Archive | November, 2008

No Prescribing Data For Detailing?

Detailing physicians and providing them with samples has been the cornerstone of the pharmaceutical industries marketing efforts for years. Over the past few years, there have been changes where physicians don’t allow detail reps to meet with them or even physician groups that charge them for the meetings.

There have also been attempts to move to eDetailing where physicians log-in to virtual detailing sessions on their own time or attempts to push advertising or other drug information into the software solutions that prescribers use (electronic prescribing, practice management, electronic medical record).

One of the critical components for detailing is knowing doctor’s prescribing behaviors. How many prescriptions do they write? What drugs do they write for? This allows the pharma companies to focus their reps on the high prescribers that prescribe their competitors products or generics disproportionately.

So, if I interpret the recent decision from the New Hamshire District Court, it would appear that they are upholding an initial decision to prohibit companies from using this prescribing data for detailing. This is a big enough issue that I am sure it will get appealed again, but it would be a game changer if it is upheld.

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Joining The Board of Advisors at CareFlash

After learning more about CareFlash, I was excited to have the opportunity to join the Board of Advisors.  You can learn more about the company below, but what struck me was the examples of how this could be used by a family dealing with a complex medical situation where they needed help from their community of friends.  After seeing several families with kids in the ICU for prolong periods of time, I can only imagine their challenge in keeping everyone up to date on their child’s condition and seeking out help with errands without being overwhelmed.  CareFlash offers a simple, Health 2.0 type approach to solving that problem using blogging, a shared calendar, and 3D annimation of medical conditions. (See a video tour here.)

We deliver unprecedented healthcare advocacy and world class education to people in the richest circumstances imaginable, while offering unique philanthropic benefits to healthcare-related foundations, advocacy groups, religious institutions, etc. What CareFlash does is unique and unprecedented… and free.

When someone learns that they (or their loved one) have been diagnosed with a chronic healthcare challenge, a flurry of painful emotions appear ranging from fear and feelings of aloneness, to anxiety, uncertainty and even depression. As families begin the process of navigating through this experience together, it commonly becomes clear that people are unprepared and inexperienced at the realities of serving as a caretaker. CareFlash addresses these challenges, empowering our users to do the following:

Establish private and secure online communities around a loved one in order to share and facilitate updates, discussions and well-wishes

  • Update friends, family, coworkers and congregants through a ‘many-to-many’ communication tool. CareFlash streamlines the sharing of updates and well wishes
  • Educate the patient, caretaker and community on the specific disorder and treatment options at hand, using easy to understand 3-D medical animations narrated in plain everyday English, Spanish and other languages.  They range from pregnancy and neonatal issues to cancer, cardiovascular, ears/eyes, neurological, genetic, bladder/kidney, digestive/mouth, endocrine, blood/immune, respiratory, orthopedic, skin/cosmetic and hundreds of others.
  • Engage and organize involvement where help is needed… doing so in an unobtrusive, non-confrontational way through our easy-to-use iHelp Calendar
  • This is all offered to our users for free because our revenues are derived from advertising

In addition, CareFlash delivers unique philanthropic benefits to healthcare-related foundations and institutions, advocacy groups and religious institutions via alliance partnerships that provide them fundraising and marketing… never at any cost to them.

Another more lighthearted video about CareFlash is below.

This is a free service so I would encourage you to consider recommending this to families you know who could leverage this technology approach.  It is also a great tool for alumni groups (e.g., colleges, large institutions) or organizations who deal with families or patients to promote (e.g., specialty pharmacies).

Who’s Responsible For Healthcare Costs?

I was recently at the AHIP Business Forum Chicago and was in a session where Amy Holmes, CNN Political Analyst and Peter Beinart, Editor-at-Large of The New Republic held a discussion on Decision 2008 and What it Means for the Future of Health Care.  They are two of the sharpest people I have seen speak in a while and they hosted a very engaging discussion on the issues and what the Obama win means for healthcare from both sides of the political spectrum.  (They also had a very entertaining “He Said, She Said” style that captivated the audience.)

