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Is PBM Spread Pricing Increasing The Cost of Your Self-Funded Employee Health Plan?

December 28, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Terrance Killilea, Pharm.D. and Scott Haas, 12.08.11

Pharmacy benefit managers (PBMs) are contractors hired by health plans to administer health plan pharmacy benefits, and PBMs that practice spread pricing, charge plan sponsors (employers) more for prescription drugs than what’s actually paid to the pharmacy.

Spread pricing is largely unknown to employers and those who pay health bills. The practice is occasionally understood by some participants in the health system (health plans, brokers), but often not acted upon due to relationships. Spread pricing has a significant impact on health plan costs. For example, when a PBM pays a pharmacy a minor amount (say $6) for a prescription, but charges the employer and patient a much higher price (say $30). This higher amount is reflected in both the co-pay and the billing to the employer.

Clearly, this has an impact on the cost of a self-funded program, but it also impacts the premiums of fully insured programs through experience. Health plans providing fully insured coverage, where spread pricing is occurring, either do not know about spread pricing or know about it and share in the revenue. This revenue sharing often amounts to a per prescription fee paid to the health plan by the PBM. This arrangement occurs in both self-funded and fully insured situations. Regardless of the setting, spread pricing increases the cost of prescription claims above the actual cost paid to the pharmacy.

Health plans often use terms such as “transparency” or “pass-through” to explain pricing, but this does not address the actual issue of spread pricing. Elimination of spread pricing lowers claim costs for patients and plan sponsors, increases the affordability of medications, and is likely to improve overall health outcomes.

Until recently, spread pricing did not affect members of a health benefit plan. When a PBM reported a claim cost of $45, paid the pharmacy $12, and charged the member a $10 co-pay, the member was not affected by the higher claim cost. The plan, however, experienced a charge of $33 more than what was actually paid to the pharmacy. In this type of copayment  design, it’s the plan sponsor (employer) who bears the increased cost of spread pricing. 

Now, with increasing frequency, employers are establishing high deductible health plans (HDHP). An estimated 18 million Americans were covered under this type of plan in 2010*. A HDHP typically has an annual deductible of at least $1,200 for individual coverage and all expenses (except some preventive visits), including pharmacy costs, go toward the deductible. In the most common claim scenario, it’s the prescription drug cost that accumulates to satisfy the member’s deductible and out-of-pocket expenses. In some families, the prescription cost is the primary source of medical care cost, particularly in plans where maintenance check-ups and other wellness services have no co-pay or out-of-pocket exposure.

Spread pricing results in higher consumer costs. It is not unusual for generic prescription charges to be $30-$50 above the actual claim cost.** But more important, may be the affect on compliance and cost of care. While not being specifically studied, it’s reasonable to believe that compliance diminishes as the cost of prescriptions increase by 400% or more. The impact of multiple members of a family, on multiple medications, can be dramatic. The effect of high patient prescription costs on decreased adherence to therapy was the subject of a 2010 Wall Street Journal article.*** Spread pricing was not mentioned as a factor.

If higher medication costs lead to lower compliance, it’s likely to be more significant in patients with multiple or complex disease states. While the extent of lower compliance is variable, higher cost results in lower affordability and is likely to affect disease outcome. This is particularly true in situations where members are paying all of the drug cost, such as in a HDHP.

According to a recent Consumer Reports poll, 48% of adults have taken steps to save money due to the economy. Included among the actions taken were:

  • Putting off a doctor’s visit (21%)
  • Delaying a medical procedure (17%)
  • Taking risks to save on medications (28%), including;
    • Not filling a prescription (16%)
    • Taking an expired medication (13%)
    • Sharing a prescription with someone else (4%).

When one considers that a complex patient with hypertension, hyperlipidemia, and type-2 diabetes can be effectively treated with generic drugs cumulatively costing less than $300 per year, substantial compliance and successful treatment is likely. The likelihood of compliance decreases, however, when spread pricing drives the cost of that same therapy up to $2,000.

Finally, prescription cost increases due to spread pricing, places members and their families above the deductible ceiling quicker. Thus, the cost of therapy impacts the plan sponsor sooner, and negates the fiscal value of a HDHP. While this may not have a direct impact on care, it certainly increases net costs to plan sponsors, in spite of the establishment of a HDHP.

