Transcript Ann L. Woloson and Jennifer Reck, Show Me the Evidence

Show Me the Evidence
Ensuring Access to Safe, Effective and
Affordable Prescription Drugs
Ann L. Woloson,
Executive Director
Jennifer Reck,
Policy Analyst
Prescription Policy Choices
(image from http://www.deskpicture.com/DPs/Nature/Autumn/FallScene_1.html)
2011 International Symposium
on Safe Medicine
October 4, Portland, Maine
Prescription Policy Choices (PPC)
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Nonprofit, nonpartisan 501(c ) (3) educational &
public policy organization providing objective
research, information and expertise on prescription
drug policy to ensure access to safe, effective and
affordable prescription drugs in Maine and the US
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Foundation & Consumer Advocacy Group Funding:
Nathan Cummings Foundation, Endowment for Health, Maine
Health Access Foundation, Bingham Program, Consumers
Union, Community Catalyst-Pew Prescription Project, Sadie
and Harry Davis Foundation, Maine Community Foundations
Evidence-based prescribing: Most
effective, safe and cost-effective drugs
Uses unbiased, objective information (the
science) about the relative effectiveness,
safety and cost-effectiveness of Rx drugs
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Improves health care quality
Helps maintain access to health care services by investing
resources wisely
Reduces prescription drug (and health care) costs
“Preferred” does not always mean “evidenced-based” or best
value
Rising Expenditures for Rx Drugs
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2008 US spending for Rx drugs was nearly 6 times that spent in
1990 ($234.1 billion in 2008, $40.3 billion in 1990)
One of the fastest growing health care cost components, until
early 2000s, growing at double-digit rates
Rx drugs contributed 13% of the total growth in national health
expenditures from 1990 to 2008.
$58 billion estimated by the New England Healthcare Institute
to be wasted on misuse, overuse & underuse of prescription
drugs in 2008
Government share of prescription drug
spending increasing (Kaiser: Rx Drug Trends, 5/10)
PPACA and Medicare affecting Rx
coverage/spending
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ACA:
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Medicaid expansion for uninsured adults
Rx drugs are “essential health benefits” (included in the
exchanges and “benchmark-equivalent” for new eligibles
under Medicaid)
Changes in rebates (Feds to retain increases in rebates to
certain amount)
Medicare:
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50% discount for brand name drugs for beneficiaries in the
doughnut hole/gap starting in 2011
7% discount for generics annual phase in
Coinsurance phase-in over time for both brand and generics
Pharmaceutical Industry Marketing
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Industry marketing in 2009
– $10.9 billion
 $6.6 billion direct to physicians;
 $4.3 billion direct to consumers
(Kaiser Family Foundation)
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In Maine:
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$68 million in 2007
$90.6 million in 2008
Evidenced-based Drugs:
Three Points for Impact
Prescribers
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Academic detailing/prescriber education (counters drug
reps in prescriber’s offices)
Consumers
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Consumer Reports Health Best Buy Drugs™ / Consumer
component to academic detailing (counters direct-toconsumer advertising)
Payers
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Drug Effectiveness Review Project (DERP), AHRQ Effective
Healthcare, Consumer Reports Health Best Buy Drugs™
Providers/Prescribers: Maine Independent
Clinical Information Service (MICIS)
Maine’s academic detailing (prescriber
education) program
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Educational outreach to prescribers at practice site
Balanced data about medications based on evidencedbased, independent, non-commercial sources
Current clinical modules: Adult Type 2 Diabetes, Antiplatelet
Therapy, Hypertension, Atrial Fibrillation, Chronic Pain
Management
Upcoming: Anti-psychotics
Administered by the Maine Medical Association
www.mainemed.com
Maine Independent Clinical Information
Service (MICIS)
Newest module:
Helping the hurt without hurting the patient:
outpatient management of chronic pain
Covers pharmacology of pain management:
Acetaminophen, NSAIDS, opiates and opiate-like agents, anticonvulsants and antidepressants
Comparative safety, efficacy and costs of pain medications
Attenuating the risks of adverse events from pain medications
Guidelines for reducing the risk of opiate addiction and misuse
To request an educational session on this module or others,
contact the Maine Medical Association:
207.622.3374 or [email protected]
Maine Independent Clinical Information
Service (MICIS)
Impact:
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Over 1300 modules detailed to more than 750
unique prescribers in Maine
76% reported that they plan to change their
prescribing habits based on information from a
MICIS educational module
Consumer engagement
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80 drug ads every hour, every day on TV
(Nielsen Co.)