The big changes they felt were bound to happen were cuts in Medicare and an expansion of the SCHIP program, and there were others that they said would be debated including being able to sell insurance across state lines, the government offering coverage, individual coverage mandates and coverage for pre-existing conditions.  But the biggest part of the discussion was around healthcare costs.  Costs that are out of control, who pays for services, and where will the money come from.  While at an aggregate level talking about healthcare’s spiraling costs is simple, it is not the heart of the issue.

Isn’t the issue about how as an industry we get individuals to change their behaviors?

The most powerful force for changing the economics of healthcare is the healthcare consumer.  If the consumer changes behavior (even small changes) there are billion dollar impacts in cost.  Our research shows that if a plan the size of Aetna is able to improve adherence by 1% they could save $238M!  According to the Journal of Occupational and Environmental Medicine (JOEM), 70% of all healthcare expenses are lifestyle related.  This is not a new number but it translates to $1.4 trillion in healthcare costs that could be controlled simply by modifying healthcare behaviors. 

So if our lifestyles are “killing us” and destroying a system meant to improve our quality/length of life, why are we not talking about that at the national level as THE core issue?  How can we as industry professionals develop solutions that support consumers and facilitate the changes they need to make?

I was excited to see in the third Presidential debate that both candidates addressed responsibility being in the hands of the individual.  Next steps:  Let’s see some discussion on programs and policies that truly look to impact healthcare consumer behaviors.

(This is a guest post from Chuck Eberl, VP of Marketing, at Silverlink Communications.)

Happy Thanksgiving! Enjoy The Turducken

I must admit that one of the foods I have been fascinated with (but have never eaten) is the Turducken.  It is a turkey stuffed with a duck stuffed with a chicken stuffed with stuffing or sausage.  Regardless of what you eat tomorrow, enjoy the day.

If you’re healthy, reflect on how lucky you are since more than 50% of the US population is on some chronic medication.

If you’re sick, reflect on how lucky you are that there are researchers and companies trying to find cures for your disease. 

If you’re frustrated by the costs of the US healthcare system, focus on the positive which is the access we have compared to many other people around the world. 

If you work in healthcare, reflect on how lucky you are to be in a stable part of the US economy. 

Enjoy your family and the day!

Off Label Drug Use

Once a drug is approved, it can be prescribed by physicians for any reason.  Those reasons can include conditions that were not studied by the manufacturer in the clinical trials.  And, those off-label uses are not things that can be marketed to the physican.

Some of this is controlled by prior authorizations (PAs) which require a physician to call into the managed care company or the pharmacy benefit management (PBM) company to justify the use of the medication.  This is often used on high cost medications with a high percentage of off-label prescribing.

For example, it is estimated that 76% of the prescriptions writen for Seroquel are for off-lable purposes.  (See article on this and other information here.)  This article also lays out the top drugs that are used off-label.

  • Bupropion (Wellbutrin) approved for depression, commonly used off-label for bipolar diaorder.
  • Sertraline (Zoloft) approved for depression, commonly used off-label for bipolar disorder.
  • Venlafaxine (Effexor) approved for depression, commonly used off-label for bipolar disorder.
  • Celecoxib (Celebrex) approved for joint sprain/strain, used off-label for fibromatosis — soft tissue tumors.
  • Lisinopril (Prinivil, Zestril) approved to treat high blood pressure, used off-label for coronary artery disease.
  • Duloxetine (Cymbalta) approved to treat depression, used off-label for anxiety.
  • Trazodone (Desyrel) approved to treat depression, used off-label for sleep disturbance.
  • Olanzapine (Zyprexa) approved to treat schizophrenia, used off-label for depression.
  • Epoetin alfa (Procrit, Epogen) approved to treat chronic renal failure, used off-label for anemia from chronic disease.

MD Rating Sites

(Getting a few things out here and off my desk)

This is a question I often wonder about.  I was glad to see that e-patients put a report online.  I haven’t read it yet, but I think it is something that many of you would want to know.

I think that the main issue Given hit upon in the report (but I’m not sure she recognizes as the primary challenge of doctor rating sites) is the numbers issue. With over 700,000 physicians in the U.S., a ratings database of 10,000 or even 20,000 is pitifully and woefully small.