While spread pricing has been a common practice in the PBM marketplace for years, the impact on member costs and member quality of care is now greater. It’s advisable for all plan sponsors to assess the extent of spread pricing that is occurring in their pharmacy benefit and examine methods to eliminate it.

Footnotes

  • *American Association of Preferred Provider Organizations. APPO 2010 study of consumer-directed health plans.
  • **Based on competitive claim analysis where a transparent PBM has reported actual costs paid to pharmacies. There is no reason to believe that a larger PBM would be paying the pharmacy more than the smaller PBM for which the actual claim price is known.
  • *** http://online.wsj.com/article/SB10001424052748703927504575540510224649150.html

About the Authors

Dr. Killilea and Mr. Haas both work in the Portland, OR office of Wells Fargo Insurance Services USA, Inc.  Terrance Killilea, Pharm.D. is Vice President, Integrated Healthcare Metrics -Clinical and Fiscal Integration.  Scott Haas is Vice President, Integrated Healthcare Metrics.

Over-the-Counter versus Prescription Drugs

December 14, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Navitus Clinical Journal – December 2011

Hundreds of drugs are available over the counter, including, but not limited to, cough and cold medications, pain relievers (aspirin, ibuprofen) and heartburn drugs. Over-the-Counter (OTC) drugs are drugs that you can buy without a prescription. Many of these drugs have been available for a very long time and have long track records for safety. Others are newer and often started out as prescription drugs. Some drugs that have become available as OTC in the past few years include heartburn drugs – Zantac, Pepcid, Prilosec OTC – and the allergy drug Claritin.

Why do drugs become OTC?
Drug manufacturers have an incentive to make their product(s) available OTC, since it is easier for patients to purchase a drug over the counter rather than via a prescription from their doctors. Because of the availability of OTCs, switching a drug to OTC can increase the drug manufacturer’s sales.

Drug manufacturers may also want to have their product available OTC as part of a larger strategy to protect and increase their profits. This usually happens when a prescription drug’s patent is about to expire. For example, when Prilosec’s patent expired, the manufacturer petitioned the Food & Drug Administration (FDA) to make it available over the counter, while at the same time introducing a “new,” chemically similar prescription drug, Nexium.

Regulation and safety of OTCs
The FDA regulates OTC drugs, just as it regulates prescription drugs. The FDA decides whether to allow a drug to make the switch from prescription to OTC. To approve a drug as an over-the-counter drug, the FDA must find that:

  • Its benefits outweigh its risks. In other words, the improvements to the patient’s health from taking the drug are more valuable than any negative side effects.
  • Its potential for misuse and abuse is low. The drug should not be habit-forming and should not encourage people to overuse it.
  • Consumers can use the drug for self-diagnosed conditions. The drug is not intended for a condition that needs testing or a doctor’s diagnosis, such as high cholesterol. Instead, the drug treats a symptom that is obvious to the average consumer, such as headache or allergy.
  • The drug can be adequately labeled. The warnings and instructions for use are clear and easy to understand without any training.
  • The drug does not need a doctor’s supervision, and the drug is easy to use. For example, the drug does not need a doctor to monitor and change the dosage.

In general, the risks or side effects of OTCs are low, how to use them is clear, they treat conditions that patients can easily recognize, and they give consumers greater choices.

Are OTC’s less expensive than prescriptions?
It depends. OTCs may be covered by your plan sponsor. If that is the case, you may only need to pay a copay for these drugs. Depending on your plan sponsor’s plan design, the copay may be less expensive than the cost of the OTC. Alternatively, your plan sponsor may not cover the OTC you need, but it may cover a generic version of that drug. In this case, the generic version is likely less expensive than the OTC.

As dozens of blockbuster drugs begin to lose their patents in the next few years, we can expect to see more switches from prescription-only to OTC.

Savings Experiment: Treating the High Cost of Prescription Drugs

February 17, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: WalletPop.com, by Barbara Thau – 2.15.2011

As the economy still muddles through a funk, the price of prescription drugs continues to soar. in fact, drug prices are the fastest growing chunk of consumers’ healthcare expenses, according to the non-profit Families USA.

But there are myriad ways to meaningfully trim your prescription drug bill. From generic drugs to assistance programs — here’s how to save on your meds — and do so safely.

Avoid Brand Names

To slash as much as 70% off the price of your medications, buy generic.

“If you are given a prescription for a brand name drug from your doctor, it’s always good to ask, ‘Is there a generic equivalent for this drug?’ ” says Jody Rohlena, senior editor at Consumer Reports’ ShopSmart.

