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Specialty Drug Trend of 18.4% Dwarfs Traditional Drug Trend of -1.5%

March 11, 2013 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Drug Channels, 3/6/2013

Express Scripts just released the latest iteration of its long-running Drug Trend Report. This year’s report includes both Express Scripts and legacy-Medco covered lives, so it’s the most comprehensive look at pricing and utilization.

Study findings

  • Specialty drug trend of 18.4% dominated traditional drug trend of -1.5%.
  • Drug trend for traditional drugs fell to a record-low -1.5%, due largely to the growing substitution of less-expensive generic drugs.
    • Utilization increased by 0.6%, but costs decreased by 2.2%.
  • Drug trend for specialty drugs was 18.4%, consistent with its high growth rate over the past six years.
    • Utilization decreased by 0.4%, while costs increased by 18.7%.
  • Specialty spending is concentrated in a few conditions. For traditional drugs, treatments for the top three conditions of diabetes, high blood cholesterol, and high blood pressure–accounted for 30% of total per-member, per year (PMPY) spend.
  • For specialty drugs, treatments for the top three conditions–inflammatory conditions, multiple sclerosis, and cancer–accounted for 58% of total PMPY spend.
  • Trend reflects two primary components
    • Change in Utilization (the total quantity of drugs obtained by plan members)–Utilization varies with changes in the number of plan members on drug therapy, the degree to which plan members are adherent to their drug therapy, and a change in the average number of days of treatment.
    • Change in Unit Costs–Unit costs vary with:
      • 1) the rate of inflation in brand-name drugs prices,
      • 2) shifts to different drug options within a therapeutic class,
      • 3) a shift in mix of therapeutic classes utilized by plan members, or
      • 4) the substitution of generic drugs for brand-name drugs.

 

Drug Prices Up 3.5% For 2012

December 04, 2012 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: www.express-scripts.com, 11.28.12

According to the Express Scripts Prescription Price Index, prices on a market basket of the most highly utilized brand-name medications increased 13.3 percent from September 2011 to September 2012, far outpacing the overall economic inflation level of 2.0 percent. During the same timeframe, prices of generic medications declined 21.9 percent. This 35.2 percentage point net inflationary effect is the largest widening of brand and generic prices since Express Scripts began calculating its Prescription Price Index in 2008.

“The patent cliff has fueled a growing price disparity between brand-name and generic medications,” said Steve Miller, M.D., chief medical officer at Express Scripts. “The trend emphasizes the nation’s continued need for the tools we employ to help patients make better decisions, including generic use when appropriate.”

Drivers of Traditional Drug Trend

During the first three quarters of 2012, spending on traditional medications decreased 0.6 percent over the same period in 2011, primarily driven by lower prices brought on by increased use of generic medications.

The top traditional therapy class is mental and neurological disorders (including antidepressants), which now consumes 24.7 percent of all traditional drug spend. Although use of these medications has increased 3.1 percent compared to the first three quarters of 2011, total spending in this class is down 1.9 percent due to newly available generic antidepressants and antipsychotics.

Total spending on medications to treat high blood pressure and high cholesterol decreased 7.7 percent, primarily driven by the continued impact of patent expirations for blockbuster drugs.

Drivers of Specialty Drug Trend

Specialty drug trend continues its year-over-year double-digit growth. During the first three quarters of 2012, spending on specialty medications increased 22.6 percent over the same period in 2011, primarily driven by unit cost increases. In the first nine months of 2012, specialty drug costs consumed 20.8 percent of total pharmacy spend.

“The continued rise in spend on specialty medications underscores the nation’s need to accelerate the pathway for biosimilars,” Dr. Miller said. “Additional competition within these therapy classes would provide a necessary market control against price inflation.”

The three therapy classes representing the largest amount of specialty drug spend continue to be rheumatoid arthritis/autoimmune conditions, multiple sclerosis and cancer.