Preaching To The Choir

On the Maritz healthcare blog, the author talks about segmenting the population to drive wellness behaviors.  I couldn’t agree more.  That’s what we always talk about.  Understand what motivates different people is critical.  Bob Nease talked about this the other day on the Express Scripts blog.  You have to help people feel confident and provide them with a motivating and personal message that compels them to take action.

The challenge is aggregating data and learning from prior interactions to understand how people respond, when they respond, what mode they respond to, and what motivates them.  (among other things)

That is why communications is both a science and an art.

Do I Pay The Mortgage Or Chemo Bill?

15% of Freddie Mac’s deliquencies this year were due to illness.  I am sure this is a combination of medical bills and lack of ability to work, but this is a real issue.  As one of the comments on the WSJ Blog about this said, it’s the “perfect storm”.

Obama and his team have a real challenge (or opportunity) to figure out how to help us out of this market that we are in.

Physicians Vs PBMs?

I shared one of Toni’s quotes the other day and have some follow-up information that she sent me.  I will have to try and read it and share later today.  In the meantime, I saw this quote this morning from the same interview that she gave.

PBMs would love to move toward some standards that the physicians had access to.  That is the whole objective of electronic prescribing.  Every time the physician chose a drug, it would tell them if it was on formulary; if there were drug interactions; if there were coverage issues; and what the copay was.  I am not sure most physicians want this.  This would push a lot of work into their already abreviated office visits.

Additionally, I am not sure it is all the PBMs issue.  Everyone has different perspectives on cost, drug coverage, benefit design, etc.  I don’t think we will get to a common benefit design in this country that would simplify the PBM’s job.  Customization is the number one driver of cost within the PBM.  It causes huge IT issues.  It causes huge training issues.  It requires all kinds of inefficiency.

I am not sure that Toni and the PBMs are far off in what they want, but the reality of implementing it is a long way off.

“Physicians deal with too many health plans and numerous PBMs, and from our view they have no consistency. We have no way of knowing the various protocols and regulations they operate with, and new product designs make it impossible to keep up. Formularies are cumbersome and change all the time, and it is unclear who controls the formulary. It appears that formularies are based on [achieving] optimal revenue, not evidence-based. The goal should be to reduce hassles for primary care physicians and lower costs to patients and purchasers of health care. Health plans and PBMs are seen as the problem, not the solution.”

— Toni Brayer, M.D., who has practiced internal medicine in San Francisco for more than 20 years, has served as president of the S.F. Medical Society, and is chief of staff at California Pacific Medical Center, told AIS’s Drug Benefit News.

All I Want For Christmas Is A Pre-Paid HC Gift Card

I am surprised more people aren’t offering this.  Last year, Highmark BCBS in Pennsylvania offered a $25-$5,000 pre-paid Visa gift card that people could use for health related expenses.

Of course, you can always buy a Visa or AMEX gift card and give it to someone, but I think there is a certain perceived value in giving it to someone with an intent for the purchase.  It would be an easy safety net for your kid at college or a nice surprise to give to someone at the holidays.

An Example of Being Overmedicated

We all know that people have a lot of prescriptions.  Here is an interesting story about one individual and the process that her family went through to do essentially Medication Therapy Management (MTM) and find out the right mix of drugs.  I don’t know the person recommended in the story, but I certainly recommend making sure your physician and especially your pharmacist know all your drugs and talk with you to see about potentially having too many prescriptions (especially once you are above 10 different medications).

Each added prescription increases the likelihood not only of a problematic interaction but also of misuse. Studies show that half of older people sometimes fail to follow their Rx instructions. It’s no wonder. Consider my mom’s regimen: She took 32 pills a day, at five different times—some once a day, some twice, some three times, and some as needed. One pill had to be split in half for the morning dose but not for the evening dose. Some were taken with food, others on an empty stomach. She also used three different asthma inhalers plus a nebulizer, all on different schedules. I’m half her age, and I couldn’t keep that straight.

