Post on 16-Jul-2015
Tuesday, February 24Speaker: Alan Lukazewski, Director of Clinical Pharmacy
Moderator: Mel Grau, Marketing Coordinator
3 Pharmacy Trends for 2015
Speaker: Alan Lukazewski, RPh
• 30 years of pharmacy
experience
• Certified diabetes
educator
• Certified geriatric
pharmacist, with
expertise in mitigating
adverse drug events
• More than half of generic drugs
experienced price increases in just 2 years
– Some increases as high as 1,000%
– Now some more expensive than brand drugs!
• In recent years, there has been a drastic
rise in pharmaceutical costs overall.
POLL: Over 50%
2015 Pharmacy Trends
Generic Drug Inflation
“Me-Too” Drugs
Specialty Drug Crisis
Adverse Drug Events
• 1,000% price increases on some drugs
– Ex: Digoxin, a common heart medication, cost
less than $10 per script, but is now over $100
• Why?
– FDA sanctions
– Reduced competition
– Raw ingredient shortages
“High-cost” generics
Top 10 generic drug increasesProduct NADAC per Unit
(July 2013)NADAC per Unit
(July 2014)% Change in NADAC
per Unit
Tetracycline 500 mg capsule $0.05 $8.59 +17,714%
Tetracycline 250 mg capsule $0.06 $4.26 +7,340%
Captopril 25 mg tablet $0.02 $0.83 +4,434%
Captopril 12.5 mg tablet $0.02 $0.67 +3,937%
Captopril 50 mg tablet $0.03 $1.31 +3,806%
Captopril 100 mg tablet $0.06 $2.04 +3,570%
Clomipramine 75 mg capsule $0.42 $8.15 +1,818%
Doxazosin mesylate 1 mg tab $0.05 $0.62 +1,169%
Fluconazole 100 mg tablet $0.14 $1.50 +996%
Doxazosin mesylate 2mg tab $0.06 $0.56 +899%
NADAC = National Average Drug Acquisition CostSource: Pembroke Consulting analysis of Center for Medicare & Medicaid Services data files
• PBM program to reduce drug spend
– Interchange to therapeutic alternatives
• Ex: Captopril is currently on the WEA Trust Value
Choice Drug Plan, but will be removed and another
Value Choice drug, Lisinopril, is the recommended
option.
• Will also add another Value Choice option in a
related category called Losartan.
– We will provide advance notification to
members
2015 forecast: PBM changes
Branded “me-too” drugs
• New drugs with no therapeutic or safety
advantage over existing, lower-cost,
branded drugs
• Costs are 30-40% higher
• Inhalers of combined steroids and
bronchodilators are used for Chronic
obstructive pulmonary disease (COPD)
• Examples: Advair and Symbicort
– Symbicort can cost 124% more than Advair
– Changing to Advair can save $100 per script
Example: COPD drugs
• Nasal inhalers for seasonal rhinitis
• Examples: Veramyst and Fluticasone
– Veramyst Nasal Spray and Fluticasone are
same active ingredient and equivalent in
efficacy
– Moving to Fluticasone saves $96 per script
Example: COPD drugs
• Implement MedPerform High- Preferred
Drug List (PDL)
• Substitute with equally effective, lower cost
equivalents
Forecast: Formulary changes
Specialty drugs, defined
High cost (>$1200/Rx)
Treats complex disease
Requires closer monitoring
Requires special handling, storage, distribution
Limited distribution
Requires patient administration training
Skyrocketing costs
• Specialty drugs
– Less than 4% of drugs dispensed
– More than 30% of drug spend
– By 2018: more than 40% of drug spend
– Average of $3,100 per script
• vs. $29 generic and $240 brand non-specialty
• Ex: Sovaldi, Enbrel, Humira, Remicade, Harvoni
• Strengthen preauthorization process
– Minimize unnecessary use
• Formulary preferred agents
– Lower cost in therapeutic category
• Manage utilization
– Adherence
– Duration of therapy
– Prevent or mitigate adverse effects
Cost management strategies
• Unintended effects of a medication
– Causes symptoms that require medical
attention
– Can affect quality of life or how you function
• Ex: Martha and Remicade
– Infection rate as high as 32%
Adverse drug event, defined
ADE: incidence
0
0.5
1
1.5
2
2.5
3
3.5
4
25-44 years old 45-64 years old 65+ years old
Adverse Drug Events leading to MD Visits per 10,000 persons per year
per 10,000 persons per year
Impact of Adverse Drug Events
Ambulatory Care : $1,300Increased Hospital Stay: $7,000 - $13,000
Strongest Predictors:
• Total number of
medications taken
• Total number of
chronic conditions
Important Predictor:
• Age
Predicting ADE
0
20
40
60
80
100
120
0 1 2 3 4 5 6 7 8 9 10
# Drugs
% Patients w/adverse events
% Patientsw/adverse effects
• Encourage your
employees to review
their medications
yearly
• Provide information
about alternative
methods
Preventing ADE