Adherence, generics to reduce $403bn in waste
The latest drug trend report from pharmacy benefit manager Express Scripts estimated that if patients using maintenance medications used cheaper therapies when possible, adhered to their medication therapies and used home delivery, it could eliminate $403 billion in pharmacy waste every year.
Of course, nobody can control everything patients do at all times, and all patients on maintenance medications using home delivery instead of going to the pharmacy would mean fewer face-to-face interactions between patients and their pharmacists and less cost-saving medication therapy management, even if, according to Express Scripts, it could contribute to $88.3 billion in annual savings.
Nevertheless, what Express Scripts called harnessing the “good intentions” of patients could still cut that $403 billion in waste by a third. According to the report, the biggest portion of potential savings, $258.3 billion, could come from improvements in adherence, with reduced hospital admissions, emergency room visits, doctor visits, laboratory tests, additional therapy and other costs.
“Don’t let behavior fool you,” Express Scripts chief scientist Bob Nease said. “Patients’ behavior is often misleading and doesn’t represent their underlying intentions. Our research and experience show that most patients, when presented with a choice, make decisions that lower costs and improve their health — decisions that also are in the plan sponsor’s best interest.”
Medication nonadherence happens for a number of reasons, but not because patients desire poor health outcomes. For example, according to a recent study published in the journal Archives of Internal Medicine, patients taking cardiovascular drugs appear to become less adherent when they have to see multiple physicians and make frequent trips to the pharmacy. The study — conducted by researchers at Brigham and Women’s Hospital in Boston, Harvard Medical School and CVS Caremark — analyzed data from 1.8 million patients taking statins and 1.5 million taking angiotensin receptor blockers or angiotensin-converting enzymes between June 2006 and May 2007. They found that greater complexity in prescribing and filling prescriptions resulted in lower levels of adherence, and those with the least refill consolidation had adherence rates 8% lower than those with the most, concluding that strategies to reduce the complexity of prescribing and filling prescriptions could help improve adherence.
One possible way to improve adherence is to reward patients for it. HealthPrize Technologies, for example, has developed an online and mobile app that provides patients with cash rewards and interactive games designed to encourage them to take their medications as prescribed and directed. One study, which the company conducted in January, found that patients given such incentives were adherent 88% of the time. At the time of publication, HealthPrize was planning to partner with RealAge to conduct a study of asthma patients who had taken the RealAge Test.
Another “good intention” detailed in the Express Scripts report is using cheaper medications. The report found that $56.7 billion was wasted due to use of higher-cost medications that generate no additional health benefit. The report included a Harris Interactive study showing that 82% of patients using branded drugs would actually prefer generics. According to the Generic Pharmaceutical Association, the main trade group representing generic drug manufacturers, use of generics saved $139.6 billion in 2009.
CVS fights disease in ethnic communities
CVS/pharmacy spent the last couple of months sponsoring nearly 300 free screening and consultation events in Atlanta, Washington, D.C., and Philadelphia targeting African-American communities.
Part of the chain’s To Your Health program, the events were an extension of the A Su Salud events targeting Hispanic customers in Los Angeles, Dallas, Houston and Miami. To Your Health started in Atlanta on April 17, moving on to Washington, D.C., on June 12 and Philadelphia on June 19.
The events were designed to target health issues prevalent in the ethnic population in those communities; for example, the rate of diabetes among African-Americans is 11.8%, compared with 6.6% of non-Hispanic whites, according to the American Diabetes Association. Among 195,000 patients screened during the A Su Salud events in 2009, 22% had diabetes, 28% had high blood pressure, 33% had high cholesterol and 36% were at high to moderate risk of osteoporosis.
“Chronic diseases like diabetes disproportionately affect the African-American population, and early detection can make a tremendous difference for a disease that must be managed for a lifetime,” CVS Caremark chief medical officer Troyen Brennan said. “We urge patients to find out if their blood glucose, blood pressure and cholesterol are within a healthy range.”