Today Show On Saving Money On Healthcare

Interested in seeing a clip from the Today Show on saving money – here it is[Sorry…you have to listen to a short advertisement first.  But, you should see a large video in the top right which will play a commercial and then bring up the interview of an executive from AARP.]

Changing Behavior – Examples

On the Express Scripts Consumerology Blog, I noticed a new entry this morning from Bob Nease (Chief Scientist) about changing behavior.  It points to two things – motivation and self-efficacy.  (What’s in it for me and do I believe I can be successful.)

There is an interesting study from the University of Michigan that he discusses, and he also provides some detail on one of their web pilots.  What the web study showed is that a simpler message led to more “click throughs”.  This is very similar to what we see in the voice channel of communications.

If I call you and tell you there is an opportunity to save money with your health benefit, you are likely to go to the next step or transfer to hear more.  On the other hand, if I tell you a lot in the message, I might get a much lower click-through (or continuation or transfer) rate.

Since ultimately, I care about conversion in the claims data (i.e., did the patient really change behavior) these metrics are nice proxies but don’t mean much.  I care about did the patient and their physician actually act on the recommendation or the opportunity to save money.  I posted that as a comment on the blog so hopefully Bob can add that detail.

We have clearly seen this in some of our programs where we would rather qualify them on the phone and then transfer them leading to a higher close rate than simply drive up transfers.

Beating The Generic Process

Anyone who works with drug manufacturers knows that once a drug gets closer to its patent expiring, they are going to look for creative ways of extending the patent life – new approvals (e.g., pediatric dosing), an extended release (XR) version, or a me-too drug for example. And, as a product manager, who can blame them.

As the payor or the public, this is a greedy action that they take. In another WSJ article from the other day (“How a Drug Maker Tries to Outwit Generics”), it deals out the strategy that Cephalon (the manufacturer) is taking relative to its narcolepsy drug Provigil. I give them credit for a well thought through plan (although I am not sure I would have made it public).

Over the past 4 years, they have raised the price by 74% (now $8.71 per tablet). At the same time, they are preparing to bring a longer acting version of the drug called Nuvigil to market. So what does this price increase accomplish:

  • They are maximizing revenue and profit in the waning years of the patent (which expires in 2012).
  • They are going to launch Nuvigil in 2009 at a much lower price which will encourage most payors to exclude coverage of the higher priced (and older) Provigil and shift utilization to Nuvigil.
  • When the patent expires in 2012, anyone still on Provigil will be quickly moved to the generic version, but most of the market share will have shifted to Nuvigil so they can then begin to raise the price on that drug with less dramatic market share erosion.

This wouldn’t work in a lot of drug classes because there already is a generic available and dramatic price increases would drive utilization to the generic alternatives. But, if you are one of the only brand drugs to treat a condition, you have a lot of pricing upside.

November Adler’s Drug Store Counter

From this month’s publication of Adler’s Drug Store Counter by Meredith Adler from Barclays Capital, I found two telling things.

She highlights the drug trend and generic fill rate numbers from the big PBMs (as I have done before). What it made me think about is that with Medco and CVS Caremark having lower generic fill rates, they actually have a better opportunity for lower trend in subsequent years (with the right programs to close the gap).

In another chart, she shows how different areas of the healthcare market are increasing in cost. Pharmacy is increasing at the fastest rate (as it has several of the past few years). Fortunately, it typically only represents about 15% of the healthcare costs, AND it is the easiest to influence. Patients have a lot more opportunity to research and talk with their physician about prescriptions than discussing whether a particular blood test is appropriate.

cost-increases-in-hc

Who’s Going to be a General Practitioner

I was just talking with someone yesterday about what happens as the retail clinic concept (e.g., Minute Clinic) and virtual consultations (e.g., American Well) take off. Given that primary care physicians (aka General Practitioners) have seen increased reimbursement pressure, will these trends finally make that the least desirable job coming out of medical school? [Which would be a shame in my opinion.]

In a survey done by The Physician’s Foundation in May, they had 12,000 responses from US physicians that confirmed this. [They define primary care physicians (PCPs) as family practitioners, general internists, pediatricians, and OB/GYNs.]

