PBM reports reduction in drug costs despite increase in drug inflation
Progressive Medical says there was an additional decrease due to product and claim mix for a combined 6 percent reduction in prescription cost per claim. Combined with a drug inflation rate in the average wholesale price of 5.5 percent, the company reported a net decrease among its clients of 0.5 percent in the total prescription cost per claim for 2012.
The numbers are included in Progressive's annual Drug Trend Report. The decrease was the third consecutive among the company's clients.
The analysis is based on Progressive's in-network pharmacy data for 2011-12 and included more than 200,000 claims and nearly 3 million prescriptions.
Specifically, the company reported a decrease in the number of prescriptions per claim of 2 percent and in days' supply dispensed per prescription of 0.8 percent. There was also a 3.2 percent reduction in its product and claim mix.
The top five medication categories per drug spend included opioids, anticonvulsants, anti-inflammatories, antidepressants, and dermatological agents. Where muscle relaxants were among the top five medication categories per drug spend in 2011, they were replaced by dermatological agents in 2012.
"We view this as a positive trend due to brand versus generic utilization; as well as the result of change in product mix including the use of short-acting muscle relaxants versus the more expensive long-acting alternatives, regardless of generic status," the report says. "The trend also shows that while muscle relaxants can assist in lowering pain symptoms, their long-term use is often contraindicated. Despite the absence of a dramatic decrease, we consider the shift to be a positive trend that is helping achieve better outcomes."
Opioids. The number of opioid prescriptions per claim decreased from 2011 to 2012, as did the days' supply of opioid containing prescriptions. Overall, there was a decrease in the opioid prescription cost per claim of 4.2 percent.
"From an industry perspective there are several reasons opioid analgesics are beginning a downward trend," the report states; "prescribing patterns are changing in response to federal and state guidelines, use of Prescription Drug Monitoring Programs, application of urine drug testing, and the evolution of abuse-deterrent formulations."
Abuse-deterrent formulations attempt to prevent opioid analgesics from being crushed and misused. The report notes that several existing products have been reformulated to combat this issue in the last several years, including OxyContin, oxecta, and opanaEr. Others are "in the pipeline."
Actions by the Food and Drug Administration's advisory panel "will have an impact in future medication spend," the report says. The panel voted against approval of an extended-release version of hydrocodone and recommended moving combination hydrocodone products to schedule II.
"Changing the Drug Enforcement Agency's classification or 'up-scheduling' hydrocodone combination products would require a written prescription for all new prescriptions and would ban refills of these products," according to the report. "In comparison, as a schedule III drug, these products can be phoned in by the prescriber and may have up to six total fills to be used within six months of original issue date. We are actively following this potential reclassification, as the change may decrease utilization."
The FDA is also considering whether to alter the labeling for opioid analgesics to limit use to less than 90 days, limit dose to 100 mg/day morphine equivalents, and to strike from the labels the term "moderate" from "moderate to severe pain," the report noted.
Also on the horizon, the report predicts, will be discussions about medical marijuana and personalized medicine, which the authors suggest will become prominent over the next several years. "With gene sequencing completed, many variations in how a drug acts in the body have been discovered, with significant inter-patient variability," the authors explained. "Determining if a patient has any of these genetic variations may figure how drugs should be dosed for pain."
They also predict ongoing activity regarding nontraditional dispensing, repackaged medications, the use of pharmacy networks, and general workers' comp reform.
Read more at the WorkersComp Forum homepage.
May 6, 2013
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