mark e. greg, pharmd pharmacy programs to increase generic
TRANSCRIPT
Mark E. Greg, PharmD
Pharmacy Programs to Increase Generic Prescribing
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Introduction – Why Generics?
• 75% of prescriptions in U.S. are filled with a generic (Q1 2010)• Well-established Clinical Profiles
– Long-term Safety Data– Clinical Outcomes
• Undergo the Same Rigorous FDA Approval Standards as Brand Name Drugs
• Brand Costs Increasing 8-9% 2009-2010 • Generics Cost 30% to 80% Less than Brand Name Drugs• Every 1% Increase in Generic Prescribing Reduces Overall Drug
Spend by 1%*• In 2009, Increased Use of Generic Medications Yielded Savings of
$14.8 Million for the Payers, Employers and Patients Served by Advocate Physician Partners**
*Source: Express Scripts, Inc. Generic drugs first for millions. May 24, 2006. Available at: http://phx.corporate-ir.net/ phoenix.zhtml?c=69641&p=irolnewsArticle&ID=860127&highlight =. Accessed June 20, 2010.
**Source: The 2010 Value Report – Advocate Physician Partners
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Benefits of Generic Medications
• Lower Prescription Drug Cost for Payer• Lower Patient Copays and Overall Costs• Fewer “Nuisance” Phone Calls and Faxes to
Prescribers/Physician Offices • Pharmacies Make Money Filling Prescriptions• A “Win-Win” Situation for All
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Major Branded Medications Losing Patent Protection 2009-2012
2009 2010 2011 2012Depakote* Arimidex* Actos Lexapro
Imitrex* Cozaar* Femara Lovenox
Lamictal* Effexor XR* Levaquin Lunesta
Prevacid** Flomax* Lipitor Plavix
Topamax* Hyzaar* Xalatan Seroquel
Valtrex* Lovenox(?)* Zyprexa Singulair
* Available generically ** Available generically or as an OTCSource: Medco. Accessed at http://www.medcohealth.com/art/corporate/anticipatedfirsttime_generics.pdf. Accessed on March 4, 2010.
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• Physician Membership– 900 Primary Care
Physicians– 2,500 Specialist Physicians– Total membership includes
800 Advocate-employed Physicians
• 9 Hospitals and 2 Children’s Hospitals
• Central verification office certified by NCQA
• 230,000 capitated lives/700,000 PPO lives
Advocate Physician Partners
Advocate Physician Partners delivers services throughout Chicagoland.
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Generic Drug Utilization - APP
• Generic Drug Usage Initiatives are Key Components of APP Clinical Integration (CI) Program
• CI Measures Promote Use of Clinically-Appropriate, Cost-effective Medications
• Four Measures Related to Use of Generic Medications
– Overall Generic Drug Prescribing – Generic Nasal Steroids– Generic Proton Pump Inhibitor (PPI) Prescribing– Generic Statin Prescribing
• May Be up to 20% of Total Possible CI Score• Target (%) Goals are Specialty-specific
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0%10%20%30%40%50%60%70%80%
2004 2005 2006 2007 2008 2009
47%52% 56% 60%
66%71%
APP Generic Dispensing Rates
Generic Drug Utilization - APP
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Generic Drug Utilization - APP
2009 Generic Usage Rate
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APP Generic Utilization - 2009
Outcomes• Increased Overall Use of Generic Drugs to 71%• Increased Generic Statin Utilization to Over 60%• Increased Generic PPI Utilization to Over 60%
From 2004 to 2009• Generic Dispensing Rate Increased by 24 Percentage
Points
For 2009• Increased Use of Generic Medications Yielded Savings
of $14.8 Million for the Payers, Employers and Patients Served by Advocate Physician Partners*
*Source: The 2010 Value Report – Advocate Physician Partners
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Strategies to Encourage Generic Prescribing
Academic Detailing• Jerry Avorn, MD – Harvard University
– First Coined the Term “Counter-Detailer”– Change Prescribing Behavior and Save $
• APP Academic Detailing Initiative Supported by Clinical Pharmacists
• Academic Detailing Programs Have Been Shown to Improve Prescribing Decisions and Reduce Inappropriate Use of Pharmaceuticals
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Strategies to Encourage Generic Prescribing
Commonly Utilized Techniques With Academic Detailing Include:1. Establish Credibility by Referencing Authoritative and
Unbiased Sources of Information and Presenting Both Sides of Controversial Issues
2. Stimulate Active Physician Participation3. Highlight and Repeat Essential Messages4. Define Clear Educational and Behavioral Objectives5. Provide Prescribers with Necessary Tools 6. Provide Positive Reinforcement of Improved Practices in
Follow-up Communication/Visits
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Strategies to Encourage Generic Prescribing by Prescribers
• Use Various Forms of Communication– Email– Mail– Quarterly Mailings Including Patient-Specific, Actionable
Information – Website– Phone Conversations– Large PHO Meetings– Scheduled Breakfast, Lunch, or Dinner Meetings with Practice– Scheduled Face to Face Conversations
• Communicate, Communicate, Communicate!
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Benefit Plan Design Options
• Make Generic Copay More Attractive than Brand Copay– Increase the Spread Between Copay Tiers– Consider $0 Copay for Generics
• Fund Employee Flexible Spending Accounts – Promote use of OTC and Generic Medications
• Allergy (e.g., Claritin OTC, Zyrtec OTC)• PPIs (Prevacid 24HR, Prilosec OTC, Zegerid OTC)
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Benefit Plan Design Options
• Encourage Participants to Use Rx Benefit Card for $4-15 Prescriptions at Kmart, Sam’s Club, Target, Walmart, etc. – Most Prescribers Aware of Various $4 Generic Programs– Encourage Plan Participants to Present Prescription Benefit
Card– Copayment Should Be $4-15 or Lower– Encourage Plan Participants to Use Flexible Spending
Account Dollars – Access to Claims Data is the Key!
