Mediscor Medicines Review 2011

Transcription

1 Mediscor Medicines Review 2011 Mediscor Client Workshop August 2012 Presented by: Madelein Bester Benefit Management Mediscor PBM

2 Content Background of the report Overall trends Expenditure per benefit type Provider type Originals vs. generics Therapeutic groups

3 Background of the report 10 th annual publication Goal to measure trends in medicine expenditure in the private health care sector Schemes contracted for entire period (1 mil lives) Excluding capitation schemes and non-medical schemes

4 Expenditure trends All medicines: Key indicator % Change year-on-year 2011 vs vs Total expenditure Gross cost per beneficiary Item cost Gross cost per item Utilisation Items per beneficiary 5.0 % 7.6 % 0.3 % 5.8 % 5.3 % 1.7 %

5 The role of item cost Single exit price / ingredient cost Dispensing fee Number of units dispensed Medicine mix

6 SEP of basket of medicines 1.8% 5.6% Max 7.4% 4.6% -1.0%

7 Utilisation trends Existing medicines % Change year-on-year Key indicator 2011 vs vs Prevalence % Utilising beneficiaries 2.7 % 2.2 % Intensity Items per utilising beneficiary 2.8 % 3.6 %

8 New chemical entities New chemical entities are novel or innovator medicines that were launched to the South African healthcare market during the previous five years ( ). + contribution to change in expenditure (0.9%) 3.5% of expenditure & 1.0% of volume Key indicator % Change Cost per beneficiary (R) 29.7 % Cost per item (R) 9.7 % % Prevalence 11.7% Intensity 5.8 %

9 NCEs vs. Existing medicines Key indicator NCEs Existing medicines % Expenditure 3.5 % 96.5 % % Volume 1.0 % 99.0 % Cost per item (R) R 482 R 132 % Prevalence 5.8 % 81.8 % Intensity

10 Expenditure per benefit category 9.5% 3.9% 3.0% 2.7% Acute 9.8% PMB Expenditure Non-CDL chronic Oncology OTC Other Volume PMB 2007: 22.6% 2008: 23.5% 2009: 25.5% 2010: 28.6% 32.3% 9.1% HIV/AIDS 38.8% 8.2% 1.7% 1.4% 0.7% Acute PMB OTC Non-CDL chronic Other PMB 2007: 18.4% 2008: 20.7% 2009: 22.5% 2010: 24.9% 28.9% 50.1% HIV/AIDS Oncology

11 Changes per benefit category Benefit % Expenditure % Volume % Expenditure % Volume Acute PMB (CDL chronic) Non-CDL chronic Oncology OTC HIV/AIDS

12 Acute Non-CDL chronic HIV/AIDS Oncology Other OTC PMB Rand Percentage Benefit category Cost per item Prevalence

13 Changes per benefit category Benefit Item cost (R) % Prevalence Intensity Item cost (R) % Prevalence Intensity Acute PMB (CDL chronic) Non-CDL chronic Oncology OTC HIV/AIDS

14 Percentage Expenditure per provider type % Expenditure % Volume Retail pharmacies Courier pharmacies Dispensing doctors

15 Expenditure per provider type Benefit % Expenditure % Volume Item cost (R) % Prevalence Intensity Retail pharmacy Courier pharmacy General practitioners Specialists

16 Percentage Expenditure per provider type Acute OTC PMB Non-CDL chronic HIV/AIDS Oncology Other 10 0 Retail pharm acies Courier pharm acies General practitioners Medical specialists

17 Rand Originals vs. generics Average Rand per item 250 R R R Original with patent valid Original with patent expired Generic equivalents R 2.50 R 1.50 R 1.00

18 Generic utilisation 52.4% 2010: 50.0 % 28.4% Original with valid patent 19.2% Original with patent expired Generic equivalents

19 Top 10 therapeutic groups 2011 Rank 2011 Therapeutic group % of total expenditure % of total item volume Average cost per ben (R) Average cost per UB (R) Average cost per item (R) UB as % of total ben Average # items per UB 1 Anti-hypertensives Cytostatics Anti-diabetic agents Anti-depressants Hypolipidaemic agents Gastric acid reducers Anti-viral agents Bronchodilators Beta-lactam antibiotics Non-steroidal antiinflammatory drugs