Medications commonly used to treat hepatitis C continue to have the largest specialty spend increase, 117.3 percent over the same period in 2011. Increased utilization is driving this trend, as new patients begin and continue treatment with one of two new medications.

Eight of the nine notable new medications approved in the third quarter are specialty medications. Many of these medications are second-line and third-line drugs indicated to treat advanced cancers.

Spotlight on Obesity Medications

The report reviews the two new anti-obesity medications approved this summer by the U.S. Food and Drug Administration. In clinical trials, many patients taking either of the new medications lost at least 5 percent of their body weight.

“The potential benefits of these new anti-obesity medications need to be compared against their risks and cost,” Dr. Miller said. “We are cautiously optimistic about the possibilities of these and other drugs like them, provided that they are prescribed appropriately and integrated with other lifestyle modifying programs that help patients make healthier choices that maintain their weight over time.”

Antidepressants May Raise Risk For Pregnancy Complication

March 27, 2012 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News

Use tied to maternal high blood pressure, study finds, but benefits may still outweigh risks

www.medtipster.com Source: Healthday.com 3.22.12 – Steven Reinberg

Pregnant women taking the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) face a slightly increased risk of developing dangerously high blood pressure, Canadian researchers report.

This condition, known as preeclampsia, can harm both mothers and their unborn infants, the researchers noted. However, this association may not be cause-and-effect, so women should not just stop taking these medications but should consult with their doctor if they are concerned, they stressed. Two of the most commonly prescribed SSRIs are Paxil (paroxetine) and Prozac (fluoxetine).

“We know that antidepressants should be used during pregnancy, but they should be used with caution,” said lead researcher Anick Berard, director of the research unit of medications and pregnancy at CHU Ste-Justine’s Research Center and a professor with the Faculty of Pharmacy at the University of Montreal.

The association between SSRIs and hypertension is a new finding, she added.

The report was published in the March 22 issue of the British Journal of Clinical Pharmacology.

For the study, Berard and her colleague, Mary De Vera, collected data on women in the Quebec Pregnancy Registry. They looked at more than 1,200 women who had high blood pressure during pregnancy that did or did not result in preeclampsia and who had no history of high blood pressure before pregnancy, and compared them with more than 12,000 healthy women.

They found women taking SSRIs had a 60 percent higher risk of developing high blood pressure. In absolute terms, the risk went up from 2 percent to 3.2 percent.

It appears that all SSRIs are not equal when it comes to risk, however. For instance, for women taking Paxil the risk was increased 81 percent, or to 3.6 percent in absolute terms.

“It’s a big relative increase, but if you look at absolute risk it is 1 percent,” Berard said.

These findings are important because SSRIs are the most common drugs used to treat depression, and of the estimated 20 percent of women who suffer from depression during pregnancy, between 4 percent and 14 percent take antidepressants, the researchers said.

Commenting on the study, Dr. Gene Burkett, a professor of obstetrics and gynecology at the University of Miami Miller School of Medicine, said that “this study has severe limitations. There are a lot of factors in preeclampsia they do not account for, so they don’t show a cause-and-effect relationship.”

However, pregnant women should be concerned about SSRIs for a lot of other reasons, he said. The medications have been linked to lower birth weights, he noted.

“Every physician has to measure the risk of taking an SSRI vs. the risk of not taking it in patients who really need it,” Burkett said.

“If the patient is really in need of it, then you have to give it to them, because the consequences, especially after delivery, of those patients who are depressed can be anything up to suicide or killing their infant; these are the extremes,” he said.

“We do see cases of women whose depression gets worse after delivery and wind up killing their babies,” he said. “Those patients benefit from SSRIs, and the benefits may be greater than the risks of not taking them.”

However, many women with mild depression may be able to cope without SSRIs, Burkett said. “But if you do take a woman off an SSRI during pregnancy, they need to be followed closely,” he noted.

“In some cases you cannot take women off SSRIs; in other cases you can; you have to evaluate each woman individually,” Burkett said.

Research published earlier this month also found risks associated with SSRI use during pregnancy. Dutch doctors reported that the medications were associated with delayed head growth of the fetus.