A recent report by Best Buy Drugs, a division of Consumers Union (Consumer Reports’ parent company), examined the safety and effectiveness of prescription medications and found that generics are as safe and effective as brand names.

Tap Low-Cost Prescription Programs (Located On Medtipster.com)

Take advantage of the price war being waged among national discounters and supermarket chains for generic prescription medications.

Walmart, Target and Kroger charge $4 for a month’s supply on hundreds of generic drugs. Some other options, recommends ShopSmart, include Costco, Kmart, Drugstore.com and Walgreens, which also run reputable and highly-affordable discount drug programs.

To save a few extra dollars, ask your doctor for 90-day prescriptions. Walmart, for example, offers $4 for a month’s supply and $10 for a 90-day supply. With buying in bulk, the savings will add up as you fill more prescriptions and it will also save you trips to the drugstore.

‘Splitting’ the Cost

If you take prescription drugs to treat a chronic illness, you might be able to save money by splitting your pills — literally cutting them in half. With prescription medication costs soaring, many doctors are advising patients to do just that.

Pill-splitting can save money because pharmacies routinely charge roughly the same amount for a particular medication, regardless of the dose. But don’t go it alone: It’s crucial to consult your doctor about splitting your pills as not all medicines can be safely divided.

For example, a once-a-day drug may cost $100 for a month’s supply in either a 100-milligram dose or a 50-mg dose. If your doctor prescribes the 50-mg pill, it will set you back $100. But if your doctor prescribes the 100-mg pill and instructs you to cut it in half, $100 will get you two months worth of the medication, according to The Shoppers Guide to Prescription Drugs: Pill Splitting, a report from Best Buy Drugs.

Pill-splitters cost between $5 and $10 and can be found in most drugstores.

Although the American Medical Association opposes the practice, they acknowledge that many pills can be split safely if done correctly, the Best Buy Drugs report says.

Ask for Help

If you’re having trouble paying for medication, let your doctor know.

A physician can help spell out your options, such as financial help through your insurer, if you have one, and patient-assistance programs that you might qualify for.

Some pharmaceutical companies also provide free and low-cost medications to people who cannot afford to pay for medications.

RxAssist offers a database of such programs, as well as ways to manage your prescription drug expenses. DestinationRx is another source, with price comparison tools and guidance on drug-purchasing options.

Rx Savings for Seniors

The quest for affordable medication takes on a heightened sense of urgency when it comes to seniors: Most seniors are on a fixed income and are among the biggest consumers of prescription drugs, representing 34% of the prescriptions filled in the U.S., according to Families USA.

High costs mean that many seniors “have had to make some tough decisions in terms of taking their medicines,” says David Allen, a spokesman for AARP.

Now the government is offering some relief. A provision in the new healthcare law is designed to take a bite out of what’s known as “the doughnut hole,” and over time close the coverage gap on prescription medications.

As things were last year, once seniors spent $2,830 on medication, they had to pay 100% for their prescriptions until they reached the $3,610 threshold — a financial hardship for many older Americans. Now, when they reach the $2,830 threshold, the government will chip in 50% of the cost for brand-name drugs and 7% for generics, Allen says. By 2020, the doughnut hole will cease to exist, says Allen.

If you’re on Medicare, keep track of your particular prescription costs with AARP’s Doughnut Hole Calculator.

Use it to alert you when you’re nearing the coverage gap. It also will offer a list of alternative, lower-cost drugs based on your prescription drug profile that you can take to your doctor to discuss whether switching to a lower-cost drug will work for you.

In addition, AARP provides a handy Drug Savings Tool link where consumers can compare a drug’s efficacy and price against alternative medications listed by Best Buy Drugs.

Buyer Beware: Pharmacy Fraud

Pharmacy fraud is alive and well and living on the Internet. Scam artists are there seeking money, or personal information to commit identity theft.

These types of predators mostly hunt their prey online, says Sally Hurme, senior product manager of education and outreach for AARP, who tracks pharmacy scams that target the entire drug-purchasing population.

When an online offer seems too good to be true, it probably is. An email offer for prescription medications at bargain basement prices (that does not come directly from a well-known retailer or your health insurance company) is most likely a scam, Hurme says. And email that says “Viagra for $10″ or “Prilosec for $5,” for example, should go right in your email trash — chances are that it will wind up in your spam folder anyway.