20 Top 10 products 2011 Rank 2011 Rank 2010 Brand name Therapeutic group % Total expenditure % Total item volume Avg. cost per UB (R) Avg. cost per item (R) % UB Avg. # items per UB Lantus SoloSTAR 100IU/ml Nexiam 40mg Tab Prexum Plus Tab* Gleevec 400mg Tab Herceptin IV Soln Insulin Proton pump inhibitor ACE inhibitor and diuretic combination Cytostatic 0.8 < < Cytostatic 0.8 < < Celebrex 200mg Cap Selective COX2 inhibitor NovoMix 30 Flexpen 3ml Crestor 10mg Tab MabThera 500mg Vial Prexum 4mg Tab* Insulin Statin Cytostatic 0.6 < < ACE inhibitor * Generic equivalent

21 Anti-diabetic agents 3rd class in 2011, 4 th in 2010, 6 th in 2009 Two insulins on top 10 products - Lantus SoloSTAR TM (#1) - NovoMix 30 Flexpen (#7) Therapeutic group Rank % Total expenditure % Total item volume Avg. cost per UB (R) Avg. cost per item (R) UB as % of total ben Avg. # items per UB Insulins Oral anti-diabetic agents Other anti-diabetic agents Incretin-based therapies: Exenatide (GLP1 analogue) Vildagliptin (DPP-4 inhibitor)

22 Cytostatics 2 nd in 2010, 2 nd in 2009, 3 rd in 2008 & 5 th in % of expenditure (up from 6.2% in 2009) 0.3% of volume (same as 2009) Three agents in top 10 products and Five agents in top 50 products

23 Top 10 Cytostatics Product Gleevec TM 400mg Tab Herceptin TM IV Soln MabThera TM 500mg Vial Taxotere TM 80mg Inj Velcade TM 3.5mg Inj Oxaliwin TM RTU Vial 100mg/20ml Vidaza TM 100mg/4ml Inj Avastin TM 400mg/16ml Inf MabThera TM 100mg Vial Active ingredient Imatinib mesylate Overall rank 2011 % Total expenditure % Total item volume Avg. cost per UB (R) Avg. cost per item (R) UB as % of total ben Avg. # items per UB < Trastuzumab < Rituximab < Docetaxel < Bortezomib < Oxaliplatin < Azacitidine < Bevacizumab < Rituximab < Xeloda TM 500 Tab Capecitabine <

24 Gastric acid reducers Nexiam TM 40mg moved down to 2 nd place after 2 years at #1 Four agents in top 50 products (all are Proton Pump Inhibitors) Therapeutic group % Total expenditure % Total item volume Proton pump inhibitors (PPIs) Antacids and combinations Cytoprotective agents H2 receptor antagonists

25 Gastric acid reducers Therapeutic group Year Avg. cost per UB (R) Avg. cost per item (R) UB as % of total ben Avg. # items per UB Proton pump inhibitors Antacids and combinations Cytoprotective agents H2 receptor antagonists

26 Hypolipidaemics Moved down from #2 in 2006 to #3 in 2009 and #5 in 2010 and 2011 Despite increase in prevalence in group! - Prevalence : 8.5% in 2006 to 10.9% in Item cost : R169 in 2006 to R122 in 2011 Lipitor 10mg #1 in 2006 down to #166 in 2011 Introduction of generics Therapeutic group % Total expenditure % Total item volume Avg. cost per UB (R) Avg. cost per item (R) UB as % of total ben Avg. # items per UB HMG-CoA reductase inhibitors (statins) Fibrates Other

27 34.1% of expenditure Hypolipidaemics Statins - % volume Active ingredient % of expenditure Atorvastatin Simvastatin Rosuvastatin Other Six 41.2% statin of expenditure active ingredients First generic launched: - Atorvastatin (Lipitor TM ) 2007 Currently 6 generic equivalent available Avg item cost: R158 (2010) to R127 (2011) - Simvastatin (Zocor TM ) 2002 Currently 17 generic equivalent available Avg item cost: R48 (2010) to R44 (2011) Rosuvastatin no generic available Avg item cost: R239 (2010) to R236 (2011)

28 Highlights from the report Increase in use of high cost specialty medicines Cost of cytostatics continues to increase Generic utilisation is still increasing more savings can still be achieved CDL cost becoming bigger portion of the pie

29 Thank you For more information please contact Madelein Bester