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Study: Physicians do not consistently follow ADA-recommended prescribing guidelines for newly diagnosed diabetics

BY Antoinette Alexander

WOONSOCKET, R.I. — Physicians in 35% of cases involving more than 250,000 newly diagnosed diabetes patients did not follow the American Diabetes Association/European Association for the Study of Diabetes consensus guidelines for recommended treatment, according to a new CVS Caremark study.

In addition to the quality of care implications, because those guidelines recommend use of generic medications rather than more expensive branded medications, patients, payers and the healthcare system could be paying an additional $420 million annually for the newly initiated treatment, the researchers stated.

The study was conducted by researchers from CVS Caremark, Harvard University and Brigham and Women’s Hospital, and was published this week in the American Journal of Medicine. The review looked at pharmacy claims of 254,000 patients who were newly started on a diabetes medication between Jan. 1, 2006, and Dec. 31, 2008. The research found more than one-third of initial treatment regimens for diabetes did not include the ADA’s recommended first-line drug, which is a generic.

"While 65% of the patients we studied received care consistent with the ADA consensus statements, our results highlight remaining gaps between practice recommendations and contemporary pharmacotherapy for diabetes mellitus (Type 2)," researchers wrote in the study.

"We felt it was important to look at how the guidelines were being followed to review the quality of care for patients with diabetes who were newly initiating drug therapy. However, because the guidelines recommend generics as a way to provide cost-effective quality care, the economics of this review were impossible to ignore. That makes this study the first, to our knowledge, to define the fiscal implications of therapeutic choices in a large population of patients with diabetes," stated Niteesh K. Choudhry, associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, associate professor at Harvard Medical School and senior author of the study.

Choudhry added, "With approximately 2 million new cases of diabetes each year, if the medication patterns and insurance coverage for our cohort is representative of the U.S. population, an excess expenditure of $1,120 per patient per year would translate to more than $420 million in additional direct medication costs for diabetes therapy outside the established consensus guideline recommendations. Because the prevalence of diabetes is increasing quite dramatically, the potential savings from improved adherence to these recommendations could far exceed these estimates."

"We found significant variability in clinical practice for treating patients with diabetes," added Troyen A. Brenan, CVS Caremark EVP and chief medical officer, and head of the research initiative with Harvard and Brigham and Women’s. "As we look for ways to rein in the cost of health care, we need to look at how physicians apply practices such as the ADA-recommended consensus guidelines because they align clinical effectiveness with cost-effective prescribing."

Type-2 diabetes has emerged as one of the most significant health issues worldwide. In the United States, more than 20 million people have diabetes, and the number of Americans with the disease is expected to increase by 165% by 2050. In the United States, treatment of the disease is estimated to cost $200 billion annually.

The researchers reviewed how doctors are treating newly diagnosed patients through a review of CVS Caremark’s claims data to learn more about the clinical practices for those patients who are prescribed oral medications as part of their treatment. Because there is a substantial price difference between generic and branded medications, the researchers said a look at the economics of treatment was in order. The pharmacy claims they reviewed showed those being treated with generics spent an average of $116.10 over six months, compared with $677.20 for the more expensive therapies. That is a difference of $560 per patient for six months, or $1,120 per patient per year.

CVS Caremark has been working with Harvard and Brigham and Women’s to assist in the research of ways to improve pharmacy care. The collaboration, which has been in place for the past three years, has resulted in more than 20 published peer-reviewed articles about patient medication-taking behavior and issues of adherence.


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Coming out of 2011, Safeway looking toward higher comps, stronger pharmacy biz

BY Michael Johnsen

PLEASANTON, Calif. — Pharmacy and identical-store sales were identified as positives for Safeway, which discussed its fourth-quarter results with analysts on Thursday.