Scam artists often masquerade as online pharmacists. They woo consumers to pay upfront in exchange for a supposed drug discount card. Shoppers who “order” their medications receive nothing at all, or drugs that are compromised in some way — be they expired or at the wrong dosage.

Be skeptical. Before filling a prescription online, be sure that the pharmacy requires a doctor’s prescription. And never provide your personal information — such as your Social Security number, credit card or health history — to a website unless you’ve verified that it’s secure, says AARP.

Dependence on Prescription Drugs Rise with Costs

October 01, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Health Care Uncovered, by Brandi Funk – 9.30.2010 (http://ow.ly/2N3Sp)

It looks like government isn’t the only thing that Americans are increasingly dependent on.

A new report from the Centers for Disease Control earlier this month shows that prescription drug use in the U.S. is on the rise, with half of all Americans currently on at least one prescription drug.

Who pays for these drugs? In 2009, U.S. prescription drugs sales topped $300 billion .

Sadly, as the number of people without health insurance rise and as more insurance companies get pickier about the drugs they cover, many cannot afford to pay for these drugs.

There is no question that the rising use and cost of prescription drugs is a major cause of rising health care costs in this country so if we want affordable health care and reform, we must start here, looking for alternatives.

According to the Generic Pharmaceutical Association, generic drugs have saved Americans $734 billion in the last 10 years so ask your health care provider if switching your prescription drug to generic is a good alternative for you.

Websites such as Medtipster allow you to search for discounted generic drug programs available at pharmacies throughout the USA.

Many of these drugs are available for as little as $4 or less.

  • If your medication is available through one of these programs, you will see a list of pharmacies with pricing, in your neighborhood.
  • If your medication is not on one of the discount generic drug programs they will notify you when it is, or they will suggest a ttherapeutic drug equivalent.
  • If your medication is not available in generic form, they will search for drug brand coupons you can print and take to your local pharmacy.

Why pay more than you have to?

Other Prescription Drug Assistance Websites

http://www.xubex.com

http://www.needymeds.com

http://www.pparx.og

http://www.rxoutreach.com

Almost Half of Americans Took a Prescription Drug in Past Month

September 03, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Health Blog – Wall Street Journal Blogs, By Katherine Hobson – 9.02.10

The government today released some new stats on prescription-drug use through 2008. The headline finding: Over the previous decade, the proportion of Americans (of all ages) reporting they took a prescription drug in the past month rose to 48% from 44%.

Some other key findings:

The percentage of people reporting the use of multiple prescription drugs in the last month also rose, to 31% for two or more prescriptions and 11% (a near-doubling of the previous 6%)) for five or more drugs.

As you’d expect, prescription-drug use varied by age, with about 20% of kids under 12 and 90% of older Americans (defined as age 60 and over — sorry, Mom!) reporting the use of at least one drug in the past month.

Among the 60-plus crowd, more than 76% used at least two drugs in the past month and 37% used at least five. Of that finding — which stems, of course, from the fact that older folks often have multiple diseases — the report says that “excessive prescribing or polypharmacy is also an acknowledged safety risk for older Americans, and a continuing challenge that may contribute to adverse drug events, medication compliance issues and increased health-care costs.”

The type of drugs used most often were asthma meds for kids, central nervous system stimulants (such as those used to treat ADHD) for teens, antidepressants for the middle-aged and cholesterol-lowering drugs for older people.

The Pharmaceutical Research and Manufacturers of America (PhRMA), the trade association for drug makers, said in a statement that “as we learn more about disease, prescription medicines are justifiably playing an increasingly important role.” The group noted that many patients still lack access to needed medications, and that in many cases early interventions and improved compliance would improve health outcomes. “The best solution for all patients is to strike the right medical balance between proper and effective use of prescription medicines and other therapies and interventions,” it said.

A few months back, the pharmacy-benefits manager Medco issued its own figures for prescription-drug use and spending, covering 2009. It reported that use among adults held fairly steady, edging up slightly among those over 65 and dropping a bit for those aged 50-64 — but use among those 19 and under rose by 5%.

The myth of the perfect drug

June 28, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News

www.Medtipster.com Source: The Boston Globe – Christoph Westphal, 6/28/2010

If we focus too much on side effects, we might forfeit important new medications

WHEN IT comes to prescription drugs, patients expect benefits but appear intolerant of risks. What would happen in a world that accepts no risks in its pharmaceuticals? We would have very empty medicine cabinets.

