The Official Medtipster Blog

have your healthcare and afford it, too
Subscribe

Five Largest PBMs

September 26, 2011 By: Nadia Category: HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Mallory Gillikin, 9/20/2011, www.BusinessInsurance.com

Business Insurance released its ranking of the nation’s largest pharmacy benefit managers. 

  1. Medco - Franklin Lakes, N.J.-based firm reported $66 billion in unbundled PBM revenues in 2010, a 10.4% increase from 2009
  2. CVS Caremark Corp.  – Woonsocket, R.I.-based firm retained the No. 2 position in the 2011 ranking, reporting $47.8 billion in unbundled PBM revenues in 2010, a 6.4% decrease from 2009.
  3. Express Scripts Inc. – Reporting nearly $45 billion in unbundled PBM revenues in 2010, St. Louis-based  firm remained in the No. 3 position in this year’s Business Insurance ranking. Express Scripts, which acquired WellPoint Inc.’s NextRx subsidiaries in December 2009, reported an 81.7% increase in unbundled PBM revenues in 2010.
  4.  Prescription Solutions Inc. - Irvine, Calif.-based firm and
  5. Catalyst Rx - Rockville, M.D.-based firm rounded out the top five largest PBMs.

To view the full ranking or to purchase copies of the 2011 Directory of Largest Pharmacy Benefit Managers, go to www.BusinessInsurance.com/directories.

DAW Prescriptions May Add $7.7 Billion To Healthcare Costs

March 25, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: CVS Caremark – 3.25.2011

Approximately five percent of prescriptions submitted by Pharmacy Benefit Management (PBM) members in a 30-day period during 2009 included a “dispense as written” (DAW) designation. This practice – whereby doctors or patients demand the dispensing of a specific brand-name drug and not a generic alternative – costs the health care system up to $7.7 billion annually, according to a new study by researchers at Harvard University, Brigham and Women’s Hospital. Moreover, these requests reduce the likelihood that patients actually fill new prescriptions for essential chronic conditions.

In a study published this week in the American Journal of Medicine, the researchers demonstrate that DAW designations for prescriptions have important implications for medication adherence. They found that when starting new essential therapy, chronically ill patients with DAW prescriptions were 50 to 60 percent less likely to actually fill the more expensive brand name prescriptions than generics. “Although dispense as written requests would seem to reflect a conscious decision by patients or their physicians to use a specific agent, the increased cost sharing that results for the patient may decrease the likelihood that patients actually fill their prescriptions,” the researchers said.

“This study shows that dispense as written requests are costing the health care system billions,” said William H. Shrank, MD, MSHS, of Brigham and Women’s Hospital and Harvard, and the study’s lead author.  “The further irony is that patients with prescriptions specifying a certain brand seem less likely to fill their initial prescriptions, adding to the medication non-adherence problem.”

“Previous to this study, little was known about the frequency with which doctors and patients request dispense as written prescriptions,” said Troy A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark and a study author. “Those who advocate for dispense as written and argue that the practice provides patients and physicians with greater choice will probably be surprised to learn that the practice increases costs and exacerbates non-adherence.”

The study reviewed 5.6 million prescriptions adjudicated for two million patients from January 1 to January 31, 2009. The review found that 2.7 percent of those prescriptions were designated DAW by doctors, while another two percent were requested DAW by patients.

If existing safe and effective generic alternatives had been provided in place of those brand-specific prescriptions, patients would have saved $1.7 million and health plans would have spent $10.6 million less for the medications.  The researchers said that assuming a similar rate of DAW requests for the more than 3.6 billion prescriptions filled in the U.S. annually, patient costs could be reduced by $1.2 billion and overall health system costs could be reduced by $7.7 billion.

The study is a product of a previously announced three-year collaboration with Harvard University and Brigham and Women’s Hospital to research pharmacy claims data in order to better understand patient behavior, particularly around medication adherence.  Annual excess health care costs due to medication non-adherence in the U.S. have been estimated to be as much as $290 billion annually.

