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Drug Costs Keep on Rising
By DAN REYNOLDS, senior editor of Risk & Insurance® PMSI, the Tampa-based pharmacy benefits manager, has released its annual survey results on drug use by its clients and found that costs are going up, not down.
One of the chief culprits in this uncomfortable bump was 2007 litigation that saw the privately-held Purdue Pharma, the maker of Oxycontin, defend its turf against manufacturers of generic versions of the drug. Oxycontin was already the most frequently used brand name in workers' compensation pharmacy utilization, with 6.8 percent of the total spend of PMSI clients in 2008. The results of the litigation produced an average increase in 2008 in the cost of Oxycontin of six percent. Even more dramatic was the negative impact on the frequency of use of Oxycontin generics. In the first quarter of 2007, according to PMSI data, more than 60 percent of the total Oxycontin prescriptions were dispensed as generics. That number stayed well above 50 percent throughout the remainder of the year. But come the New Year and the impact of the Purdue Pharma litigation, the use of generics plummeted. Generic Oxycontin use sunk below 50 percent in the first quarter of 2008, dove to below the 30 percent range by the second quarter and bottomed out in the 10 percent range by the third quarter of 2008 before bouncing into the 20 percent range by the end of the year. Long-acting Oxycontin prescriptions, which were already expensive, got steadily more and more expensive. According to PMSI data, the price of the average Oxycontin prescription rose from around $400 in the first quarter of 2007 to closer to $500 by the end of 2008. The PMSI study uncovered yet another unpleasant nugget if you have the appetite for any more. For the first time in the history of the PMSI study, an antidepressant cracked the top 10 as ranked by total drug costs. Injured workers who needed either their nerves numbed for pain suppression or their depression treated were turning to the more expensive antidepressant Cymbalta in greater and greater numbers. Use of Cymbalta increased by 13.9 percent in 2008, which led PMSI to label it as the dominant antidepressant in the workers' compensation field. Such chemical standbys as Zoloft, down 13.4 percent, Effexor, down 10.4 percent and Lexapro, down 4.8 percent, all saw usage declines. The authors of the PMSI study do hold out hope that PBM's can "influence" cost by such tools as broadening the use of mail order pharmacies, increasing generic substitutions and driving greater network penetration. The tough part to digest for anyone who hears that is the naked fact that according to PMSI's own numbers, both utilization and cost are increasing at greater rates than they were previously. June 1, 2009 Copyright 2009© LRP Publications |
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