Nearly 26 million Americans are living with diabetes, according to the Centers for Disease Control and Prevention. Atlanta, one of the focus cities of the To Your Health campaign, is in what the CDC calls the “diabetes belt,” an area covering 644 counties in 15 mostly Southern states where diabetes prevalence rates are at least 11%. The area has a large African-American population, a group with a disproportionate risk of developing diabetes. Within the belt, 11.7% of people have diabetes, compared with 8.5% of people in the country as a whole.
African-Americans also are at higher risk of developing high blood pressure, also known as hypertension, than other groups. According to the CDC, 42.2% of African-American men and 44.1% of African-American women have the condition, compared with 31.2% of Caucasian men and 28.3% of Caucasian women, and 24.8% of Mexican-American men and 28.6% of Mexican-American women. Across ethnic groups, 31.8% of men and 30.3% of women have hypertension.
Q&A: A new drug for Type 2 diabetes — Wa’el Hashad, Boehringer Ingelheim
Last month, the Food and Drug Administration approved Tradjenta (linagliptin), an oral Type 2 diabetes drug made by German drug maker Boehringer Ingelheim and Indianapolis-based Eli Lilly. The drug belongs to the class known as dipeptidyl peptidase-4 inhibitors, which also includes Merck’s Januvia (sitagliptin). With diabetes affecting some 26 million Americans and growing rapidly, Drug Store News spoke with Wa’el Hashad, BI’s VP cardiovascular and metabolic disorders marketing, about what the approval of Tradjenta means for the diabetes market.
Drug Store News: What do you see as Tradjenta’s biggest advantages over other diabetes drugs in general, as well as over other DPP-4 inhibitors on the market?
Wa’el Hashad: Tradjenta is the first in its class to be approved at one dosage strength, so there is only one dose to remember for all patients. Tradjenta can be used as a stand-alone therapy or in combination with other commonly prescribed medications for Type 2 diabetes — including metformin, sulfonylurea or pioglitazone* — and has demonstrated reductions in hemoglobin A1C levels of up to 0.7% compared with placebo. The recommended dose of Tradjenta is 5 mg once daily, and it can be taken with or without food. With Tradjenta, no dose adjustment is recommended for patients with kidney or liver impairment. Tradjenta should not be used in patients with Type 1 diabetes or for the treatment of diabetic ketoacidosis, a disease that causes increased ketones in the blood or urine. It has also not been studied in combination with insulin.
We are confident in Tradjenta’s potential to compete effectively in the Type 2 diabetes market and are very excited to make Tradjenta available to the millions of people whose diabetes is not adequately controlled. The FDA’s approval of Tradjenta means physicians will have another option for treating their patients with Type 2 diabetes whose blood sugar is uncontrolled. Alternative treatment options are important because Type 2 diabetes can be difficult to manage, and it is often very personal, meaning treatment regimens need to address individual patient needs.
DSN: What is the drug’s greatest advantage from a patient and pharmacist perspective?
Hashad: Tradjenta is the first in its class to be approved at one dosage strength, so there is only one dose to remember for all patients. We recognize pharmacists play an important role in further educating patients about Tradjenta. Boehringer Ingelheim Pharmaceuticals and Eli Lilly are committed to ensuring primary care practitioners and pharmacists are aware of when Tradjenta becomes available and are able to educate patients appropriately.
DSN: What prompted BI and Lilly to develop Tradjenta together?
Hashad: Tradjenta was discovered by Boehringer Ingelheim. In January 2011, BI and Lilly formed a strategic alliance in diabetes. This cooperation gives BI and Lilly the combined benefits of Lilly’s expertise in the diabetes market and two basal insulin analogs, as well as BI’s rich and innovative late-stage pipeline. The alliance leverages the collective scientific expertise and business capabilities of two leading research-driven pharmaceutical companies to address patient needs arising from the growing global diabetes epidemic.
DSN: How will the launch of Tradjenta affect the diabetes market in the years to come?
Hashad: The oral diabetes market is a $15 billion market, and DPP-4s are the fastest- growing segment of this market. We believe Tradjenta will further expand this growing market and bring a new treatment option to patients, healthcare providers and pharmacists.
* Pioglitazone is the generic name of Takeda’s Actos.