Leading Retail Clinics Expanding Their Roles

January 06, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Dow Jones Newswires – Philadelphia Bureau, 1.5.2011

Drug-store clinics, supported by hospital systems and insurers, are girding to play a broader role in delivering medical care as the U.S. health system faces a growing doctor shortage.

Where retail clinics met skepticism from the medical community a few years ago, industry leaders see them gaining acceptance and taking on greater responsibility, complementing rather than replacing primary physicians.

Retail clinics operated by national pharmacy chains CVS Caremark Corp. (CVS) and Walgreen Co. (WAG), which together represent two-thirds of the market, are forming partnerships with health systems and have expanded the scope of services offered, moving beyond flu shots and sore-throat care into screenings and monitoring of chronic conditions.

“From a quality perspective and an affordability (perspective) we present a good solution,” said Dr. Andrew Sussman, associate chief medical officer of CVS Caremark and president of its MinuteClinic business. “We are at a unique and in some ways defining moment.”

Clinics see their role growing as millions more people gain insurance coverage under the U.S. health overhaul in 2014, intensifying a national physician shortage also heightened by an aging and increasingly diabetic population.

The health-system partnerships, in turn, are expected to help drive expansion of a decade-old U.S. retail clinic industry that peaked at 1,211 as of December, according to consultant Tom Charland of Merchant Medicine LLC, who tracks the industry in his ConvUrgentCare Report.

“We are predicting much greater clinic expansion in 2011 vs. 2010, largely because of these partnerships,” Charland said.

Merchant Medicine estimates the industry added 28 clinics net this year, a 2.4% increase. Wal-Mart Stores Inc. (WMT), which house independently owned clinics, led that growth, more than doubling the sites in its stores to add 63 clinics, Merchant Medicine said.

MinuteClinic and Take Care Clinic chains, though, both have seen double-digit percentage growth in patient visits this year. Although MinuteClinic closed a few locations in 2010, it expects to add 100 clinics a year to reach about 1,000 by 2015, roughly double the current number.

Drop-in clinics, generally staffed by nurse practitioners, say they don’t aim to become a “medical home” for patients, although a significant percentage of those visiting them–more than half of those using MinuteClinic and 40% at Walgreen’s Take Care Clinic–lack a primary physician.

“We are increasingly playing a role as an advocate and navigator for these patients,” said Peter Hotz, vice president for Walgreen’s health and wellness division.

Walgreen wouldn’t say whether its clinics are profitable, although Hotz said they should contribute to revenue and earnings as they grow. CVS expects MinuteClinic to be break-even by the end of 2011. Neither company breaks out the financial figures for its clinics.

CVS Caremark sees MinuteClinic, which added monitoring of diabetes, hypertension and cholesterol in 2010, as a partner with health systems in a “medical home network,” Sussman said. The company has entered collaborations with hospital systems in several states and is in talks with others.

Ohio’s Cleveland Clinic academic medical center has called its relationship with MinuteClinic “a true continuity of care model,” and the two organizations are working to integrate electronic medical records systems to facilitate sharing of patient information.

For Walgreens, which operates 359 Take Care Clinics plus 370 worksite health centers, the expanded retail clinic role fits a strategy to make its pharmacies “health-care destinations,” Hotz said. The clinics recently formed a collaboration with the Ochsner Health System in New Orleans and are developing other potential partnerships.

Insurers appear to support an expanded role for clinics. Roughly 70% of visits at MinuteClinics and Take Care Clinics are covered by commercial or government insurance.

“Most insurers cover all of our services, including chronic-condition monitoring. Payers have expanded coverage as our range of services has expanded,” CVS Caremark spokeswoman Carolyn Castel said.

While WellPoint Inc. (WLP), the largest U.S. managed-care company by members, prefers patients use primary care doctors as their medical homes, “we also recognize that not every market has an adequate supply of primary care physicians to fill this role and that not every member desires such an intimate relationship with a (physician),” spokeswoman Jill Becher said.

