December 30, 2009 
1 Comment
When there was a large demand several months ago, there wasn’t any supply. Now there is adequate supply, but the demand has gone down. Will there be another spike in demand in the Spring?
With all the retail pharmacies and clinics having supply, we are now going to see the competition for the consumer. (See WSJ story)
December 29, 2009 0 Comments
Without getting into all the clinical rules, I’ve always looked for a cut-to-the-chase consumer list of when to avoid what specific foods if you take certain medications.
Finally, in Real Simple magazine (pg. 74, Jan 2010), I found one. Here it is:
I’m not sure of the science here, but I’m assuming that it’s real. I’ve heard the grapefruit advice before, but never the others. Do physicians and/or pharmacists tell you this?
The story also goes on to recommend a few foods:
So…watch what you eat!
December 28, 2009 0 Comments
I got this question e-mailed to me today. The patient has been using the same drug for years and it lost it’s patent about 6 months ago. They just found out that they could have saved a lot of money and wondered who should have told them. Here’s my thoughts.
So, with lots of nuances, my reply was that no one had a legal obligation to tell her, but they all had good incentives to do it. I suggest talking to the physician and/or the pharmacist.
December 28, 2009 0 Comments
Here’s a short list of the big drugs that might lose patent protection (i.e., have a chemically equivalent generic become available) in 2010. This is always subject to change and is based on data from PBMI which is summarized from presentations at the AMCP.
| 2010 | Aricept® | donepezil | Alzheimer’s disease |
| Cozaar® | losartan | High blood pressure | |
| Effexor XR® | venlafaxine | Depression, panic disorder | |
| Flomax® | tamsulosin | Benign prostatic hypertropy | |
| Hyzaar® | hydrochlorothiazide and losartan | High blood pressure |
December 28, 2009 1 Comment
As of 1/1/2010, Medicare beneficiares will face a new hassle at the pharmacy. How big of a deal will this be? I honestly don’t know.
But, from their site:
Starting January 1, 2010, if your pharmacy tries to sell you a version of a drug that isn’tlisted with the FDA, your Medicare drug plan might not pay for it. This means you mightgo to the pharmacy where you regularly get your Medicare-covered prescriptions filled, andif the pharmacy stocks only a version of the drug that isn’t listed (and, therefore, your planwon’t cover), the pharmacy may not be able to fill your prescription that day.
Since there are multiple manufacturers of a generic medication, multiple forms (capsule, tablet), and sometimes repackagers, this could complicate things for patients simply trying to fill their medications. I’m not sure I understand what’s being addressed here.
December 23, 2009 0 Comments
Every once in a while you have that great workout. As we get ready for the 60% surge in gym memberships that occur with 1/1, I started thinking about what criteria I use to know this.
Of course, you can’t do this everyday or you can’t recover (and you probably aren’t very comfortable). But, I often find that the best way to get this is to try a new routine or new workout. I’ve done this new core workout a few times at the Lifetime Fitness in Chesterfield, MO which seems pretty easy but is really hard. I have trouble with certain movements the next day for sure.
December 22, 2009 0 Comments
I’ll borrow our tagline from Silverlink Communications – Because People Are Different – to follow-up on my post on direct mail from yesterday. The first commentor makes a good point. Certainly e-mail doesn’t work for everyone. Nor does the phone (although it is generally ubiquitous today).
The reality is that different segments require different modes of communication. The question is how to figure that out.
And, the question that I surprisingly don’t hear many people ask is why is there so much direct mail when we as a culture are generally more interested in being environmentally aware than ever (although we still have a long way to go). Why kill a tree when other modes are more effective, less expensive, and offer better consumer insights?
December 21, 2009 2 Comments
Given all the progress we’ve made in the past 15 years around communications, I wonder why direct mail is still a primary component of communications. Obviously, there are some times when compliance requires a written notification, but considering you can’t tell if someone opened the mail and most companies don’t process return mail, you really have no visibility or ability to audit.
Written communications are also so static unlike a website or an automated call where a response can alter the next step in the communication.
Additionally, there is a time lag on written communications that you don’t have with e-mail or with an automated call.