“Fetal body growth is a marker of fetal health, and fetal head growth is a marker for brain development,” said lead researcher Hanan El Marroun, a postdoctorate fellow in the department of child and adolescent psychiatry at Sophia Children’s Hospital and Erasmus Medical Center in Rotterdam. “We found prenatal exposure to SSRIs was associated with decreased growth of the head, but not decreased growth of the body.”

How Can You Help the Medicine Go Down?

March 30, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: The Wall Street Journal, 3.28.2011 -by Katherine Hobson

Too many people don’t take the drugs they’re supposed to. Tackling that problem could save a lot of money and a lot of lives.

Medication can do great things for people—but only if they take it. And a lot of people aren’t taking it.

Half of patients in the developed world don’t properly take their drugs for chronic conditions, according to the World Health Organization. The additional costs for treating diseases that progress unchecked run into the hundreds of billions of dollars a year. One study estimates nearly 90,000 people die prematurely in the U.S. each year because of poor adherence to high-blood-pressure treatment alone.

So how do you get people to take their medicine? There isn’t one answer, because there isn’t one reason people aren’t sticking to their regimens. Cost, forgetfulness, side effects and doubts about effectiveness can all be factors, among others. And for many people the health-care system isn’t designed to monitor or encourage adherence to drug prescriptions.

But there are plenty of health-care professionals and researchers tackling this issue, and they have some ideas about what can be done and what should be done. Here are some of those ideas.

More Refill Information

Doctors and other health-care providers need “some way of tracking to know if patients are refilling their medications, so we can step in and help people” if they aren’t, says Robert Reid, a physician and researcher at Group Health Cooperative, a Seattle-based nonprofit health-care system that coordinates care and coverage.

Providers like Group Health and Kaiser Permanente, a large managed-care consortium based in Oakland, Calif., can track refills because they manage all aspects of their patients’ care, so all information for each of their patients is collected in one easy-to-access electronic record. Alec Does, a family-medicine physician at Kaiser Permanente Anaheim Hills, says that when he shows patients records indicating they haven’t been consistently filling their prescriptions, “90% of the time, they’ll open up” and start talking about any issues they’re having.

But most people don’t get their care from such comprehensive providers, so their doctors rarely have access to their pharmacy records.

The technology to fix that problem exists, says Valerie Fleishman, executive director of NEHI, a national health-policy research institute based in Cambridge, Mass. “Physicians are sending prescriptions to the pharmacy, so we have the capability to close that feedback loop,” she says. The problem, she says, is that most doctors are paid for specific services, like office visits and medical procedures—not for managing their patients’ health outcomes. So there is no financial incentive for them to take on the cost of tracking prescription refills.

There is no quick fix for this problem, Ms. Fleishman says, but the recently passed health-care overhaul bill includes funding for new models for care and payment that might do a better job of rewarding providers for doing whatever it takes to keep patients healthy.

Get Pharmacists Involved

“Retail pharmacists appear to be able to play a really substantial role in encouraging patients to use their medications better,” says William Shrank, an assistant professor of medicine in the division of pharmacoepidemiology at Brigham and Women’s Hospital in Boston. “They are an underutilized resource.”

At Stamford, Conn.-based customer-communications company Pitney Bowes Inc., on-site pharmacist Antonio Tierno says he talks with patients about their conditions and medications. If a patient is picking up a refill behind schedule, he’ll ask what’s up. “If a person is late, you need to find out why,” he says.

Mr. Tierno says he always asks patients if they know why they’re taking a drug. That conversation can help ensure that patients will take their medication, he says, by making the drug’s benefits clearer to them and by making them feel more involved in their care.

A study by researchers at the Walter Reed Army Medical Center in Washington, D.C., published in the Journal of the American Medical Association, found that a pharmacy-care program for 200 people age 65 and older who were taking at least four medications for chronic conditions boosted adherence to 97% from 61% after six months. Patients were educated about their medications, including usage instructions; medications were dispensed in blister packs that made it easier to keep track of whether they had taken their pills for the day; and pharmacists followed up with patients every two months.