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30% of people have spoken to their doctors about a
drug ad; 44% got the prescription they asked about
(Kaiser Family Foundation)
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PPC is working with Consumer Reports Health Best
Buy Drugs™ to promote evidence-based drugs
Vision: independent scientific evidence (what works
best, is safest, and most often, more affordable - not
branding and marketing - should drive consumers
Consumer Reports Health Best Buy Drugs™
What works best, is safest and most costeffective (tried and true)
www.CRBestBuyDrugs.orgReports
Drugs to treat high cholesterol: The Statins / Drugs to treat hepatitis C
Drugs to treat rheumatoid arthritis/ Migraine Headache Drugs – the Triptans
Drugs to Treat Enlarged Prostate / Osteoarthritis, Pain – the NSAIDs
Drugs to Treat Muscle Spasms and Spasticity: Muscle Relaxants
Drugs to Treat Nausea and Vomiting: The Oral 5-HT3 Antagonists
Drugs for Heartburn, Acid Reflux Disease - the PPIs
Drugs to Treat Schizophrenia and Bipolar Disorder /Antidepressants
Attention Deficit Hyperactivity Disorder Drugs
Angina, High Blood Pressure – Calcium Channel Blockers
High Blood Pressure, Heart Failure – the ACE Inhibitors
Heart Disease and High Blood Pressure – Beta-Blockers
Treating Type 2 Diabetes – the Oral Diabetes Drugs
Constipation Drugs / Menopause – Hormones/ Sleeping Pills for Insomnia
Treating Chronic Pain – the Opioids
Treating Bipolar Disorder, Nerve Pain and Fibromalagia – the Anticonvulsants
Treating Heart Disease, Heart Attack, and Stroke – Antiplatelets
Overactive Bladder / Asthma and Lung Disease – Inhaled Steroids
Alzheimer’s Disease Drugs/ Allergies, Hay Fever, and Hives – Antihistamines
Consumer Magazines
Best Buy Drugs offers a free,
independent consumer magazine
free of advertising
Request copies through PPC by contacting
512-2138 or [email protected]
 Compare to WebMD Magazine
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includes many advertisements
sponsored sections are not reviewed by the WebMD
Editorial Department for accuracy, objectivity or balance
Payers: Lewin Group Study (12/2010)
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Identified $30 billion in state savings over the next
decade beyond rebates
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Savings associated with improved pharmacy benefit
management from Medicaid managed care organizations
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Generic utilization (68% in Medicaid FFS vs. 80% in Medicaid MCO)
Dispensing fees & ingredient costs (higher for FFS than MCO)
Drug Utilization (evidence-based)
Estimated 14.8% reduction → Lewin estimates these
approaches could yield14.8% savings for pharmacy spending
($14 mil for ME)
Payers: Minnesota Study*
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Increasing the utilization of evidenced-based
recommended drugs can yield cost-savings
of more than 50% (for drug categories
studied)
Achieved through formulary/ PDL changes
that incentivize value-based utilization of
prescription drugs
*Kjos, AL, et al. A comparison of drug formularies and the potential for cost-savings.
American Health & Drug Benefits, vol 3, No. 5 (September/October 2010): 321-330.
Payers: Avandia Example
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ME: Avandia was listed as preferred in 2009
Avandia sales peaked at about $3 billion in 2006 - world’s bestselling diabetes Type II med. Sales dropped sharply after a 2007
NE Journal of Medicine report linking it to increased heart attach
and cardiovascular death risks
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Metformin, a generic drug, is recommended drug
alternative (supported by DERP/CRHBBD™)
Estimated potential savings for replacing Avandia
with metformin in 2009: $150,000 (does not include
potential savings related to improved quality)
Evidence-based Resources for
Medicaid
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DERP
Collaboration of public entities (the Center for Evidence-based
Policy and the Oregon Evidence-based Practice Center) that
produces systematic, evidence-based reviews of the comparative
effectiveness and safety of drugs in many widely used drug classes
in order to inform public policy and related activities in local settings
Medicaid Evidenced-based Decisions Project
Provides participating states with high quality evidence and analysis to
support benefit design and coverage decisions made by state
programs (Alabama, Alaska, Arkansas, Minnesota, Missouri, New
York, Oklahoma, Oregon, Washington Wisconsin, West Virginia)
Payers
Are States working to make sure public health
programs are incentivizing the use of the
best, most effective and safest drugs?
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Are states using evidence-based information?
How are States integrating evidenced-based
information into Rx drug coverage decision-making
processes?
Payers
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Generic medications will continue to offer
greater value than brand-name medications for
most patients
Encouraging cost-effective medication use,
regardless of levels of subsidies applied, will
reduce … overall out-of-pocket costs as well as
federal outlays for prescription medications,
allowing health care resources to be used more
efficiently.” (Shrank, W. & Choudhry, N. NEJM p 1011625, Jan. 19, 2011)
Resources
Consumer Reports Health Best Buy Drugs™
www.CRBestBuyDrugs.org
Drug Effectiveness Review Project (DERP)
http://www.ohsu.edu/xd/research/centersinstitutes/evidence-based-policycenter/derp/index.cfm
AHRQ Effective Healthcare Program
http://www.effectivehealthcare.ahrq.gov/
For more information
Please visit www.policychoices.org
Contact information:
Ann Woloson
[email protected]
Jennifer Reck
[email protected]
207-512-2138