Coinciding with the Atlantic Health Care Forum I attended a couple of weeks ago was the release of the 2010 Annual Drug Trend Report (a market and behavioral analysis) from Express Scripts, a pharmacy benefits management company and mail-order pharmacy which handles both traditional and specialty drugs.
The primary gist of the presentation and release of the Report was a focus on making it easier for patients to change their prescription-filling behavior to improve compliance and adherence, and to lower costs to the healthcare system over all. According to research which Express Scripts commissioned, patients are aware of effective methods to lower drug costs but that they do not actively pursue those methods when it comes to their personal prescription-filling behaviors.
An example would be that consumers/patients know that generic medications are cheaper than brand medications. But patients do not ask their doctor to prescribe generic medications at the time of their appointment. For me, it is my insurance company who automatically switches my medications to the generic form at the pharmacy unless I insist on the brand. As a result, I am responsible for paying the difference in cost between the brand and the generic which is an effective method of influencing my behavior.
Another scenario arising from Express Scripts’ research involves mail-order pharmacies (of which Express Scripts is one). They propose that patients have knowledge that it is less costly to order their medications through mail-order, but that they continue to fill prescriptions at the local retail pharmacy. Express Scripts proposes that the disparity is rooted in a difference between intent and action among patient behavior. I somewhat disagree.
One argument for using mail-order is that you will typically receive a 3-month supply of medication as opposed to a monthly supply at the local pharmacy. A benefit of having a 3-month supply on hand is an increase in adherence. If you do not refill your prescriptions on time and run out, you cannot remain adherent. The hole in Express Scripts’ logic is that many of us are able get that 3-month supply at the local pharmacy without being required to use mail-order. I really appreciated it when my insurance company made that change a couple of years ago.
The importance of continuing to take your medications as prescribed is the message we hear over and over. An increase in adherence and compliance will supposedly decrease overall healthcare costs by preventing illness and further chronic disease. Studies have been published which support this theory. For medications such as those which control blood pressure, diabetes, or cholesterol, it makes sense. For medications used in multiple sclerosis, I have doubts.
Adherence and compliance sound like perfectly good things when it comes to taking care of your heath. So why do those two words make me cringe just ever so much?
Likely because I hear them used frequently by marketing folks who are working with pharmaceutical companies to improve their products’ positioning and market share. Of course the pharma companies want us (the patients) to remain 100% compliant and to adhere to our treatment regimens. That is part of business and you better bet that MS medications are a big business.
[On a side note: Did you know that you can miss 19% of your doses of medication and still be considered “compliant”? I recently learned that taking your medication as prescribed 80% of the time is considered “compliant” for research purposes. Wow. I would have thought that the percentage needed to be higher.]
Within this drug trend report was information specific to specialty medications such as those used for multiple sclerosis and rheumatoid arthritis. In 2010, the amount spent on specialty medications (through the Express Script pharmacy benefit management programs) increased 19.6% as compared to the amount spent in 2009. The top three disease categories which use specialty medications (inflammatory conditions, multiple sclerosis, and cancer) made up 68.3% of the total amount spent on specialty drugs as compared to 66.7% in 2009 and 63.7% in 2008. 22.9% was spent on MS drugs alone.
The total amount spent on MS medications increased 25.4% from 2009-2010. The amount had increased 34.4% from 2008-2009 and 18.3% from 2007-2008. The result is an amount spent in 2010 on MS medications which is double what what spent in 2007. Double in three years. If forecasts are correct, the amount spent on MS drugs will more than double again in three years.
Much of this increase is due to an increase in the price of each medication. The price for Copaxone was increased 19% according to the 2010 Drug Trend Report, while utilization for MS drugs is actually decreasing slightly. It is not expected that the introduction of new medications will cause prices to go lower and we’ve seen this already with the introduction of Gilenya in September 2010. The market response to Gilenya’s $48,000 price tag was an increase in price of other MS medications, not a decrease (see The Rising Price of MS Disease-Modifying Medications)
I just wonder if this racing train will ever slow down.