After 12 months, those who continued to get the pharmacy care kept their adherence at about 96%, while adherence among those for whom the program was discontinued dropped to 69%.

Another review of efforts to improve adherence—sponsored by CVS Caremark Corp. and carried out by Dr. Shrank and other researchers from Brigham and Women’s Hospital, Harvard University and CVS—found that nurses talking with patients as they were discharged from the hospital were right behind pharmacists in terms of how often they successfully encouraged patients to take their medications as directed.

Treat Patients as Individuals

Every patient’s story is different—so every solution has to be tailored to the individual.

The first step is to engage the patient with a simple, open-ended question, says Elizabeth Oyekan, area pharmacy director at Kaiser Permanente South Bay Medical Center: What’s getting in the way of picking up your medications?

“That will give you some concrete information, and then you target the solution to the individual patient,” she says. Kaiser has created a set of online tutorials to help doctors and others engage more effectively with patients who are skipping their medications.

If a patient is worried about side effects, a health-care provider might offer a substitute for the medication, or a lower dose. For the forgetful, it could be as easy as using a simple pillbox, or maybe something more technologically advanced, such as text-message reminders or souped-up pillboxes with audio or visual alerts.

If money is the problem, the solution may be generic substitutes, a mail-order program (which not only provides drugs at a lower cost but also helps those who have trouble getting to a pharmacy), or a drug company’s assistance program.

In many cases, though, problems can be addressed only by looking at medication adherence as a behavioral issue with often complex roots, says Alan Christensen, chairman of the psychology department at the University of Iowa. As with diet and exercise, getting people to change their behavior can be difficult.

“There’s more and more interest in how to better motivate and engage patients beyond just simply reminding them or reducing financial barriers or simplifying therapy,” says Dr. Shrank. Multifaceted programs that entail various combinations of those elements and education delivered by health-care professionals have shown promise in studies, but “we don’t have a good sense of what precisely is the right mix,” Dr. Shrank says. And, he says, if that ideal mix turns out to involve a lot of expensive face time, someone will have to figure out how to implement those efforts in a cost-effective way.

Are statins overprescribed for low-risk patients?

January 26, 2011 By: Nadia Category: Cholesterol, HealthCare, Medicine Advice, Medtipster, Prescription News

www.Medtipster.com Source: Boston Globe – 1.24.2011

It’s a common scenario: A 60-year-old woman is told she has high cholesterol but has no other risk factors for heart disease like high blood pressure, diabetes, or a smoking habit. Should she take a statin to lower her cholesterol?

Many doctors say, why not? But a review study by the Cochrane Collaboration, a nonprofit research organization, suggests otherwise. The review, which analyzed 14 trials involving the use of statins to prevent heart disease in low-risk patients, found only “limited evidence” that the drugs provide significant benefits, especially in women, and urged that “caution should be taken when prescribing statins” to prevent heart disease.

The cholesterol-lowering drugs – which include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor) – have clearly been shown to reduce heart attacks, strokes, and deaths in higher risk patients such as those with diabetes or established heart disease. And they have minimal side effects.

In fact, the American Heart Association recommends that low-risk patients with high cholesterol consider taking a statin if lifestyle changes, such as increased exercise or weight loss, don’t work to bring cholesterol levels down.

But the Cochrane review study – written by British researchers – calls that practice into question, highlighting “shortcomings” in studies that found clear benefits in anyone who took statins to lower high cholesterol levels.

“The potential adverse effects of statins among people at low risk of [cardiovascular disease] CVD are poorly reported and unclear,” the authors wrote.

Other experts, though, disagree. “I think they make grand pronouncements that are wrong,” says Dr. Chris Cannon, a cardiologist at Brigham and Women’s Hospital who participated in another recent review study of statin use in low-risk patients published in the November issue of Lancet. (Cannon has accepted research grants from statin manufacturers and served on an advisory board for Bristol-Myers Squibb, which makes the statin Pravachol.)