Every June, 200 biotech and pharmaceutical CEOs gather in Boston. This year, the deputy commissioner of the Food and Drug Administration spoke to the group on the evolving risk-benefit analysis regarding prescription drugs. Much of the ensuing dialogue with the CEOs centered on society’s changing views of drug benefits and risks.

The first “wonder drug,” aspirin, was synthesized by Bayer in 1897 and marketed in 1899. This extremely rapid path from initial experiments to market is impossible to imagine in today’s world. Now, aspirin has some wonderful properties – it reduces inflammation, prevents blood from clotting, lowers fever, and lessens pain. Millions of Americans take aspirin every year, without a doctor’s prescription. However, side effects kill roughly 10 out of 100,000 men taking aspirin. In fact, it is possible that aspirin would not be approved today by the FDA, so dramatic is the shift in society’s risk-benefit views regarding pharmaceutical products.

That shift spelled the doom a few years ago of another drug with significant benefit, but some risk, namely Vioxx. Merck had shown beneficial effects of Vioxx in severe arthritis in thousands of patients, and the drug was approved. After Vioxx reached the market, however, the risk of death from heart attack, estimated by independent academics to be on the order of 20 to 30 out of 100,000 patients taking the drug, led Merck to remove Vioxx from the market. There are likely patients with severe arthritis who would accept the risk of side effects, in order to benefit from this effective medicine. But these patients no longer are able to make their own risk-benefit calculations. Instead, society has determined on their behalf that this therapeutic option should no longer be available to them.

How dangerous, in comparison to taking aspirin or Vioxx, is driving a car? According to the National Safety Council, the risk of dying in a car accident during one year is about 155 out of 100,000. The death rate of car usage actually appears a good deal higher than the likelihood of death caused by taking Vioxx or aspirin. Nevertheless, no one is arguing that cars should be taken off the market. Instead, society has decided that the benefits of cars outweigh their risks.

As society has shifted to a view that medications should have virtually no risks, the inevitable effect has been to reduce the flow of important new drugs. It is certainly fair to rigorously test any new medication prior to approval. In addition, any new drugs should be monitored for safety and efficacy after they have reached the market.

But society must be careful to weigh the benefits of effective new drugs for diseases that until now have been poorly treated, versus the added risks of the new medications. If we focus too much on the risks of drugs, and do not balance those risks against the benefits, fewer drugs will be approved and reach patients in need. That is a risk in and of itself.

On your next drive, remember that it may be riskier to get in your car than to take the drug Vioxx, which was shown to be highly beneficial to patients with severe arthritis, but has been removed from the market.

Drug Rebates On The Way

May 31, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Los Angeles Times, 5.28.2010

Senior citizens who hit the so-called doughnut hole in Medicare’s drug benefit will begin getting $250 rebate checks in two weeks, the Obama administration announced Thursday — providing one of the first tangible benefits of the recently enacted healthcare law.

The rebates, designed in part to bolster support for the controversial law, are the first steps in a decade-long phase-out of the unpopular gap in Medicare Part D drug coverage.

Seniors now enrolled in a Medicare Part D plan pay 25% of the cost of their prescription drugs until the total bill reaches $2,830. At that point, enrollees must pay the full cost of their prescriptions until their total out-of-pocket spending reaches $4,550. Catastrophic coverage then kicks in and enrollees pay 5% of drug costs for the rest of the year.

Department of Health and Human Services officials said Thursday that the first 80,000 seniors who hit that coverage gap, or “doughnut hole,” will be sent checks on June 10, five days before the deadline.

Checks will then go out monthly until the end of the year as more seniors fall into the gap. Health and Human Services Secretary Kathleen Sebelius said Thursday that the department estimated slightly more than 4 million seniors would ultimately get rebates.

“Seniors do not have to do anything to get this check. They don’t have to sign anything. They don’t have to apply for it,” Sebelius said, warning recipients not to be fooled by scam artists seeking personal information by claiming it is necessary to process rebates.

Starting in 2011, the rebate will be replaced by a discount. Seniors whose expenses fall within the doughnut hole will qualify for a 50% discount on drugs. That will be gradually phased up to a 75% discount in 2020, effectively eliminating the coverage gap.

Thursday’s announcement comes as the Obama administration works to highlight benefits of the new healthcare law in the face of persistent public wariness.

