Pbm news v4 no.

PBM S P R I N G E D I T I O N
news
S P R I N G 1 9 9 9
V O L U M E 4 / N U M B E R 1
Y2K2 (TOO)
PBMI ANNUAL CONFERENCE
Route To: ______
SOLD-OUT
Not to be outdone by every other media outlet in the world, PBMI feels the need to discuss Y2K issues too. The reason, as many individuals room only sign so, in early March, we cut off prepare for a doomsday that may not occur, is that registration to PBMI's annual utilization some public agencies are encouraging patients to stockpile critical medicines. Some are recom- are registered to attend this April conference. mending that people have at least three-month but were unable to sign-up in time, let us The question for plan sponsors is, what are you going to allow your members to receive as a conference this fall. If not, registration for covered benefit? Are you going to allow members to receive refills they might not otherwise qualify for? Is everyone going to get their last refill PBMI's utilization management conference, through the mail service pharmacy so they can have the maximum quantity on hand? Is your mailservice pharmacy prepared for any increase involume that may occur in December? What happens to a calendar-year-based drug budget ifthere is a significant spike in utilization inDecember 1999? Notwithstanding issues that pharmaceutical manufacturers are facing in terms of simply What would the impact be on our costs if
producing sufficient quantities of drugs, are you we implement a copayment structure to
and your PBM prepared to face non-system issues incent formulary drug use?
related to Y2K? In the end, the Y2K problem may One of the hottest trends, at least among PBM News is published
not manifest itself as a computer systems issue.
HMOs, is the use of cost-sharing programs Perhaps, the biggest problem may be the some- that encourage formulary drug use. In these what reasonable reaction of the general populace programs, patients must pay a higher cost- raised in this article, it is important to identify any cost-sharing designs is to charge members a potential weaknesses in your existing delivery $25 copayment for each non-formulary drug, system and to establish policies for dealing with $15 for each formulary drug, and $5 for each these issues. To date, when queried PBMs indi- cated they do not have any concerns regarding maintaining mail service pharmacy inventory prevalent in benefit plans defined by HMOs levels. Additionally, the plan sponsors indicate than it is with employer defined carved-out that their beneficiaries will not be allowed to drug benefit programs. According to several have implemented this type of cost-sharing NEW BREED OF WEIGHT-LOSS DRUG SOON TO
receiving placebo with a weight-maintenance diet lost 4.5% of BE RELEASED
their original weight, or an average of 12.8 pounds.
In addition to helping reduce the patients' weight, Xenical This article was prepared by Elaine Manieri, R.Ph., Senior has other important affects. A study has shown that along with Consultant with Sevon Associates. Sevon Associates, located in weight loss, Xenical also improves glycemic control (blood Philadelphia, provides pharmacy benefit management consulting sugar) and lowers the dose requirements of drugs used to treat services to managed care organizations nationwide. patients with type II diabetes. Additionally, the agent was shown After Redux was withdrawn from the market because of to improve LDL/HDL ratios (good to bad lipids), total choles- life-threatening complications and serious health complications terol, triglyceride levels and blood pressure.
were discovered related to the phen-fen combination, seriously Remember, however, that anti-obesity drugs are a common over-weight individuals were left with fewer pharmaceutical prescription benefit exclusion. Xenical will be excluded from treatment options. Now, a new way to shed those surplus most benefit plans unless some action is taken. In the past, anti- pounds is close at hand. A new weight-loss drug is slated for obesity drugs were excluded because they were amphetamines, release in the first half of 1999. The drug not only promotes were somewhat addictive, and were frequently abused by weight loss and reduces weight regain, but a recent trial has patients. This is not the case with Xenical. Although only time shown it to improve obesity-related risk factors when used in will tell, when used appropriately this drug may provide signifi- cant quality of life improvements for beneficiaries and may Xenical (orlistat, Hoffman-La Roche), is part of a class of provide corresponding savings in overall health care costs.
drugs known as lipase inhibitors. It works by preventing the Xenical is expected to generate a lot of consumer demand.
body from absorbing approximately 30% of all dietary fat. The The Internet is already packed with information on it. Examine undigested fat travels through the intestines and winds up in the your prescription benefit design to determine whether you cover stools. After two years of therapy with the Xenical-diet combi- anti-obesity drugs. Consult your PBM and other clinical experts nation, patients lost approximately 7.6% of their initial body to determine the best strategy for managing the use of Xenical weight, or an average of 19.3 pounds. Patients in a group and other similar drugs that may be approved in the future.