The Lancet study found that high-risk and low-risk patients who take statins to lower their cholesterol can reduce their risk of having a heart attack, stroke, or heart procedure by 25 percent.

In absolute risk terms, statin users who don’t have heart disease would lower their yearly risk of having heart complications from 1.8 percent to 1.4 percent. Those who have already been diagnosed with heart disease would lower their yearly risk from 5.6 percent to 4.5 percent – and those with type 2 diabetes from about 5 percent to about 4 percent.

The lower your heart disease risk, the smaller the benefits you’ll receive from statins. That means the risk of side effects will play a greater role in determining whether you should take the drug. The Cochrane report found that statins didn’t increase the risk of cancer and posed a small risk of rhabdomyolysis, a serious condition involving the breakdown of muscles.

The biggest side effect, severe muscle soreness, occurs in about 3 to 5 percent of users, though some research indicates the incidence may be higher in women and for those who take higher doses or more potent statins.

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.

Expensive brand Rx costs giving you high blood pressure?

October 18, 2010 By: PharmaSueAnn Category: Medtipster

Taking an ARB for high blood pressure – the first generic in the class is here Generics for Cozaar and Hyzaar are now available and may also be a generic- therapeutic alternative for:

Diovan and Diovan HCT
Benicar and Benicar HCT
Avapro and Avalide
Micardis and Micardis HCT
Teveten and Teveten HCT

Hypertension drugs going generic; Firms get OK to market cheaper high blood pressure medications

April 15, 2010 By: Nadia Category: Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Los Angeles Times, 04/09/2010

For many of the one-in-three American adults who have high blood pressure, a cheaper alternative to brand-name medications is about to become available.

Losartin, the angiotensin II receptor blocker marketed under the brand names Cozaar and Hyzaar (the latter of which combines losartin with the diuretic hydrochlorothiazide) for more than a decade, will become available in generic formulations, following a Food and Drug Administration decision announced this week.

Four drugmakers have won the FDA’s blessing to make and market the hypertension drugs in generic forms.

Wasting no time, the first company to receive broad FDA approval to market the generic drug, Teva, announced yesterday the launch of its losartin potassium-film-coated tablets in 25-milligram, 50-milligram and 100-milligram strengths.

If you’re a patient being treated with other brand-name angiotension receptor blockers for hypertension — Atacand, Avapro and Diovan — you may have to wait for less expensive drugs.

Atacand won’t be available in generic form before 2011 at the earliest, and Avapro and Diovan are not expected to reach the market in generic form before 2012.

The FDA’s Office of Generic Drugs states flatly that generic drugs are the same as the brand-name first-to-market drugs they copy — same active ingredient, same means of action, same safety and effectiveness profile — they’re just much cheaper. But the formulations in which those active ingredients are packaged do change when they are reproduced as generics.

For a very small number of people and with a few types of drugs, pharmacologists acknowledge that that can make a difference in how — or even how well — a drug works.

So, if the size, shape, color or brand marking of your regular prescription blood pressure medication changes in the next few months (and if it suddenly becomes less expensive), rejoice over your lower bill. But also, be sure to ask the pharmacist if you have been switched to a generic version of the drug your physician originally prescribed.

And for a couple of weeks after switching to a generic, check your blood pressure a bit more regularly to make sure your hypertension is still under control with the medication.

One more warning: There are five other classes of medications used to treat high blood pressure, and all do so by different means than the angiotension II receptor blockers.

Insurance companies and pharmacy benefits managers are aggressive in trying to switch patients to a new generic drug if it can save money, even if it means switching a patient to a new class of drugs.

The practice is called therapeutic substitution. Sometimes, it can often save you money while managing your condition just fine.

But for some individuals, another class of medication won’t work as well or may not be recommended.

Again, ask your pharmacist if you don’t recognize the medication you’re getting, and check with your physician if the switch is something you haven’t discussed.

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