Although WellPoint doesn’t cover the comprehensive chronic-condition monitoring that some retail clinics have started to offer, it does contract with all the major clinics and as of March it will cover an additional 24 services offered by nurse practitioners at retail clinics, including conducting lipid panels, glucose monitoring and testing for tuberculosis and HIV.

Medicine is the best medicine; help patients keep taking it

December 07, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Boston Globe, 12.3.2010

Patients who don’t take their medications are a well-documented problem in medicine. If doctors are to spot patients who might stop complying with prescriptions, it’s vital to have a fuller understanding of why and how it happens.

As many as 40 to 60 percent of those with chronic conditions like high blood pressure, heart failure, or diabetes don’t take their medicines regularly. The reasons vary – some patients never fill their prescriptions; others feel better and stop their drug regimens; in still other cases, side effects or the burden of too many pills discourage patients from refilling their prescriptions. Whatever the motive, failing to take needed drugs leads to worse health and higher spending, as patients land in the hospital for preventable conditions that cost the health care system hundreds of millions of dollars a year.

But a new study this month in the Annals of Internal Medicine, by researchers at Brigham and Women’s Hospital and Harvard Medical School, shines the spotlight on another contributor: Patients not picking up prescriptions that have already been filled.

The analysis, funded by CVS Caremark, looked at over 10 million prescriptions filled over a 3-month span in 2008 and found that 3.3 percent were never picked up. The number seems small, but translates to 110 million abandoned prescriptions per year in the United States. It costs a pharmacy an estimated $5 to $10 to prepare, then return to the shelves, an unclaimed medication, so the authors estimate the problem could be costing more than $500 million a year. CVS Caremark has a clear interest in bringing that number down – but so do patients and doctors.

The problem could worsen as technology evolves: Prescriptions sent electronically were 65 percent more likely to be left behind, probably because they bypass the step of having the patients hand- deliver a slip to the pharmacist. As electronic prescribing continues to take hold nationwide, insurers should be vigilant that prescription fill rates may reflect compliance less accurately than with traditional prescriptions.

Not surprisingly, prescriptions with $40 to $50 copays were the most likely to be abandoned. According to William Shrank, the study’s main author, this means that during economically hard times “even insured patients are experiencing sticker shock, and walking away from the pharmacy, without filling essential medications.”

Doctors are unlikely to know their patients’ copays for drugs, but taking the time to talk about drug costs would help them identify those who might never pick up their prescriptions. Down the road, those extra minutes of chat time at the office become multiple dollars saved at the hospital bedside.

Steep Co-Pays May Cause Some to Abandon Prescriptions

November 17, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News

www.Medtipster.com Source: HealthDay, 11.15.2010 – By Serena Gordon

In these tough economic times, even people with health insurance are leaving prescription medications at the pharmacy because of high co-payments.

This costs the pharmacy between $5 and $10 in processing per prescription, and across the United States that adds up to about $500 million in additional health care costs annually, according to Dr. William Shrank, an assistant professor of medicine at Harvard Medical School and lead author of a new study.

“A little over 3 percent of prescriptions that are delivered to the pharmacy aren’t getting picked up,” said Shrank. “And, in more than half of those cases, the prescription wasn’t refilled anywhere else during the next six months.”

Results of the study are published in the Nov. 16 issue of the Annals of Internal Medicine.

Shrank and his colleagues reviewed data on the prescriptions bottled for insured patients of CVS Caremark, a pharmacy benefits manager and national retail pharmacy chain. CVS Caremark funded the study.

The study period ran from July 1, 2008 through Sept. 30, 2008. More than 10.3 million prescriptions were filled for 5.2 million patients. The patients’ average age was 47 years, and 60 percent were female, according to the study. The average family income in their neighborhoods was $61,762.

Of the more than 10 million prescriptions, 3.27 percent were abandoned.

