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Pharmacy Trends for 2013 and Beyond

May 29, 2013 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com

As pharmacy trends shift and costs for plan sponsors increase, we continue to maintain a panoramic view of the industry to control medication spend for our clients. By keeping plan sponsors informed of these shifts and our strategies for handling them, plan sponsors are empowered to make informed choices about their pharmacy benefit plans. In the spirit of our transparent business approach, following are some key trends we foresee occurring in this marketplace.

Generics Plateau

In 2012, new generics entering the market reached record highs, with more than 80% market share as two major brand products (Lipitor and Plavix) lost their patents. The product with the fastest growth in 2012 was atorvastatin  – the generic version of Lipitor. The medications were considered blockbuster agents, with more than $1 billion in annual sales before turning generic.

While sales of generics grew, sales of brands decreased. Because of the influx of generic products, 2012 was a marquee year. As such, we expect fewer generics exclusivity periods in coming years, and generics are expected to reach a ceiling where they can no longer surpass their current market saturation.

Growth & Trend by Therapy Class

Therapy classes with the most growth in 2012, based on total scripts dispensed, included:

• Anti-depressants • Seizure disorders • Proton Pump Inhibitors

The top five therapy classes, which accounted for one-third of plan sponsor drug spend, included:

• Oncologics  (used to treat cancer) • Respiratory agents (used to treat asthma and Chronic   Obstructive Pulmonary Disease (COPD)) • Antidiabetics (used to lower elevated blood sugars) • Lipid regulators (used to lower high cholesterol or related   disorders) • Antipsychotics (used to treat schizophrenia and related   disorders)

Trends in Specialty

Less than one percent of the U.S. population uses specialty medications, but these products account for 25% of all pharmacy spend. As you are aware, the staggering costs in this pharmacy channel are not new. The good news is that we hope to see increased competition soon, with 38 specialty products expected to have patent expirations through 2017, and new legislation that will promote competition in this therapeutic space.

At the same time, the FDA has approved many more drugs in recent years that treat oncology and orphan diseases. Orphan drugs are used in treating very rare diseases, known as orphan diseases. Because of the niche market on these products, the cost to produce and sell them is very high. For instance, five of the most recently approved orphan drugs will cost at least $150,000 per patient per year. Costs for these products will only continue to rise, since drug makers and biotechnology companies for these products currently have no competition.

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.”

Pharmacies embrace expanding medical role

September 13, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: News & Observer – 9.12.2010

After years of adding everything from groceries to grills to their inventory, drugstore chains are once again emphasizing their pharmacies.

Pharmacists are being asked – and paid by insurance companies – to monitor their customers’ health. That could include counseling them on chronic diseases, making sure they’re taking their medications, and screening for maladies from diabetes to high cholesterol.

While many pharmacists have long done more than dispense pills, this is the first time many have been able to offer such a wide range of medical services – partially because of changes in the way pharmacists are educated, and partially because of legislative changes that have cleared the way for an expanded role.

For pharmaceutical chains, the change is an opportunity to develop new sources of revenue in a highly competitive industry.

For customers, it’s another option for health care, and one that may be less expensive and take less time than a trip to the emergency room or an urgent care clinic.

“I think it’s a mixture of everything that’s going on,” said David Catalano , a Raleigh pharmacist who works for Walgreens . “[Customers] are trying to get some advice as quick as they can from someone they can trust.”

The emphasis on pharmacists makes economic sense for health insurers. Pharmacists have expertise and often have a customer’s entire medical picture, so they can catch prescription overlaps or possible drug interactions. Nor do they command the same fees that a physician does from a health insurer.

The push toward enlisting pharmacists to do more than dispense drugs comes as the nation is trying to lower health care costs. A 2007 study from the New England Healthcare Institute estimated that 13 percent of total health care expenditures – more than $290 billion a year – are made simply because people don’t take their medications as prescribed. Those people have a higher likelihood of winding up in the emergency room or with other complications because they did not follow their doctor’s instructions.

But not everyone is happy with pharmacists treading on turf that was once solely the territory of doctor’s offices and urgent care clinics.

“Store-based health clinics can offer patients an option for episodic care but cannot replace the patient-physician relationship,” said Rebecca Patchin , a doctor from California and board member of the American Medical Association . “Patients deserve timely access to affordable, high-quality care provided by health care professionals that are appropriately and adequately trained. Convenience should never compromise safety.”

‘Closer than my doctor’

Over the past four years, James Evans has come to rely on Prasanna Bafna, a pharmacist near his Durham home, for much of his medical advice.

On Thursday, Evans was at his Rite Aid for an hourlong counseling session with Bafna.

They reviewed Evans’ medications, including drugs for diabetes, high blood pressure and poor circulation.

Though the pharmacist didn’t tell him to make any major changes, Evans said the opportunity to speak with a medical professional for such a length of time is invaluable.