Since President Obama signed the law in March, administration officials have secured commitments from insurance companies to immediately begin offering parents who buy their own insurance the option of including their adult children under 26. Employers who provide coverage may choose to make the option available, but it is not mandatory until October.

The administration is also working with states to create new high-risk pools this summer to allow people who have been denied coverage because of preexisting medical conditions to get insurance. However, there are questions about whether there is enough money to do this.

The new healthcare law’s biggest changes — including the creation of regulated insurance markets, the requirement that everyone have health insurance, and the ban on insurance companies denying coverage to sick people — do not go into effect until 2014.

Generic Drug Prices Drop, Brand Prices Continue Rising

May 25, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: FDAnews.com – Washington Drug Letter, 5.25.2010

AARP: Generic Drug Prices Drop, Brand Prices Continue Rising

The prices of brand-name prescription drugs most often used by Medicare beneficiaries increased nearly 10 percent over the 12-month period ending in March, an AARP report says.

While generic drug prices fell during the April 2009 to March 2010 period, the average price of top brand drugs used by Medicare beneficiaries rose 9.7 percent, continuing an upward trend in annual drug price increases, according to the AARP Public Policy Institute Rx Watchdog Report released last week.

Prices of generic drugs most widely used by Medicare beneficiaries dropped 9.7 percent while prices for widely used specialty drugs rose by 9.2 percent.
“These trends resulted in an average annual rate of increase of 5.3 percent for manufacturer drug prices during the 12 months ending with the first quarter of 2010 despite an extremely low rate of general inflation for all consumer goods and services,” the report says.

Drug companies raised the price of about two-thirds (90 of 144) of specialty drugs studied in the one-year period. Two of the 144 specialty drugs had a drop in price, and both were generics. For an individual taking one specialty medication, the average annual increase in cost of therapy rose by $2,760 during the study period.

AARP’s analysis echoes that of pharmacy benefit managerExpress Scripts’ 2009 Drug Trend Report, released last month. Prices of drugs in the most popular therapeutic classes increased 9.1 percent in 2009, according to that report.

PhRMA, however, said the AARP report is misleading and based on incomplete information. The report fails to take into account discounts and rebates generally negotiated between drug manufacturers and payers, which can significantly lower the cost of brand-name medicines, ultimately benefiting patients, Senior Vice President Ken Johnson said.

“Also, the report’s conclusions ignore the reality that prescription medicines represent a small and decreasing share of growth in overall health care costs in the United States,” Johnson said. “Not only is the current rate of growth for prescription medicines historically low, but the recent decline in drug spending growth has contributed to the lowest rate of total health care growth in almost 50 years.”

U.S. Drug Sales Saw Growth In 2009; Indicate Economy’s Comeback

April 05, 2010 By: Nadia Category: Medtipster, Prescription News

www.medtipster.com blog article source: www.drugstorenews.com – author: Alaric DeArment

U.S. Drug Sales Saw Growth In 2009, IMS Health Says

Pharmaceuticals appear to be slowly making a comeback, as 2009 saw drug sales almost three times as high as in 2008, according to a new report by IMS Health.

IMS reported 5.1% sales growth in ethical pharmaceuticals and insulins through retail and nonretail channels, with sales reaching $300.3 billion, compared with 1.8% growth in 2008.

“In 2009, demand for pharmaceuticals proved stronger than in the prior two years, yet remained at historically low levels,” IMS SVP Healthcare Insight Muray Aitken said. “While the 32 innovative products launched last year brought important new treatment options to patients in a number of disease areas – including cancer, thrombosis and atrial fibrillation – they drove only a limited increase in drug spending. Access for the first time to lower-cost generic treatment options in the areas of epilepsy, migraine and immune system disorders had a more moderate impact on market growth than generic launches in previous years.”

Greater use of specialty drugs accounted for much of the growth, growing 7.5% last year and now constituting 21% of U.S. market value, and sales of monoclonal antibodies for treating cancer – such as Genentech’s Avastin (bevacizumab) and Herceptin (trastuzumab) and Rituxan (rituximab), by Genentech and Biogen Idec – grew by 9%.

Meanwhile, economic conditions didn’t dampen demand for prescription drugs, as the volume of dispensed prescriptions grew by 2.1%, to 3.9 billion, compared with 1% growth in 2008; while the volume of new therapy starts in 17 major chronic disease areas declined by around 1%, the volume of add-on therapy starts, switches and refills rose by almost 2%. Use of generic drugs has continued to rise, and generics now represent 75% of all dispensed prescriptions in the United States, with the total number of prescriptions having increased in 2009 by 5.9%.