Cost appeared to be the biggest driver in whether or not someone would leave a prescription, according to the study.

If a co-pay was $50 or over, people were 4.5 times more likely to abandon the prescription, Shrank said, adding that it’s “imperative to talk to your doctor and pharmacist to try to identify less expensive options, rather than abandoning an expensive medication and going without.”

Drugs with a co-pay of less than $10 were abandoned just 1.4 percent of the time, according to the study. People were also a lot less likely to leave generic medications at the pharmacy counter, according to Shrank.

The medications most frequently abandoned were cough, cold, allergy, asthma and skin medications, those used on an as-needed basis. Insulin prescriptions were abandoned 2.2 percent of the time, but Douglas Warda, director of pharmacy for ambulatory services at the University of Chicago Medical Center, said this might be a cost issue, but it could also be that some people are afraid to inject insulin.

The study also found that antipsychotic medications were abandoned 2.3 percent of the time.

Drugs least likely to be abandoned included opiate medications for pain, blood pressure medications, birth control pills or hormone replacement therapy, and blood-thinning medications, according to the study.

Young people between the ages of 18 and 34 were the most likely to forgo their prescriptions, and new users of medications were 2.74 times more likely to leave their drugs behind.

Prescription orders that were delivered to the pharmacy electronically — via the computer — were 64 percent more likely to be abandoned than prescriptions walked into the pharmacy.

“We’re definitely not saying that e-prescribing is bad; it’s great, but there appear to be some unintended consequences,” said Shrank.

There was no way to tell if people never tried to pick up their prescriptions, or if they went to retrieve them but chose to leave them behind because of the cost.

Warda said he believes that more patients might pick up their medications if the instructions from their physicians were clearer. For example, prescriptions for proton pump inhibitors were left at the pharmacy 2.6 percent of the time. These medications reduce the amount of acid in the stomach and can help prevent heartburn or more serious problems. “If the physician message is, ‘You need to take these medications for two to three months and it will reduce your pain and help your body heal,’ fewer people might abandon these medications,” he said.

Plus, if cost is an issue for you, bring it up with your doctor ahead of time, he added. “Don’t get blindsided at the pharmacy. Always ask your physician if there’s a generic option, or if there’s something cheaper that might work just as well. Sometimes people are embarrassed to say anything, but it’s better to ask and get a medication you can afford.

“If you get to the pharmacy, and you can’t afford the medication, follow up with your doctor or ask the pharmacist if there’s a cheaper alternative,” suggested Warda.

More than 3M seniors may have to switch drug plans

August 25, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: The Associated Press – By Ricardo Alonso-Zaldivar – 8.25.2010

A plan by Medicare to try to make it simpler for consumers to pick drug coverage could force 3 million seniors to switch plans next year whether they like it or not, says an independent analysis.

That risks undercutting President Barack Obama’s promise that people can keep their health plans if they like them.

And it could be an unwelcome surprise for many seniors who hadn’t intended to make a change during Medicare’s open enrollment season this fall.

The analysis by Avalere Health, a leading private research firm, estimated that more than 3 million beneficiaries will see their prescription plan eliminated as part of a new effort by Medicare to winnow down duplicative coverage and offer consumers more meaningful choices.

Seniors would not lose coverage, but they could see changes in their premiums and copayments.

Medicare officials dismissed the Avalere estimate without offering their own number. “Anybody who is producing that kind of analysis is simply guessing,” said Jonathan Blum, deputy administrator for Medicare.

But Bonnie Washington, a senior analyst with Avalere, said the company’s analysis used Medicare’s specifications.

For example, Medicare has already notified insurers they will no longer be able to offer more than one “basic” drug plan in any given location. Several major prescription plans, including CVS-Caremark and AARP, offered two basic options throughout the country this year, Washington said. Eliminating that particular form of duplication among the top plans would force 2.75 million beneficiaries to find new coverage, according to Avalere’s estimate.

