DAW Rxs drive up healthcare costs, study finds
WOONSOCKET, R.I. — "Dispense-as-written" prescriptions are exacerbating medication nonadherence and costing the U.S. healthcare system billions of dollars, according to a new study by researchers at Harvard University, Brigham and Women’s Hospital, and CVS Caremark.
According to the study, published this week in the American Journal of Medicine, researchers found that DAW designations for prescriptions — a practice whereby doctors or patients demand the dispensing of a specific brand-name drug and not a generic alternative — costs the healthcare system up to $7.7 billion annually.
The study estimates that patients would have saved $1.7 million and health plans would have spent $10.6 million less for the medications if effective generic alternatives had been provided in place of brand-specific medications. Assuming a similar rate of DAW requests for the more than 3.6 billion prescriptions filled in the United States annually, patient costs could be reduced by $1.2 billion, and overall health system costs could be reduced by $7.7 billion.
Researchers also found that when starting new essential therapy, particularly among chronically ill patients with DAW prescriptions, patients were 50% to 60% less likely to actually fill the more expensive brand-name prescriptions than generics.
"Previous to this study, little was know about the frequency with which doctors and patients request dispense-as-written prescriptions," stated Troyen Brennan, EVP and chief medical officer of CVS Caremark and a study author. "Those who advocate for dispense-as-written and argue that the practice provides patients and physicians with greater choice will probably be surprised to learn that the practice increases costs and exacerbates nonadherence."
The study reviewed 5.6 million prescriptions adjudicated by CVS Caremark for 2 million patients from Jan. 1 to 31, 2009. The review found that 2.7% of those prescriptions were designated DAW by doctors, while another 2% were requested DAW by patients.
Good story, particularly bringing out the impact on compliance. DAW occurs more frequently than plan sponsors think and creates an unnecessary impediment to higher generic fill rates, which creates higher costs for the plan sponsor and member.
Zostavax now approved for patients ages 50 years and older
SILVER SPRING, Md. — The Food and Drug Administration has approved a vaccine for shingles in older patients.
The agency said Thursday that it had approved Merck’s Zostavax (zoster vaccine live) vaccine in patients ages 50 to 59 years. The vaccine already is approved for those ages 60 years and older.
Shingles, caused by the varicella-zoster virus, the same virus that causes chickenpox, affects about 200,000 people in the United States ages 50 to 59 years each year.
While chickenpox mostly affects children, the virus lies dormant in certain nerves in the body, sometimes coming back in the form of shingles later in life, usually in older patients and in those with weakened immune systems.
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NCPA, healthcare groups recommend CMS delay ‘short cycle’ rule
ALEXANDRIA, Va. — In a letter to the Centers for Medicare and Medicaid Services, the National Community Pharmacists Association and 20 healthcare groups expressed their concerns over the proposed Medicare Part D long-term care “short cycle” rule.
The groups recommended that CMS postpone its implementation of a rule that would require dispensing certain prescription medications in seven-day supplies or less, rather than the traditional 30-day supply.
“Industry shares CMS’ interest in reducing waste in the provision of pharmaceuticals,” the letter stated. “Pharmacies currently utilize a number of different techniques in an attempt to achieve this goal, including the use of shorter dispensing cycles for a limited number of expensive medications, automated dispensing systems and drug take-back and credit programs. However, the relative costs and effectiveness of these techniques in reducing waste have not been adequately studied or reported in peer-reviewed literature.
“[We recommend that] CMS postpone its implementation for seven-day-or-less dispensing (using authority granted by the implementing statute to allow the effective date to be for plan years beginning on or after Jan. 1, 2012) while conducting a proper analysis of the rule’s true costs by using a comprehensive study or pilot of realistic dispensing options,” the letter concluded.
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