An Expensive Commodity!

Transcription

1 Managing the Cost of Drug Therapies and Fostering Appropriate Drug Use in AARP International Forum on Prescription Drug Policy June 10 th, 2003 Washington, D.C. Bob Nakagawa, B.Sc.(Pharm.), FCSHP Director of Pharmacy Fraser Health Authority, An Expensive Commodity! The price of a barrel (42 gallons) of crude oil - $13.60 compared with a barrel of other common commodities Gasoline Coca-cola Evian Budweiser Wesson Oil Tanning Oil Remy Martin Brandy Visine eye drops Flonase nasal spray Alteplase (Canadian $) Drotrecogin $45 $79 $190 $343 $435 $4,290 $7,845 $32,202 $238,133 $4.6 million $25.4 million Modified from USA Today chart Big Business The larger companies are now competing directly with countries as financial entities on the world stage Pfizer is ranked 17 compared with Australia (11) Sweden (19) and Singapore (39) BMJ 13 APR

2 Fortune 500 Revenue Assets Equity April 15, 2002 Pharmacare Expenses $1,600 $1,400 $1,200 $1,000 millions $800 $600 $400 RDP/Limited Use introduced 1995 LCA introduced 1994 $200 $0 87/88 88/89 89/90 90/91 91/92 92/93 93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01 01/02 02/03 Drug Plan Expenses Determinants drug prices what we pay plan beneficiaries who can access benefits drug benefits which drugs are paid for under what circumstances drug utilization how the drug benefits are used for the plan beneficiaries 2

3 Drug Prices PMPRB for patent medicines generics Average Foreign to Canadian Price Ratios, Patented Drug Products, Ratio Italy Fra nce Sweden Canada Germany Source: PMPRB UK Switzerland US PMPRB Impact 3

4 Plan Beneficiaries seniors low income disease groups universal plans protect from catastrophic drug expenses Drug Benefits based on value/ worth of a drug not all drugs provide equal value generic drug programs special authority drugs reference drug program Drug Withdrawals/Safety Warnings Ticrynafen Zomepirac Benoxaprofen Nomifensine Terfenadine Encainide Astemizole Temafloxacin Cisapride Troglitazone Grepafloxacin Troglitazone Trovafloxacin Tolcapone Thromboembolism Anaphylaxis Jaundice Hemolytic anemia Drug interaction/cardiotoxicity Increased mortality Drug interactions Multiple problems Cardiotoxicity Hepatic failure Cardiovascular events Hepatic failure Hepatic toxicity Hepatic toxicity 4

5 Prescrire Rating Scale New products ratings la revue Prescrire 2,693 drugs or indications, not OTCs or line extensions not acceptable, 73, 3% judgement reserved, 116, 4% Bravo, 7, 0% nothing new, 1780, 66% real advance, 73, 3% offers an advantage, 212, 8% possibly helpful, 432, 16% New Breakthrough Drugs? 5

6 Drug Utilization Escalation Prescribing more expensive drugs more frequently and in larger quantities new therapies therapy advances no improvement Aggressive marketing new products that offer little or no therapeutic improvement new diseases Direct to consumer advertising Value for Money Tools New drug reviews Low cost alternative (LCA) Limited use drugs Reference drug program (RDP) New Drug Reviews independent literature review critical appraisal of methodology independent analysis of data comparison with gold standard rather than placebo price considerations value for money? 6

7 Managing Drug Costs: The Low Cost Alternative (LCA) Program effective April 1994 drugs with same active ingredients coverage limited to the cost of the lowest cost alternative non LCA partially covered up LCA price Fostering Appropriate Drug Use: Limited Use Drugs ensures drugs are used appropriately 2nd, 3rd or 4th line agents not used as 1st line licenced indication does not identify place in therapy e.g. angiotensin II antagonists, PPIs for PUD, ACE inhibitors in hypertension... criteria based funding prior authorization Fostering Appropriate Drug Use: The Reference Drug Program Pharmacare funds gold standard effective safe evidence based Special Authority experienced Adverse Drug Reaction ineffective 7

8 Reference Drug Program reference price funded for all patients funded for patient specific reasons (those who can benefit) $$$ NSAIDs Comparative Costs (x30 days) Ibuprofen EC-ASA Naproxen Piroxicam Sulindac Tiaprofenic acid Diclofenac Rofecoxib Celecoxib Arthrotec EC-Naproxen Ketorolac Nabumetone Etodolac $0 $20 $40 $60 $80 $100 $120 RDP Evaluations Harvard McMaster University of Washington 8

9 Harvard Evaluation Physician Visits Summary drug expenses are determined by price, plan design, formulary management and utilization BC has maintained a publicly funded drug plan by actively managing the cost of drug therapies and by fostering appropriate drug use 9