When other changes are taken into account, as many as 3.7 million Medicare recipients may have to switch, the analysis concluded. That amounts to about 20 percent of the 17.5 million enrolled in stand-alone drug plans.

Avalere serves industry and government clients with in-depth research on Medicare and Medicaid. The company’s president was a health care budget analyst in the Clinton White House.

Former Medicare administrator Leslie Norwalk said the change might make things easier for people signing up for Medicare but harder for those already in the program.

“If you’re in a plan that you like and you have to change it, it will be disruptive,” said Norwalk, acting administrator under President George W. Bush. “It depends on how (Medicare) handles it to try to make it as seamless as possible.”

Reducing the number of Medicare drug plans has long been a goal for consumer advocates. This year, nearly 1,600 plans offered a dizzying range of options, many of which were not significantly different.

But Medicare is going ahead with the consolidation in a hard-fought election year. Republicans have barraged seniors with charges that Obama and the Democrats raided the program to expand coverage for younger generations under the health care overhaul. Obama’s promise that people can keep health plans they like was made in the context of that broader debate, but the president has repeatedly assured seniors their Medicare benefits are safe.

“Some opponents of the (health care) law may say that this is taking away choices, but we have heard from our members for years that the (drug coverage) options can be confusing,” said Nora Super, AARP’s top health care lobbyist. The seniors lobby supports the change. AARP’s public policy branch is separate from its business side, which sponsors Medicare and other insurance plans.

Medicare official Blum said the agency is working with insurers to keep disruptions to a minimum. For example, seniors could be automatically reassigned to a comparable plan offered by their insurance company. Premiums may not necessarily be any higher, Medicare officials said.

“We are not reducing the number of (insurers). We are not reducing the number of quality plans,” said Blum, adding that having fewer, more distinct choices will benefit seniors. “That puts beneficiaries in a stronger, rather than weaker position.”

Besides eliminating duplicative basic coverage, insurers that offer more than one enhanced coverage plan will have to show they are clearly different.

Medicare is expected to release its list of drug plans for 2011 late next month. Instead of 40 or more choices in each state, seniors may have around 30 plans to pick from.

Copyright © 2010 The Associated Press. All rights reserved.

Pharmacy Benefit Discounts Continue, But At Slower Pace

August 12, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Dow Jones Newswires, By Dinah Wisenberg Brin – 8.11.10

The U.S.’s big pharmacy benefit managers continue to offer clients better deals this year as they compete for business, but they don’t appear to be sliding into a frenzy of unreasonable pricing.

In the current “selling season,” when PBMs look to sign customers for the following year, discounts on new contracts have deepened by one or two percentage points, on average, from a year ago. While PBMs are still lowering their pricing, the pace is slower than a year ago, when PBMs were willing to expand discounts by as much as five percentage points, according to benefit consultants who guide employers on choosing a vendor.

It is unclear how the lower prices will impact margins next year at large PBMs like Medco Health Solutions Inc. (MHS), CVS Caremark Corp. (CVS) and Express Scripts Inc. (ESRX). The increased use of generic drugs, which lowers PBMs’ costs, allows them to be more flexible with prices. That accounts for some of the discount.

The big PBMs have reported lower margins this year, citing a variety of reasons. Medco, though, specifically mentioned lower pricing on renewing contracts, among other items.

PBMs “are taking a little bit of a hit to margin, not much, but they are taking one,” said Michael Jacobs, national clinical practice leader at Xerox Corp.’s (XRX) Buck Consultants. He said the companies have ways of making up elsewhere for client discounts — through greater operating efficiency, cost-shifting to members or raising prices on other drugs.

PBMs handle prescription-drug benefits for employers and health plans, negotiating pricing — including rebates and discounts — with drug makers and pharmacies. They also run their own profitable mail-order pharmacies. The competitive industry has come under increasing pressure to pass along rebates and discounts and improve transparency.