I’ll break it out more in the table below, but in the end, direct mail costs the most yet gives you the least data, the worst customer experience, and is the least time sensitive. Seems like a problem to me.
| Channel |
Automated Call |
Direct Mail |
|
| Cost |
Low – Medium |
High |
Low |
| Ability to Personalize |
High |
Medium |
High |
| Dynamic Content |
Yes |
No |
No |
| Know if received by consumer |
Yes |
No |
Yes |
| Know how long consumer interacted |
Yes |
No |
No |
| Time from event to consumer |
Minutes |
Days |
Minutes |
| Response Rate |
High |
Low |
Low |
Now, don’t get me wrong, there is a place for direct mail.
But, why is it that so many companies begin their communications to consumers with direct mail. Is it that people are simply stuck in a rut of what they’re used to and can’t embrace decade old technology? Or is it that people don’t believe the facts in front of them?
December 17, 2009 0 Comments
You can certainly see the piece of the PBM world that I’m wrapped up in right now, but these seem to be important trends.
What are the most likely developments/trends that could affect pharmacy benefit executives in the year ahead? Why?
While healthcare reform or market consolidation could impact the industry, we don’t see either as having a material impact in 2010. We expect several trends. There will continue to be a focus on mail order utilization, specialty pharmacy market share, and generic fill rate, and the sophistication of those programs will continue to evolve. PBMs will look at how to predict responses by patients to offers such as retail-to-mail and subsequently segment the market using variables such as condition, age, and plan design. PBMs will continue to develop strategies to address programs like $4 generics, 90-day retail, and pharmacy to employer direct contracting. We have also seen a huge focus on adherence which will take several forms – automated refill programs, physician focused programs, and pharma-funded programs. Additionally, there will continue to be efforts to create a single view of the member in a longitudinal view of their claims and intervention history. PBMs will begin to think and act more like consumer companies employing techniques like motivational interviewing and behavioral economics.
How might pharmacy benefit executives most effectively prepare for these important trends?
Executives should be developing processes with an inside-out perspective that focuses on how the consumer experiences the PBM not how the PBM optimizes their process. They should be looking at how they blend claims data, lab data, communications data, and event data (e.g., website visits) to have a holistic view of the patient. Additionally, PBMs need to have a rapid testing strategy for how they evaluate consumer hypotheses and rapidly improve programs while capturing insights about their population.
December 17, 2009 0 Comments
Another question from the recent Drug Benefit News where I was interviewed with several other experts on the industry. My answer…
Other thoughts?
December 17, 2009 2 Comments
My response to this question…
The Express Scripts acquisition of Wellpoint’s NextRx certainly put several captive PBMs in play, but that appears to have died down. There may be small acquisitions, but the big 3 appear focused on expansion into more health services and internationally more than buying new lives.
Other opinions?
December 16, 2009 0 Comments
This is a great question as posed by numerous people (see WSJ blog). Now, the one reality that most people don’t realize is that the data is only directionally correct. Not everyone sells their data to the aggregators so depending on pharmacy (or PBM) marketshare the data could be close to significantly off.
Perhaps, that’s not the issue. The question is whether pharma should have a right to see prescription data by physician to understand their behavior. It’s not patient specific data so that alleviates what I think should be the big issue.
Between patients visiting healthcare sites, registering for coupons, buying disease specific publications or supplies, the individual data is probably a lot easier to get and use…and probably more accurate (at least at the household level).
Assuming no one says that pharma can’t communicate with physicians, I think the data is relevant. Certainly, they have an agenda – drive marketshare of their drugs. I think we have to assume that physicians aren’t just guppies that hear the pharma rep talk and do whatever they say. Physicians are smart, well-trained professionals that should be able to hear messaging about drug pros and cons; look at the research; talk to their peers; talk to their patients; and appropriately prescribe.
I think the prescription data probably creates a more efficient system. Physicians that use a drug frequently are visited less often by the rep and don’t spend time away from patients. Physicians that don’t prescribe a drug frequently (and prescribe a high volume of competitive drugs) probably get more visits…BUT they have the choice of saying don’t come.