“The greater availability of generic options, growing differentials in co-pays between brands and generics and efforts by patients, insurers and employers to encourage appropriate use of lower-cost alternatives were all factors in the changing mix of medicines used in patient treatment last year,” Aitken said.

Prescription sales of antipsychotics remained unchanged compared with 2008, at $14.6 billion, but the class remained the top-selling one in the United States. Measured by dispensed prescription volume, lipid regulators remained the largest therapy class, with prescriptions growing by 5%, to 212 million. At the same time, proton-pump inhibitors replaced lipid regulators as the second-largest therapeutic class in terms of sales, with sales of $13.6 billion, though that represented a 2% year-over-year decline. Lipid regulators had sales of $13.1 billion, a 10% decline from 2008 that resulted from an ongoing shift to generics.

WHAT IT MEANS AND WHY IT’S IMPORTANT

The uptick in prescription drug sales growth may or may not be yet another indicator of improvement in the U.S. economy, but it is, without a doubt, indicative of a return to growth for the prescription drug market and, by extension, an indicator of growth among retail pharmacies.

When IMS Health reported that prescription drug sales had $300.3 billion in sales in 2009, a 5.1% increase over 2008, the figure included every distribution channel. But the bulk of those sales, $164 billion, were through retail channels, including retail pharmacy chains, independents and supermarket pharmacies.

The biggest increase between 2008 and 2009 was in chain stores, which saw a 3.6% increase in prescription drug sales, from $101.8 billion to $105.5 billion. Sales in supermarkets increased by 1.4%, from $20.9 billion to $21.2 billion. Meanwhile, independents had a 2.1% decrease, from $38.1 billion to $37.3 billion. A similar trend appears when figures for dispensed prescriptions are broken down by distribution channel, with a large increase in chain stores, a smaller increase in supermarkets and a decrease in independents.

Sales of specialty drugs went up as well. With $8 billion in sales, compared with $7.5 billion in 2008, monoclonal antibodies for treating cancer rank sixth in IMS’ list of the top 15 therapeutic classes, compared with their seventh-place ranking last year. Biotech drugs for treating arthritis and inflammatory diseases rank eighth and fourteenth, respectively, though erythropoietins, for treating anemia, had a $900 million decrease in sales.

IMS doesn’t have a specific category for the specialty channel, but it does have them for mail service and home health care, two channels used extensively by specialty pharmacies. Though drug sales through the home healthcare channel had a slight decrease, from $2.6 billion in 2008 to $2.5 billion in 2009, mail-service sales increased from $46 billion to $51.5 billion, placing the channel in second place, below retail pharmacy chains, even though it ranked last when measured by U.S. dispensed prescriptions, which also decreased slightly, from 238.4 million in 2008 to 237.5 million in 2009.

Rx Abandonment on the Rise

March 24, 2010 By: Nadia Category: Medtipster, Prescription News

Rx abandonment on the rise in patients with commercial health plans, market research study said

Medtipster Source: Drug Benefit News – Author: Alaric DeArment

Patients using commercial health plans in 2009 abandoned their prescriptions at a rate 24% higher than in 2008, according to a new report by Wolters Kluwer Pharma Solutions.

The market research firm said consumers were become more price-sensitive toward drugs, particularly branded drugs; as a result, while the overall rate of abandonment was 6.3%, it was 8.6% for branded drugs, a 23% increase over 2008 and a 68% increase over 2006. Together, patient abandonment and denials for new prescriptions by payers meant that 14.4% of prescriptions went unfilled in 2009, a 5.5% increase over 2008.

Additionally, many patients are turning to generics, which accounted for 66% of prescriptions filled in 2009, versus 60% in 2008 and 50% in 2005. In 2009, there were 2.6 billion generic prescriptions filled, compared with 1.3 billion branded prescriptions.

“Today, patients wield more power and are more inclined to exert that influence in decisions about their prescription drugs,” said Wolters Kluwer Pharma Solutions president and CEO Mark Spiers. “During tough economic times, consumers tend to think more with their pocketbooks. We’re seeing increasing price sensitivity to co-pay and broader moves by patients in making decisions about their drug therapy.”

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