Currently, the industry is engaged in its selling season for 2011 contracts, with billions of dollars in new and renewing business up for grabs or already won.

“Pricing got more competitive this year,” said Kristin Begley, national pharmacy practice leader at benefits consultant Hewitt Associates Inc. (HEW), who didn’t see much switching among her large, national clients, many of which contract with CVS Caremark or Medco.

Rebates got better, and there were “overall better deals across the board,” Begley said. Also, she said, most Hewitt client bids this year required full transparency on pricing structure, with PBMs earning an administrative fee and making money on mail-order while forgoing a margin on drugs dispensed at retail.

PBMs are offering clients better discounts on generic drugs, said David Dross, partner and managed pharmacy practice leader at the Marsh & McLennan Cos. (MMC) Mercer LLC consulting business. Dross added that he has seen some bigger discounts for brand-name drugs as well, although underlying costs on branded drugs generally are increasing.

PBM managements have indicated pricing trends are rational, even though a Sanford C. Bernstein & Co. employer survey earlier this summer suggested a “notable deterioration of the PBM pricing environment,” with more than 40% of respondents noting a decrease in prices.

“Our pricing disciplines have been applied consistently for the past several years as well as going forward to 2011,” Medco spokesman Lowell Weiner said. Medco CEO David Snow Jr., who earlier this year noted instances of aggressive pricing, said last month that he was feeling more comfortable with the competitive marketplace.

Meanwhile, Express Scripts CEO George Paz has said that while “pricing has always been extremely aggressive,” the company uses clinical tools to help drive out costs.

Per Lofberg, who heads CVS Caremark’s PBM operation, recently told analysts that pricing is “intensely competitive like it always … has been, but it’s fundamentally very similar to the past. When plans go out for bid, they are always looking for better economics, and that’s a very important part of the negotiations.”

John Malley, eastern region pharmacy practice leader at Towers Watson & Co. (TW), said PBM pricing isn’t irrational, although it is changing in structure so that players offer better pricing without necessarily losing margin.

“So more simply put, the level of discounts off prescription drugs is not that different between last year and this year, but the overall value of this year’s deals, all in, is better than last year” for the clients, Malley said.

Pricing will become less important a competitive factor as more drugs go generic, Mercer’s Dross predicted. PBMs already are trying to differentiate their clinical offerings, which aim to close gaps in care, customize prescriptions based on genetics and improve compliance to produce better health outcomes and lower costs.

Generic Drug Delay Fight May Be Nearing Turning Point

June 21, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

Generic Drug Delay Fight May Be Nearing Turning Point, FTC’s Leibowitz Says
06/21/2010
www.Medtipster.com Source: Bloomberg News – Washington DC Bureau

The U.S. government’s decade-long fight to limit drugmakers’ ability to keep generic medicines off the market may reach “a turning point” soon, Federal Trade Commission Chairman Jonathan Leibowitz said.

The FTC is counting on a review by an appeals court to break a deadlock over agreements made by brand-name drugmakers that it says delay the introduction of lower-priced generic medicines. The focus is on the 2nd U.S. Circuit Court of Appeals in New York, which may decide by August whether to review a deal between Bayer AG and Teva Pharmaceutical Industries Ltd.’s Barr unit on when a generic version of the antibiotic Cipro can go on the market.

The Cipro case “signals a renewed concern about these pay-for-delay deals, and hopefully it will mark a turning point towards a legal rule that prohibits brand pharmaceutical companies from paying off their generic competitors to sit it out,” Leibowitz, 52, said in an interview. The review could bring the issue of agreements before the Supreme Court.

The fight pits drugmakers against the FTC, the Justice Department, pharmacies such as CVS Caremark Corp. and President Barack Obama, who cited the greater availability of generic drugs as a way to reduce health-care costs. There also is an effort in Congress to restrict the settlements.

Licensing Deals

The FTC contends brand-name makers offer generic-drug companies licensing rights on a product or other compensation in exchange for an agreement on when cheaper drugs are introduced. The agency said it supports settlements, except when there is some sort of financial consideration.