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Generic Voucher Pilot Program July 2007- March 2008
• Positioned as Tool to Help Physicians Increase Generic Prescribing – “an Alternative to Brand Samples”
• 2007 Pilot Program Initiated with Major Pharmacy Chain Provided Vouchers for 30-day Supply of Generic Medication at No Cost to Patient
• Top Generics by Volume Covered – Including: atenolol, hydrochlorothiazide, lisinopril, metformin, simvastatin
• “High Prescribing/Low Generic Rate” Practice Groups Selected (95 MDs in Intervention/95 MDs in Control)
• Results Demonstrated 1.77% Percentage Point Increase in Overall Generic Prescribing Compared with Control Group (p<0.047) JMCP. 2010;16(6):384-92.
• Some Practices Increased Overall GDR by 20%!
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APP Generic Medication Voucher Program
• Introduced Q4 2008• Positioned as Tool to Help Physicians Increase Generic Prescribing
– “an Alternative to Brand Samples” • $10 off Coupon Toward Copay or Cash Pay for up to 30-day Supply
of Select Generic and OTC Medications• Data Included in CI GDR Score Calculation• Open to All PHO Physicians • Specialty-Specific Vouchers:
– Cardiology– Contraceptives– IM/FP– OB/GYN– Ophthalmology – Pediatrics
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APP Generic Medication Voucher Program
• Over 4,500 Vouchers Processed to Date• Over 75 Prescribers Actively Using Vouchers -
Approximately 125 prescribers Have Used the Program at Least Once
• E-prescribing Offices - Vouchers Used as Coupons• Pediatrics (antibiotics) and OB/GYN (contraceptives) Are
Biggest Users of Program• Average Cost to PHO per Voucher Redeemed – Less than
$5.60• Average Cost to Patient per Voucher Redeemed – Less
than $2.70
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APP Generic Voucher Program Medications
• Cardiology– Over 30 medications including generics for: Altace, Coreg, Lofibra, Pravachol, Prinivil/Zestril,
Toprol XL, and Zocor
• Contraceptives – Over 20 medications including generics for: Estrostep Fe, Mircette, Loestrin Fe 1/20, Ortho Tri-
Cyclen, and Seasonale
• Internal Medicine/Family Medicine– Over 45 medications including generics for: Altace,, Celexa, Ditropan XL, Flonase, Fosamax,
Weekly, Glucophage/XR, Nasarel, Prilosec, Prinivil/Zestril, Protonix , Pravachol, Zocor, and Zoloft
• OB/GYN– Over 35 medications including generics for: Celexa, Cipro, Ditropan XL, Fosamax Weekly,
prenatal vitamin with Omega-3, Terazol-3, Zoloft
• Ophthalmology– Over 18 medications including generics for: Betagan, Ciloxin, Ocufen, Ocuflox, Pred Forte, and
Timoptic
• Pediatrics– Over 30 medications including generics for: Amoxil, Augmentin, Allegra, Bactroban Ointment,
Flonase, Floxin Otic, Nasarel, Omnicef, Zantac Liquid, and Zithromax
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Quarterly Growth in Voucher Use
Voucher Redemption by Quarter
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Participating Prescribers
Q4 2008 – Q2 2010
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Top Voucher Medications Redeemed
Medications Number of Vouchers Redeemed
azithromycin Zithromax 691
amoxicillin Amoxil 645
contraceptives various 474
cefdinir Omnicef 401
amox/clav Augmentin 346
fluticasone Flonase 209
albuterol Ventolin 171
ciprofloxacin Ciloxan 137
fexofenadine Allegra 124
lisinopril Prinivil/Zestril 99
pantoprazole Protonix 97
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Top Medical Specialties
Medical Specialty Number of Prescribers
Pediatrics 44
OB/GYN 22
Family Medicine 19
Internal Medicine 17
Cardiology 4
Ophthalmology 4
Other* 8
*Includes: Gastroenterology, Otolaryngology, Pediatric Allergy & Immunology, Pediatric Urology, Podiatry, Reproductive Endocrinology, Surgery, and Urology
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Sample Voucher Image
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Generic Voucher Program – Next Steps
• Continue Program for 2011• Continue to Grow Base of Program Participants • Add/Delete Medications Based Upon Marketplace
Dynamics, Physician Request, and Utilization Data• Introduce Electronic Prescribing Version of the
Program – Q3 2010– Generic Voucher Program Medications– Brand Manufacturer Coupons – Select Brand Name
Medications
• Publish Data
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What Your PBM Should Be Doing for You!
• Set Expectations for Generic Utilization Targets with PBM• Request “Dashboard” Indicating Generic Prescribing %’s in Key Cost
Categories– Antidepressants: SSRIs/SNRIs – Angiotensin Receptor Blockers (ARBs)– Nasal Steroids – Proton Pump Inhibitors– Statins
• Request that your PBM Perform “Counter-Detailing” with Plan Participants and Prescribers to Drive Generic Utilization – Not Brand Utilization
• Request Specifics on What PBM Is Doing to Increase Generic Prescribing
• Don’t Pay Extra for These Services!
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Summary of Key Points
• Significant Savings Opportunities Continue with Generics and OTCs for the Next Several Years
• Need Multi-pronged Approach to Encourage Use of Generic Medications
• Frequent, Timely, Actionable, Specialty-specific Information Essential
• Counter-detailing Is a Key Component of Changing Physician Prescribing Behavior
• Consider Implementing a Generic Medication Voucher Program!
