

They are accomplishing this through an online portal that they launched last year called, ExpressPAth, which manages both medical insurance information as well as pharmacy benefit data to provide doctors with a comprehensive cost/benefit analysis of options while they are considering what drug treatments a patient should be taking.

The system looks at a wide variety of real-time information when considering options, including manufacturers drug guidance, claim adjudication data, clinical standards, and prior authorization rules. In addition, over the past four years, Express Scripts has authored their own proprietary set of machine learning rules to give the system some intelligence.

The end results are better information for the patients and decreased costs for virtually everyone involved. For patients, the system will find the most cost effective drugs, and even go as far as identifying lower cost clinics for them to go to for further treatments. For insurance providers, there are cost savings – according to the report, one insurer saves $45,000 when the system determined that the patient had been on a particular drug too long.

With these results showing promise, there is a lot more ground to cover. According to CIO.com, American’s spent $325.8 billion on prescriptions last year, with certain high cost treatments looking set to balloon up over the next decade – medications for conditions like cancer and multiple sclerosis are rising by 20 percent each year and may account for more than half of all prescription costs by 2019.

How big an impact a system like this can make in these increasing costs remains to be seen, however it’s hard to believe that if this kind of algorithmic price shopping caught on, it wouldn’t eventually lead to lower prices.

While the side show in D.C. goes on this week (and into the foreseeable future), it’s encouraging to know that there are things happening out in the natural market place to help make an impact in the health and related costs in healthcare.

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