[I’m taking a little extreme of a view here since nothing is black and white, but I’m not sure I see the privacy issue here.]
December 15, 2009 0 Comments
Lance has decided to focus some of his passion and conviction on diabetes. I think this is great. Certainly, this is a condition which affects a lot of Americans and continues to get worse with the obesity epidemic.
Given the focus on the pharmacies (CVS, Walgreens) and the PBMs (Caremark, Medco, Express Scripts) on management of this condition, I wonder who (if anyone) will get Lance Armstrong to be their sponsor or public face. For the PBMs that traditional don’t have a consumer brand, I would think this is a great opportunity. I compare it to Medco having Amy Tendrich from DiabetesMine promoting Liberty Medical. While Amy might not be a household name, she is certainly a name in the diabetes community.
December 10, 2009 0 Comments
The fact that there is even a coalition called the Inflight Passenger Communications Coalition which is focused on getting passengers the “right” to use their mobile phones on planes in the US is crazy. I don’t care what they do in other countries. This would drive me insane. As someone who spends a significant amount of time on planes, the last thing I want to hear is some person talking the whole flight. This is great downtime and work time for me.
I completely agree with having Internet access. People can stay connect via SMS (text messaging), e-mail, web chats, or other written modes. Having dozens of people talking out loud in a confined space would be unpleasant for everyone.
December 3, 2009 0 Comments
Have you seen the show Hoarders? Very scary. It’s amazing that people can live like this. Logically, it would appear that there is some type of additive or compulsive behavior issue here. Go to the website and look at some of the pictures.
I can only imagine the social and health consequences of this on the entire family.
December 1, 2009 2 Comments
As a parent, I always think about setting examples for my kids. Since I do believe that playing sports is important to teach kids teamwork, coordination, social skills, and competitive skills, I think this is a key question. Sports is an integral part of our society. I see three potential role models for kids around sports: [Also, over time, I think that kids peers can become role models or certainly older kids.]
While I think there are some great professional athletes who can serve as role models (e.g., Michael Jordan, Tiger Woods), there are a lot that aren’t due to drugs, violence, unsportsmanlike conduct, gambling, cheating, and financial mismanagement. And, that’s a very hard thing to control. We’re always (IMHO – in my humble opinion) going to pay to see the best even if they’ve used steriods or have control issues.
As parents, we have the most control over ourselves. We can make sure our children see us play sports and exercise. We can stress the importance of this. We can help them learn sports and make sure they take away lessons from their playing – e.g., winning isn’t everything. [One interesting observation that I’ve had is that athletes make good sales people because they know how to keep trying and get focused even after a loss.]
But, the one I struggle with is coaches. Sometimes you may have control over the coach, but they can be a very powerful influence on your kids. They spend hours with them and provide guidance. There are some things that you obviously don’t want in a coach – too demanding, not demanding enough, someone who encourages winning at any cost. But, what do you do about the coach that is very smart and understands how to play, but isn’t in shape at all? They can’t even run down the field with the kids. What type of image does that give the kids? It seems mixed to me, but maybe I’m wrong.
[Note: I was originally going to call this “Fat Coaches”, but I think there are plently of overweight people who are athletic. But, I’m not so sure about this guy above or some other coaches I’ve seen.]
December 1, 2009 2 Comments
Here’s a simple, yet valuable gift for your athletic spouse, friend, co-worker – RoadID.
This is something you can wear or put on your shoes so that if you get into an accident while you’re working out (i.e., road running, biking, hiking) people can contact someone for you. I think it’s great. I was skeptical of the need for it for a while, but I realize that accidents do happen.
They’ve now come out with RoadID interactive. I have mixed impressions. It’s great in that you can log information into an online profile – addresses, contacts, physicians, medical information, insurance coverage, etc. If you’re in a horrible accident, all of that would be good to have. And, the reality is that you control how much is there. But, I’m still a generally paranoid person so I would worry about someone stealing my shoes and all of a sudden having access to my information.
[Too bad you couldn’t make it so that it was only enabled if some of your vitals signs were off and transmitted via a sensor to the site to unlock the information. That would be cool!]
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Contact me at gvanantwerp @ mac.com.
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