An article in the Star Ledger reflects why it is critically important for payers to implement programs to control the usage of Human Growth Hormone.  According to the story, NJ firemen and policemen have received millions of dollars of Human Growth Hormone injections  to bulk up.  And given state and municipal governments’ generous prescription coverage policies, the individuals taking the drugs paid almost nothing for the drugs, meaning virtually all of the drugs’ costs were borne by the NJ taxpayer.

Human Growth Hormone drugs are enormously expensive — typically more than $2,000 a prescription.  Moreover, average monthly usage of any of the four largest HGH sellers is typically $4,200 per month.

However, the clinical purposes for which HGH has been approved means HGH drugs should be used very infrequently.  Indeed, the American Association of Clinical Endocrinologists (AACE) has estimated that only “about 75,000 out of 265 million Americans currently have true growth hormone deficiency indicating the need for replacement therapy” through drug supplementation.  See this press release.

Nonetheless, HGH drugs are widely used for non-clinical purposes, notwithstanding their enormous cost, and numerous health providers’ warnings against such use. Why?  If you scan the internet for only a few moments, you will see extensive advertising claiming that Human Growth Hormone drugs can be used to increase muscle development, invigorate male sexual drive and prevent aging.

Notably, those who make large sums of money from the drugs’ overuse — including PBMs that are pocketing and frequently not passing through any of the huge rebates they are receiving on such drugs — have no incentive to control the drugs’ use.  Accordingly, payers must take matters into their own hands and begin to do so.

The first step to take is to determine your plan beneficiaries’ usage in order to assess the extent of over-use. Assuming the extent of use reflects it is likely that your plan beneficiaries are using the drugs for non-clinical purposes, the next step you must take is to implement programs to prevent inappropriate use, including strict prior authorization programs.

In addition, at your earliest opportunity, you should renegotiate your PBM contract to require your PBM to pass through to your plan 100 percent of all rebates and other third party financial benefits. Doing so will not only increase your prescription coverage savings, but eliminate your PBM’s incentive to allow the over-prescribing of Human Growth Hormone (and other drugs as well).

Moreover, if you represent a relatively large health plan, when you renegotiate your contract you should ensure that your PBM contract allows you to negotiate directly with manufacturers. With such contract provisions in place, you can take additional steps to decrease the cost of your now-appropriate Human Growth Hormone usage by negotiating directly with the multiple manufacturers of Human Growth Hormone.

Those manufacturers who are willing to provide discounts and rebates to lower the costs of their drugs can have their drugs placed on a lower formulary tier, with lower copays or coinsurance used to motivate plan beneficiary usage.  Those manufacturers who are unwilling to provide reduced costs can have their drugs placed on a higher formulary tier, with higher copays and coinsurance used to incentivize your plan beneficiaries to use lower-cost drugs.

After all, as is the case with several specialty drug therapeutic categories, choice does exist in the Human Growth Hormone therapeutic category of drugs, and competition can therefore be created, if payers act to create that competition.

Included in this category of drug are the following:  Norditropen, Genotropin, Humatrope, Nutropin/AQ, Omnitrope, Serostim, Sorbtive, Tev-Tropin and Salzen.