Medicines that generate about $92 billion in sales will face generic competition through 2014 because of expiring patents, according to the research firm IMS Health Inc. Medicines accounted for $250.3 billion in U.S. sales for brand- name drugmakers in 2009 and $35.8 billion for generic firms, according to Norwalk, Connecticut-based IMS.

Defending valid patents is vital, said Jerry Pappert, general counsel of Frazer, Pennsylvania-based Cephalon Inc. “If the branded company loses, it loses its franchise.”

Cephalon is being sued by the FTC, which contends the drugmaker paid more than $200 million for generic companies to drop their challenge to patents on its sleep-disorder drug Provigil. Cephalon says the settlements are in accordance with patent law.

No Delay

In the Cipro case, CVS and other pharmacies said Bayer paid $398.1 million for Barr to drop its patent challenge. David Stark, general counsel for Teva’s North America unit, said generic-drug makers aren’t delaying marketing products as a result of financial incentives. The agreements are no different than patent deals in other industries, he said.

Leibowitz said the agreements add to health-care costs. If some settlements between companies aren’t prohibited, “you’re going to pay seven, eight, 10 times as much as you otherwise would,” he said. The FTC said the deals cost consumers $3.5 billion annually, a figure disputed by economists such as Jonathan Orszag, senior managing director at the economic consulting firm Compass Lexecon in Washington and the brother of White House Budget Director Peter Orszag.

Courts have allowed the settlements as long as they don’t prevent entry of the generic beyond a patent’s lifespan.

In the Cipro case, the agreement allowed a generic drug to be sold six months before the patent expired, said Kathleen Jaeger, chief executive officer of the Generic Pharmaceutical Association, a Washington trade group.

‘Tremendous Value’

“The FTC doesn’t see the tremendous value the patent settlements have brought to the system,” she said.

Since February, courts have thrown out antitrust lawsuits over Bristol-Myers Squibb Co.’s blood-thinner Plavix and AndroGel, a testosterone ointment now made by Abbott Laboratories. The FTC lost a case over a settlement involving Schering-Plough Corp.’s K-Dur heart medication.

A three-judge panel in April upheld the Cipro settlement, though it recommended opponents seek a review by the full court.

The potential court review, along with legislation Leibowitz predicted Congress would pass this year, add momentum to efforts to limit deals. Senators Herb Kohl, a Wisconsin Democrat, and Charles Grassley, an Iowa Republican, introduced an anti-deal measure. House legislation would bar the settlements.

‘Winds Are Shifting’

“The winds are shifting on the legal front, shifting on the commission front and on the legislative front,” said Robert Doyle, a former FTC official.

Ken Johnson, a senior vice president at the Pharmaceutical Research and Manufacturers of America, a Washington trade group, said brand-name drug companies need patent protection to justify the investments required to develop medicines. Drugmakers said the settlements also provide certainty as to when generics will enter the market.

Stark said a court review may not be significant.

“I don’t think it’s a foregone conclusion just because they take it up that they reverse the trend,” he said.

Marcy Funk, a spokeswoman for Leverkusen, Germany-based Bayer, declined to comment.

All parties are watching if the 2nd Circuit agrees to hear the Cipro case. The decision may come in August, said David Balto, a lawyer representing consumer groups.

Leibowitz said he believes the FTC has a strong hand. “I have yet to see an issue that’s as black and white,” he said.

The 2nd Circuit case is In Re Ciprofloxacin Hydrochloride Antitrust Litigation, 05-2851 and 05-2852, 2nd U.S. Circuit Court of Appeals (New York).