  • 78% said there is a shortage of PCPs.
  • 49% said that over the next 3 years they plan to see less patients or stop practicing.
  • 60% said they would not recommend medicine as a career.

Would You Pay More Taxes To Cover The Uninsured

Here my democrat tendencies come out.

The Council for Excellence in Government did a Gallup Poll of 1,000 adults in June to see who would be willing to pay more in taxes to cover the uninsured. I was surprised by the results:

  • 50% age 18-36 would be willing to pay more
  • 45% age 40-64 would be willing to pay more
  • 31% age 65 and older would be willing to pay more

Maybe I know something different, but I believe there is research that shows that if the uninsured were covered that would reduce the healthcare costs paid by the insurers today.

For example…If someone is uninsured and goes to the hospital today, they are treated and the bill is never paid. Those costs are “peanut buttered” across the hospitals billable events to keep them whole. So, in most cases, we (consumers) are either paying directly or indirectly (through the insurance companies) a higher cost per incident to cover the uninsured. And, since they are uninsured, they are less likely to take preventative action (which is less expensive) and more likely to end up in higher cost events (e.g., the emergency room).

So, would I pay more in taxes to improve the general health of the country and cover the uninsured knowing that I would basically get that money back (perhaps with some time lag) through lower healthcare premiums? YES. Happily.

Drug Re-importation – Real With Obama?

This is a topic that has been around for a while. Before the Medicare Prescription Drug Plan (PDP) and a significant number of drugs losing their patents, you used to hear about people driving to Canada to get their prescriptions at reduced prices.

I believe this is one of the things that Obama talked about in his plans to lower healthcare costs. I haven’t studied up on it in a few years, but I got to work with our General Counsel at Express Scripts on our position for this several years ago. At the time, a lot of our clients were asking what they should do and what we would do.

Here were my conclusions (updated with the general market conditions above):

  • There is certainly a window of opportunity to import brand drugs from other countries (e.g., Canada) into the US and reduce costs.
  • That window will be short-lived as the US is the biggest prescription drug market based on high prices and the manufacturers will simply increase global prices putting pressure on those governments to not allow re-importation.
  • There is some increased risk of “counterfeiting” but that could be managed with some of the drug pedigree things being discussed and implemented.
  • Brand drugs are cheaper in other countries because they negotiate as a country and have larger buying power and give higher probability of market share to the approved manufacturer. [Which isn’t likely to happen in the US anytime soon.]
  • (One of my biggest ah-hah moments…) This is only relevant for brand drugs which now represent less than 40% of all drugs dispensed in the US. Generic drug prices are cheaper in the US than anywhere else for the exact same reason – competition.

As a corporation, we couldn’t encourage this activity back then, but we could process paper claims as out of network for our clients if they included those locations as part of their benefit.

So, I think it’s an outdated suggestion that will ultimately hurt the other countries for our short-lived benefit. Hopefully, Obama brings some people onto his team that look at these facts not at playing to the general public’s perception. [And, yes…I would happily volunteer to help us fix the healthcare system no matter how painful of an experience.]

The Nocebo Effect

If you ever read the label on your prescription drugs (or more likely the PI (Product Insert)), you will learn about all kinds of potential side effects ranging from mild things like headaches to much more serious but rarer conditions. The WSJ had an article earlier this week called “Power of Suggestion: When Drug Labels Make You Sick” which talks about the “nocebo effect” where knowing about potential risks makes you more likely to experience them.

“Women in the multi-decade Framingham Heart study who thought they were at risk for heart attacks were 3.7 times as likely to die of coronary conditions as women who didn’t have such fears – regardless of whether they smoked or had other risk factors.”

“In a 1960s test, when hospital patients were given sugar water and told it would make them vomit, 80% of them did.”

Richard Kradin, author of “The Placebo Response and the Power of Unconscious Healing” says that about 25% of people who get placebos (i.e., a sugar pill) complain about side effects in clinical trials.

The article tees up the question of what to do with this information. Should the information be for the physician only? [I don’t think so.] Should the physician walk the patient through the information and the key side effects? [I think they should for any serious effects or have some type of follow-up mechanism to see how the patient feels on any chronic medication.]