INDUSTRY ROUND-UP
More significantly perhaps, is that the sellers of PCS and DPS are pharmaceutical manufacturers; Eli Lilly and While there have not been many changes in the PBM SmithKline Beecham, respectively. For one reason or another, industry, the ones that occurred were big ones. For those of you these companies did not see sufficient value to continue their who have not kept up with the news, PCS Health Systems was ownership of PCS and DPS. Only one PBM, Merck-Medco, acquired by Rite Aid Corporation. Rite Aid, one of the nation's continues to be owned by a pharmaceutical manufacturer. As a largest retail pharmacy chains, operated its own PBM called response to critics of this type of relationship, PBMI believes Eagle Managed Care. Eagle will be merged into PCS and PCS that any PBM with a contractual relationship with a pharma- will continue to operate out of Scottsdale, Arizona. Few ceutical manufacturer (essentially all PBMs) is subject to changes are expected at PCS. Initially, some customers and concerns regarding conflict of interest. Ownership is not the pharmacies expressed concerns to PBMI about the purchase of predominant concern; financial incentives are.
PCS by a pharmacy chain. These concerns appear to have been In late breaking news, on March 1, Advance Paradigm announced its acquisition of Integrated Pharmaceutical Another major change is the acquisition of Diversified Services (IPS) owned by Foundation Health Systems. Advance Pharmaceutical Services (DPS) by Express Scripts / ValueRx.
Paradigm estimates that as a result of this acquisition it will be Although the acquisition of ValueRx by Express Scripts last providing PBM services to approximately 27 million people.
year certainly improved the company's visibility, the acquisi- This transaction also must pass regulatory review.
tion of DPS will put Express Scripts on an almost equal footing PBMI also is aware of merger activities involving a with PCS and Merck-Medco. This acquisition is currently number of smaller PBMs. 1999 may shape up to be the year that the PBM industry finally begins to consolidate. Stay tunedfor more industry news.
COX-2 DRUG UPDATE
This article was prepared by Elaine Manieri, R.Ph., Senior Consultant with Sevon Associates. Sevon Associates, located in Philadelphia, provides pharmacy benefit management manage. Conversely, data collected by PBMI in 1997 and reported consulting services to managed care organizations nation- in the 1998 Edition of the Wyeth-Ayerst Prescription Drug Cost As discussed in the previous issue of PBM News, and Benefit Plan Design Survey Report, indicated that only a Celebrex is the first of a new class of drugs called the Cox- negligible percentage of carved-out drug benefit programs have 2 inhibitors. Celebrex is used to treat the symptoms of implemented this type of cost share design. Data collected by rheumatoid arthritis as well as osteoarthritis. It has been PBMI in 1998 for the 1999 edition of the Wyeth-Ayerst report will touted as a "super aspirin" that reduces pain better than be presented at PBMI's annual Utilization Management confer- conventional drugs with little or no damage to the gastroin- testinal (GI) system. Although studies indicate thatCelebrex does cause some GI damage, researchers expect What does this type of cost-sharing design do for you?
that in the long run it will prove to be safer than NSAIDs.
First, it encourages the use of formulary drugs, which should Until additional studies are completed, labeling for result in lower costs for you. However, you must be certain that the Celebrex includes the standard warning about the risks formulary drugs are more cost-effective than the non-formulary associated with NSAIDs, including the risk of GI tract ulcers, bleeding, and perforation. Feedback from patients Second, it offers a voluntary means for beneficiaries to comply on Celebrex was not surprising. As would be expected, with the formulary. Formulary use is not mandated; the patient has some are doing better with Celebrex and some are finding a choice and knows the cost associated with that choice. Not that they do just as well as on NSAIDs.
restricting access to benefits is the primary concern of many Despite very little promotion, doctors wrote more than 142,000 Celebrex prescriptions in the first three weeks, Third, it should result in higher manufacturer rebates. You leading marketing experts to predict that Celebrex will be should receive higher rebates because manufacturers are willing to this year’s second fastest-selling new drug after Viagra.
pay more when this type of incentive is in place. You should also Primary care physicians and rheumatologists now generate receive higher rebates because some members will switch from 66% of Celebrex prescriptions. The Arthritis Foundation non-formulary drugs to formulary drugs, which increases the reminds the public that there is no evidence the Cox-2 drugs market share of the rebateable drugs.
provide aspirin’s protection against heart attack and stroke.