However, a 4.4% drop in gross profit margin, from 28.3% to 27%, drove Safeway shares down significantly this morning — as of early afternoon shares were down by almost $2 to around $21 per share, or just under a 10% decline. Early reports noted that the juxtaposition between rising fuel costs and inflationary food costs, coupled with a cost-conscious, value-driven consumer, placed Safeway’s ability to maintain profit margins between a rock and a hard place.

"When you have a 25% increase in [the cost of] fuel, and you have something close to a 5% increase in food … fuel is a touch more than 8% of a consumer’s budget and then you have food which is a little more than 13%," Safeway chairman, president and CEO Steve Burd said late Thursday morning during an analyst call. "That bucket of goods purchased goes up an average of 12.5%," he said. "Based on the market share data that we have, [this dynamic is impacting] virtually all food retailers."

So far into Safeway’s first quarter fiscal 2012, Safeway market share is on the rise despite the "same kind of softness in sales," Burd said. Part of that increase can be traced, however, to an influx of pharmacy patients out of the Walgreens/Express Scripts situation. "We didn’t see it in the first couple of weeks … but we’ve seen it ever since. It’s significant," Burd said. But Safeway also is organically growing its pharmacy business, Burd added. "It’s tough to generate positive [identical-store sales] in the script business … but we’re able to do that. Part of that benefit is the strong vaccination business we have; part of that is an increased focus on specialty. So we expect pharmacy business for us to be quite good this year."

On Thursday morning, Credit Suisse analyst Ed Kelly was still bullish on Safeway, noting that Safeway’s prevalence in the California market will be a strong positive to the grocer’s bottom line in the coming year. "West Coast supermarket sales — as reported by Nielsen — have outpaced national industry sales by 150 basis points in the last two months," Kelly wrote in a Thursday morning note. "While industry sales nationally have been weak, it appears California (35% of Safeway stores, but likely over 50% of earnings) has been better. It’s too early to call a recovery in the region, but any sustained improvement would be a large positive for the stock."

Overall sales were up 6.3% to $43.6 billion for the fiscal 2011 year ended Dec. 31. Identical-store sales were up 4.4% for the year; however, excluding fuel sales, same-store sales were up 1%. Safeway has been seeing significant gains in fuel sales in the past two years, Burd said. While volume across branded gasoline stations is down 3%, Burd said, Safeway’s fuel volume is up 15%. "That’s the second year in a row that we’ve been running volume increases to that magnitude," he said. "People have been responding to our fuel program."

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NACDS launches site to promote 14th Annual NACDS Foundation Dinner

BY Antoinette Alexander

ALEXANDRIA, Va. — In an effort to promote the 14th Annual National Association of Chain Drug Stores Foundation Dinner, the association announced on Thursday the launch of a new website that promotes the event as “one night for health’s dawn.”

The 14th Annual NACDS Foundation Dinner will be held Nov. 27 in New York City. In 2011, the event raised $1.77 million for scholarships, research and charitable activities from 114 benefactors.


“The NACDS Foundation is advancing exhilarating projects to make a positive impact on public health. NACDS Foundation Dinner donors deserve to know that their engagement is a catalyst for forward-thinking initiatives that seek nothing less than to transform patient care and to help people live their lives more fully,” stated NACDS Foundation president Kathleen Jaeger.



“Just this January, the NACDS Foundation announced a bold new $750,000 grant opportunity to study the health impact of pharmacist-provided medication management in medical homes or accountable care organizations. This is the kind of timely, relevant and meaningful research that is made available uniquely by the NACDS Foundation Dinner,” Jaeger added.



This research initiative builds on a complementary 2011 NACDS Foundation research project testing interventions aimed at reducing patient primary nonadherence medication rates. The research is under way with partners from Harvard University and the University of Mississippi.

In addition, the NACDS Foundation will be rolling out a new Faculty Scholars Program. This program will provide five selected pharmacy school professors with, among other resources, research grants to support community-based healthcare research.

The 14th Annual NACDS Foundation Dinner website can be accessed by clicking here, or through a link on NACDSFoundation.org.

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