I guess part of the challenge is talking with the patient about normal symptoms they are having before taking the drug. Are you drowsy? Do you have frequent headaches? Then at least they might be able to understand if they are side effects or the “nocebo effect”.

Ix and Health 2.0

Yesterday, I had a brief (5 minute) opportunity to present on a webinar by the Center for Information Therapy (Ix).  Similar to the Health 2.0 conferences, they talked about some trends and then asked 5 companies to talk about how they were delivering information to patients/members.  The companies that presented were:

As one of the moderators observed, it is interesting to see how information is being delivered using different modes.  Certainly web is great if you get people there, but as I think I have spoken about before, one of the challenges is that some of the patients at the highest risk aren’t engaged so you have to have an outbound strategy to engage them.  You can’t depend upon them engaging without being prompted.

60M Health 2.0 Users BUT…

I think we are all still waiting on the final business models to find the profitable solutions. I think many of the tools are great. Some are even amazing in what they can do. But, ultimately most of these are businesses, so how are they making money?

In a recent report by Manhattan Research, they define Healthcare 2.0 consumers as “adults who have read health-related blogs, access message boards, or participated in health-related chat rooms.” It also includes people who have contributed content through comments to a blog entry, writing, or creating and posting videos or pictures.

It seems a little easy to become a Healthcare 2.0 consumer using this definition and without much stickiness.

“Healthcare in the US is an expensive commodity and, as a result providers are always seeking to streamline operations. Allowing members to manage their own healthcare portfolio services online helps them to achieve this, as well as raising levels of customer satisfaction. It’s a win-win situation,” said David Lavenda, vice president of marketing and product strategy at WorkLight.

See study here.

See WorkLight press release on this here.

If there are 60M “users”, there is a great install base to build upon.  I think we are all hoping to see how some of these companies make their models work and blend with the establishment to change the industry.

Reaching the Hispanic Community

Based on different statistics I saw today, it is clear that a healthcare strategy for reaching the Hispanic community is needed. Just looking at what I see being done:

  • Some companies are building out a “language flag” in their databases to allow members to choose the language for communication.
    • This works a lot better than “guessing” based on their last name.
  • Some companies are offering Spanish and English versions of print documents.
    • It may exist, but I haven’t seen any companies allowing a member to “toggle” their website between English and Spanish.
  • Some companies doing calls offer patients the ability to choose Spanish during the automated call (i.e., Spanish on the fly).
    • These could be offered to every member or only to members in zipcodes with a high concentration of Spanish speakers.
  • An older solution which exists many places is hiring call center staff that are bi-lingual.
    • And many companies use the AT&T language line to support less common languages.

But, the key is that you should have some strategy and be working towards improving it and understanding the differences in that population segment.

Health 3.0 Conference

I guess we shouldn’t be surprised.  The Health 2.0 movement has gotten lots of press and had great attendance at the conferences.  Now there is a Health 3.0 LinkedIn group and conference

I am not sure I know the difference yet.  I speculated on Health 3.0 after my first Health 2.0 conference to get a stake in the ground.  The one big thing that I notice is that the speakers are established companies talking about what they are doing which was one thing missing in the Spring Health 2.0 conference, but which seemed to have changed slightly in the more recent Health 2.0 conference in October.

Context Matters – Look at Gas Prices

As I saw gas prices locally fall below $1.80 yesterday, I thought about how different that context is versus having gas closer to $5.00 per gallon.  We all saw how quickly the auto companies moved to emphasize miles per gallon in their advertising.  [You could argue that they (and the public) should have been focused on this for years.]  I wonder if that will disappear and return to the more traditional advertising.

In another example, I noticed the Wal-Mart slogan the other day which is “Save Money.  Live Better.”  I don’t know if this is new, but it caught my attention in today’s economy.  They are trying to position themselves as improving your life through cost savings. 

I haven’t seen a lot of examples in healthcare where companies are seizing on this economic focus to change their messaging.  It should be a healthcare company with the Wal-Mart slogan helping drive Information Therapy (Ix) out to members to help them understand how to optimize their out-of-pocket spending.