CVS Caremark Research Illustrates How Innovative Pharmacy Benefit Plan Design Optimizes Generic Utilization

March 11, 2010 By: Jason A. Klein Category: Free Prescriptions, Medicine Advice, Medtipster, Prescription News, Prescription Savings

Medtipster Source: CVS Caremark (NYSE: CVS), 10/13/2009, http://info.cvscaremark.com/newsroom

This is an old release from November 2009, BUT I really liked it and have been meaning to post it for some time now.  The message of the CVS Caremark release and the study is: We as an industry need to advise benefit payors to focus on changing consumer utilization behavior rather than  shifting cost. This study took 15,000 people, gave them a $0.00 copay on generic medications. What happened? Overall plan costs decreased due to a GDR (generic dispensing rate) increase and therapy compliance/adherence increased in key classes (antihyperlipidemics, antihypertensives, antidiabetics). WOW…who would have thought that by giving away the cow, you could pay for the milk…

WOONSOCKET, R.I., Oct. 13 /PRNewswire/ — CVS Caremark (NYSE: CVS) presented data at the Academy of Managed Care Pharmacy (AMCP) Annual Educational Conference, which illustrates how innovative pharmacy benefit plan design can impact generic utilization. The study further underscores how pharmacy benefit managers (PBMs) can work with plan sponsors to manage costs and improve health outcomes by working to change plan participant behavior through increased engagement. The study found that implementing a $0 copay structure for generic medications can be an effective strategy to increase generic dispensing, with the generic dispensing rate (GDR) increasing to 60.8 percent (a 4.2 percent increase) during the study period.

“Our 2009 Benefit Planning Survey found that clients are more interested in identifying opportunities to change plan participant behavior, rather than shift costs,” said Jack Bruner, Executive Vice President, CVS Caremark. “The data presented at AMCP illustrates an example of how we can work with our plan sponsors to change and optimize participant behavior in order to achieve increased generic utilization. These types of partnerships enable us to effectively reduce costs for both our client and their plan participants without compromising quality or access.”

In addition to an improvement in GDR during the study period, the analysis found that the average participant cost share for generic medications decreased almost 10 percent (9.4 percent decrease). In addition, the average plan cost per 30 days of therapy also exhibited a slight decline, despite the reduction in generic copayment rates. Prevalence of use in three key preventative drug classes also increased significantly (participants on cholesterol lowering therapy increased 13 percent, on antihypertensive therapy increased seven percent and on diabetic therapy increased nine percent) as a proportion of eligible patients.

“While some plan designs work to drive generic utilization by increasing brand medication copayments, this study demonstrates that lowering the generic copayment can also be an effective strategy to increase GDR,” said Mr. Bruner. “In addition, the data indicates that lowering the generic copayment may also be associated with an increase in participants taking key preventative drugs, which could positively impact adherence and overall health outcomes.”

The study was designed to evaluate the results of plan design changes, including implementation of a $0 copay for generic medications, on the GDR, plan participant cost and impact of plan participant behavior changes on health outcomes. During the study period, participants were allowed to fill prescriptions for generic medications at a preferred retail pharmacy network at a zero dollar copay. The study included 15,000 plan participants covered by a self-funded employer group who were continuously enrolled under the benefit for the duration of the study period (12/1/2007 through 7/31/2009). 

CVS/pharmacy Celebrates Grand Opening of its 7,000th Store

September 25, 2009 By: Nadia Category: Medtipster, Prescription News

Nádia - your personal pharmacy cost adviser CVS/pharmacy opened its 7,000th store in Little Canada, Minnesota. As part of the grand opening, Larry Merlo, President of CVS/pharmacy, announced details of a CVS plan to offer $75,000 worth of free seasonal flu shots to the unemployed in Minneapolis-St. Paul. The effort is part of CVS Caremark’s nationwide campaign to provide $3 million in free flu shots to unemployed Americans across the country. The 2,500 vouchers for free seasonal flu shots will be distributed in collaboration with Minnesota’s DEED beginning in October in an effort to keep this at-risk population healthy this flu season.

Find this CVS location and one closest to you by using medtipster.com

Get Adobe Flash playerPlugin by wpburn.com wordpress themes