Finally, by charging a higher copayment for non-formulary Arthritis patients using aspirin should discuss this matter drugs, you can recover some or all of the higher cost of non-formu- lary drugs. Ironically, depending upon your drug utilization and The price for Celebrex is between $2.42 to $5.00 per formulary, you may save even more money by collecting higher day depending on the dosage. This price is comparable to non-formulary drug copayments from your beneficiaries than you that of other prescription brand name NSAIDs on the save from lower drug costs and higher rebates.
market. However, it is much more expensive than generic How does it work? To help you calculate the potential impact, NSAIDs, such as ibuprofen and naproxen, which have been PBMI has developed a spreadsheet that can be used to model shown in many cases to be equally as effective as Celebrex.
different scenarios. The spreadsheet allows you to input varying Another Cox-2, Vioxx, has been placed on the FDA fast- copayment amounts and average costs per claim for formulary and track review. It is slated for approval in May of this year. A non-formulary drugs. Ask your PBM if they have data identifying third Cox-2 is due to come out this fall. the percent increase in the use of formulary drugs associated with This may be a good opportunity to assess your arthritis different non-formulary copayments. PBMI is hopeful that datawhich allows generalizations regarding these increases will be drug utilization management strategy or to implement a presented at a workshop on this topic at PBMI's April conference.
strategy before additional Cox-2s hit the market. The spreadsheet is a free and can be downloaded from the Free Analysis Tools portion of PBMI’s website at www.pbmi.com. Thespreadsheet is a Microsoft Excel spreadsheet. Please call PBMI ifyou have any questions or comments.
PBM news
THE 1999 PBM CUSTOMER SATISFACTION
ARE YOU GETTING THIS NEWSLETTER?
We are currently calling many of you to update our contact Obviously you got this edition of the PBM News but do you remember receiving the previous issue? In an effort to reduce the information for our annual PBM customer satisfaction survey.
cost of distributing this newsletter, it is sent as bulk mail.
We are working hard to expand the number of PBMs included However, PBMI has recently been informed that some employers in the survey report and to provide you with the information that routinely discard all bulk mail. This issue was sent via first class you need. Your comments and ideas are always appreciated.
Please feel free to contact us if you would like to participate It is important that you let us know about your company's in this year's survey and have not been contacted or if you do not policies regarding bulk mail so we can determine whether a want to participate in this survey. The survey will come to you permanent change in mailing procedures is appropriate. Please by fax at the end of April. Please use the last page of the fill out the brief survey on this page of this newsletter.
newsletter to update your contact information. Fax the backpage to (602) 530-4496 or call PBMI at (602) 730-0814.
Y2K SURVEY
NEWSLETTER SURVEY
Have you made special plans or investigated issues regarding Please indicate your preferences. Provide corrections to the benefit coverage for the Y2K problem? If so, please tell us about mailing label and fax this information to PBMI at (602) 530-4496.
your plans. We will summarize and report the results in the nextissue if there are sufficient responses. Fax this information to ❏ I would like to receive this newsletter via First Class Mail __________________________________________________ ❏ I would like to receive this newsletter via email: __________________________________________________ Your email address:_________________________________ __________________________________________________ _________________________________________________ __________________________________________________ ❏ I would like to receive this newsletter via fax: __________________________________________________ Your fax number: (________) _________ - _____________ __________________________________________________ ❏ Please stop sending me this newsletter PLEASE MAKE ANY CORRECTIONS DIRECTLY ON THIS MAILING LABEL AND FAX IT TO PBMI AT (602) 530-4496
PERMIT NO. 379
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