“It’s wonderful,” said Evans, 76, of Durham. “When it’s time for my medicine, it’s right on time. I don’t have to stand there and wait on it. The other pharmacist I used to go to, you’d have to sit and wait for hours. … [Bafna] is closer than my doctor. My doctor is eight or nine miles from here.”

Proponents of the expanded role of pharmacists say that getting customers like Evans to utilize the new services being offered is key to making the system work and lowering health care costs.

Reimbursement rates

In general, pharmacists are not reimbursed as much money as doctors are for immunizations and the like, said Dan Mendelson , CEO of Avalere Health , a health care advisory company in Washington, D.C., and a Duke University adjunct professor.

“Most pharmacies are not allowed to bill for a pharmacy visit,” he said. “They’re allowed to bill for a vaccine, but there’s no routine office visit into the pharmacy that gets paid for by the insurance.”

The insurance companies may choose to reimburse the pharmacists more money or for additional services if there is a shortage of doctors or other circumstances in a particular region, Mendelson added, but “it depends on what the insurance company is trying to accomplish with respect to its network.”

The model is getting a boost from federal legislators. Some changes triggered by the new health care law will take effect later this month, with other changes rolled out in the years to come.

As of this year, laws in all 50 states also allow pharmacists to administer immunizations, something that also clears the way for expanded services.

Some companies are using the additional services simply as another way to get customers through the door, even if some of the services are not yet reimbursed by insurance, Mendelson said.

“It’s really about bringing purchasers into the box,” he said. “That’s what they call it. The box is the four walls in the pharmacy. If you can bring purchasers into the box then you’re doing fine. If a consumer comes in and they buy all kinds of other stuff, you’re doing well.”

Enhanced training

In addition to legislative changes last year, there have also been changes in the pharmacy industry that have helped pharmacists reach this point, said Edith Rosato , senior vice president of pharmacy affairs for the National Association of Chain Drug Stores .

She credits federal plans which began paying pharmacists to counsel Medicare and Medicaid patients in the hopes of improving results. She also said that an academic change was also key Students earning a pharmacy degree must now get a year of training on counseling and interacting with patients.

That set the foundation for the industry to focus more on patient care services, Rosato said.

So far, studies have indicated the services are working.

Raleigh-based Kerr Drug has taken the lead in this state in offering preventive care and has gone so far as to design some stores to focus exclusively on health and wellness. In Asheville, the company partnered with the city and the Mission-St. Joseph’s Health System to see whether pharmacists with expanded roles could help diabetes patients better manage their diseases and save in overall health care costs.

Kerr found that the annual health care costs for the diabetes patients participating in Asheville declined by 9.8 percent per year. One employer had an average reduction of 41 percent in sick days taken by participating patients, which equated to an estimated $18,000 in increased productivity for the company.

The need for these types of clinics will only increase as the population grows older and more people are diagnosed with chronic illnesses such as diabetes, said Rebecca Chater , executive vice president of Kerr Health , a subsidiary of Kerr Drug.

“Look at the number of people who are now moving into Medicare age,” she said. “If you look at medication use in that population, people who are within the Medicare system have 13 different prescriptions on average, with 50 different medications filled each year on average. The opportunity is huge.”

But getting to a point where insurance companies are willing to reimburse for more preventive services and pharmacists are willing to offer them is tricky business, said Jay Campbell , executive director of the N.C. Board of Pharmacy.

“There is a bit of a chicken and the egg aspect,” he said. “Health care being the huge expenditure it is, folks aren’t going to want to spend money until there’s a demonstrated benefit for those services. But private insurers have to start seeing enough of a value to provide the reimbursement.”

‘Cookbook medicine’

Still, some physicians say there are risks to having health care administered by pharmacists instead of doctors.

Linwood Watson , a family medicine doctor with an urgent care clinic called Rex Express Care in Knightdale, said he thinks patients like the new options because they are very transparent. There is a set fee for each service, and no secrets about what things will cost.

“Everyone wants cookbook medicine, but what happens when your body doesn’t read the book?” he said.

Pharmacies respond by saying that they work closely with area doctors to offer referrals to customers who do not have a primary care physician or need further medical expertise.

But with so many options and such a fragmented system, Watson said, he feels patients will have to take more responsibility for their own care in order to ensure continuity.

“If you want to go buy a car, and you want a good deal, you’re going to have to do some research, keep some records and be prepared,” he said. “Are you prepared to do that for your health care?”

Copyright © 2010 McClatchy-Tribune Information Services

If You Don’t Lower Cholesterol Through Diet Now, You’ll Hate Yourself Later

May 07, 2010 By: admin Category: Cholesterol, Diet and Excercise, HealthCare, Medicine Advice, Medtipster, Prescription News

Medtipster is pleased to publish an article from it’s first guest author. Thank you Deborah!

www.Medtipster.com Source: Deborah H. Land, www.cholesterolloweringdiets.net

a. The Myth of Good and Bad Cholesterol   

For some people, cholesterol is bad because they do not know there are two types of it. These two types are LDL and HDL – the bad cholesterol is called LDL, while the good one is called HDL. Plaques can form on one’s arteries if you have a lot of LDL in the bloodstream. Eventually, your arteries will get narrow as a result of being clogged up and it will block off blood flow. The truth is, your high cholesterol is not caused by dietary cholesterol but by other things. This is caused by excessive amounts of Tran’s fat and saturated fat. Exercise and eating a lot of fiber and unsaturated fats will do a lot to keep cholesterol down.

 b. What Numbers Mean in Cholesterol

 Every adult should have their cholesterol checked at least every 5 years. When you get a cholesterol test, you’ll usually get back four different results. Here are the 4 categories and the healthy range you want to be in.