I think it is so important both to understand messaging and how that varies across segments of the population, but to also understand the need to change that messaging to reflect the macro-forces which are present in society.

Physicians As Victims Of System?

I was reading this quote from Dr. Toni Brayer who writes a good blog called EverythingHealth which seems to paint the physician and patients as irrelevant in today’s market.  I am not sure it’s that bad, and certainly this will change with individual insurance products and more people having Medicare.

I guess the question is how much of a industry structure can be set by individuals versus the market.  Maybe, I need to ask her what the operations are that she wants to improve.

“Physicians are at the bottom of the food chain and do not have the ability to improve [the operation of the pharmacy benefit]. As I see it, PBM customers are the health plans and the pharmaceutical industry. Health plan customers are the employers or purchasers. Employer customers are the stockholders or company owners. Physician customers are the patient. Physicians and patients are out of the loop except as the user of the services. Since we are no one’s customer, in a free market we are irrelevant.”

— Toni Brayer, M.D., who has practiced internal medicine in San Francisco for more than 20 years, has served as president of the S.F. Medical Society, and is chief of staff at California Pacific Medical Center, told AIS’s Drug Benefit News.

$557K vs. $24K To Save Your Life

As a follow-up to the statin study (JUPITER) which showed that Crestor could save lives, there is lots of discussion about what to do. USA Today has an article showing the cost of putting the additional 7M people on Crestor that the study was based on versus putting them on a generic statin.

Using Crestor would cost $557,000 versus $24,000 for the generic. If I am the maker of a statin (or cholesterol lowering drug), I am feeling good right now.

Two For One

Hard economic times definitely bring out the creative solutions from people. Today, I heard an advertisement to get two Kia cars for a very low price. If you can’t sell one car, sell two at a time?

Perhaps we can increase preventative care by offering two cholesterol tests or exams for one low price?

If things like this work, will they ever be used in healthcare?

Lots of companies price things at $X.99 versus $Y.00. But, copays are always flat. We pay $20.00 for a brand drug not $19.99.

250,000 Less Heart Attacks Means More Statins

It will be interesting to see how the results of a recent study impact medicine and prescription use. The study involving 18,000 patients showed that those using Crestor compared to a placebo had:

  • 54% fewer heart attacks
  • 48% fewer strokes
  • 46% angioplasties
  • 20% fewer deaths

The study volunteers had normal cholesterol but high blood levels of C-reactive protein.

  1. Will physicians prescribe more statins?
  2. Will national standards be changed to recommend statins for everyone with high levels of C-reactive protein?
  3. Do cheaper statins like generic Zocor have the same effect as Crestor?

Focus on Drug Sales Abroad

As drug sales in the US slow to 1-2% growth per year, they continue to grow by double digits internationally. From 2002-2007, the developed markets (US, Canada, Japan, and the top five European markets) grew at 52% while the emerging markets (China, India, Brazil, Russia, Mexico, Turkey, and South Korea) grew by 141%. (According to IMS data in the WSJ article “Drug Firms Target Newly Rich Abroad” on 11/5/08)

The article makes good points about the ethical questions that this may create in terms of pricing and what happens when only a small portion of the population can afford essential medications.

I guess this also poses the question of whether it is better to have no one with the access or only the top 1% of the population having access.

Medicare Costs Up 329% In 3 Years

The costs for people with a Medicare Prescription Drug Plan (PDP) continue to go up. They will go up 43% this year and have gone up 329% in the past 3 years according to a front page article in the USA Today (11/12/08). That’s the bad news.

What’s the good news – The program has cost us taxpayers less than originally estimated mostly due to the use of generic drugs.

Monthly premiums are going up to $37.10 next year according to Avalere Health. This is up from $26.03 in 2006. Members have also seen their copays go up from $1 to more than $13 (hopefully not for generics).

Open enrollment for the benefit starts 11/15. Right now there are 17M members in the PDP programs and 9M in Medicare Advantage programs that cover health and prescriptions.

There has traditionally been low “churn” among members. I wonder if this will continue. Medicare spokesman Jeff Nelligan says that most beneficiaries should be able to find a plan that is the same price or cheaper if they are willing to change.

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