Total Cholesterol – less than 200 mg/dL (5.2 mmol/L)

LDL Cholesterol – less than 100 mg/dL (2.6 mmol/L)

HDL Cholesterol – greater than 40 mg/dL (1.0 mmol/L)

Triglycerides – less than 150 mg/dL (1.7 mmol/L)

If you are over or under the desired level on any category, it is usually indicative that a diet or exercise change is needed.

c. Vitamin E and How it Can Protect the Heart

 Vitamin E is an important vitamin found in leafy vegetables, nuts, and vegetable oils. It was previously believed that a Vitamin E supplement could reduce the risk of heart disease, but several studies in the last few years have shown that this supplement does little to prevent heart attacks or strokes.

 d. Five Fabulous Foods to Decrease Cholesterol Levels

 1. Oatmeal and Oat Bran: These contain a high amount of soluble fiber, which can lower LDL.

2. Fish: Fish is a great source of omega 3 fatty acids, which lowers LDL and raises HDL.

3. Nuts: Not only are nuts high in fiber, but they contain the healthy fats you need to keep LDL in check.

4. Plant Sterols: This is found in foods like margarine, salad dressing, orange juice, and functional cookies. 2 grams per day will lower your LDL by 10-15%.

5. Soy: This popular meat replacement can lower LDL by up to 3%.

e. Health Benefits of Plant Sterols 

Plant sterols can be found in foods such as Benecol Spread, granola bars, VitaTops Muffin Tops and fat free milk. To help your heart, you should eat a lot of plant sterols-packed food and stop eating foods with saturated fat. You should know that this does not balance out a diet rich in saturated fats. To be in control of your cholesterol, you should still eat healthy and exercise often.

About the Author – Deborah H. Land writes for the cholesterol diet tips  blog (www.cholesterolloweringdiets.net), her personal hobby website she uses to help people eat healthy to lower bad cholesterol levels.

It’s Creative, It’s Unique, It’s Going to Cost How Much?

October 23, 2009 By: Tylar Masters Category: Medtipster, Prescription Savings

Tylar Masters

Tylar Masters

Healthcare Awareness Campaigns, A Look Into the Future

Tom Brady of the New England Patriots wore pink Nike shoes during the October 4th home game versus the Baltimore Ravens. Other NFL players honored October’s Breast Cancer Awareness month by wearing pink gloves, sweatbands and using pink towels.

The shoes, in particular, interest me. DeAngelo Williams, running back for my favorite team, the Carolina Panthers, came up with the idea for the pink Nike cleats because an NFL player’s cleats are so vital to their success on the field, much like breast cancer awareness is vital to the success of finding a cure. Williams’ mother suffers from breast cancer and her three sisters have all fallen victim to the disease.

Since the dominant audience of an NFL game is male, I imagine that by adding anything to do with breasts to the mix will raise some interest. I have to say, what a fantastic offensive play by Susan Komen for the cure!

This is one example of how creating a unique campaign for raising awareness about healthcare issues is extremely effective. Other similar campaigns you’ve probably seen are American Heart Association and Campbell Soup’s Go Red for Women, walks for the different causes such as autism or diabetes, red ribbons for AIDS awareness, as well as thousands of Facebook pages for different causes like Parkinson’s Disease, Lou Gehrig’s, Multiple Sclerosis, etc.

Every awareness campaign shares one major issue in common: the need for a cure. A cure in most cases means a prescription. While pharmaceutical companies are hard at work in trials desperately trying to find a formula that will cure many illnesses, they are already dispensing formulas that will cure and/or relieve symptoms of other illnesses, such as strep throat, high cholesterol and depression. Many Americans are dependent on these drugs in their daily lives to suppress symptoms, and others are in need of these drugs when they become sick. (Have you ever tried to “wait out” a cold? It’s terrible!)

Diseases and illnesses don’t care who you are, what insurance you have, how much money you make, how much money is in your savings or retirement fund, how old you are, your gender, your status on facebook… I think you get my point. With the current state of healthcare, prescription drugs need to be affordable.

Where one awareness campaign ends, another one begins. We need to raise awareness about healthcare and prescription drug costs. Because when there finally is a cure, will we be able to afford it?

For more information on DeAngelo Williams’ breast cancer awareness foundation, visit www.deangelowilliams34.com.

Tylar Masters
Manager of Marketing and Communications
Medtipster, LLC.
email: tmasters@medtipster.com
web address: www.medtipster.com

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