UF Decision Report FY06-07 Beneficiary Advisory Panel 10 Jan 2008 Promoting high quality, cost effective drug therapy throughout the Military Health System
UF Decisions, May 07 Class FY05 rank, total $ Implementation (decision date implementation date) On UF Uniform Formulary NF BCF / ECF Antilipidemics II 24 Jul 07 21 Nov 07 (120 days) Multiple meds (fenofibrate except Antara, Tricor) gemfibrozil cholestyramine colestipol Micronized and nanocrystallized fenofibrate (Antara, Tricor) colesevelam (Welchol) prescription omega-3 fatty acids (Lovaza, formerly Omacor) BCF gemfibrozil IDD-P fenofibrate (Triglide) May 07 5-ARIs ARBs 24 Jul 07 24 Oct 07 (90 days) 24 Jul 07 21 Nov 07 (120 days) PPIs 24 Jul 07 24 Oct 07 (90 days) finasteride dutasteride (Avodart) BCF finasteride candesartan (Atacand) losartan (Cozaar) telmisartan (Micardis) (& HCTZ combos) omeprazole esomeprazole (Nexium) Irbesartan (Avapro) eprosartan (Teveten) olmesartan (Benicar) valsartan (Diovan) (& HCTZ combos) lansoprazole (Prevacid) omeprazole/sodium bicarb (Zegerid) pantoprazole (Protonix) rabeprazole (Aciphex) Auto PA omeprazole or esomeprazole prior to non-formulary PPIs BCF telmisartan (Micardis & Micardis HCT) BCF generic omeprazole esomeprazole 2
Class Implementation (decision date implementation date) On UF UF Decisions, Feb 07 Uniform Formulary NF BCF / ECF Feb 07 Nov 06 Aug 06 Ophthalmic Glaucoma Agents Newer Sedative Hypnotics (SED-1s) ADHD / Narcolepsy Agents 2 May 07 1 Aug 07 (90 days) 2 May 07 1 Aug 07 (90 days) multiple meds eszopiclone (Lunesta) zolpidem IR travoprost (Travatan, Travatan Z); timolol hemihydrate (Betimol); timolol maleate (Istalol); brinzolamide (Azopt) ramelteon (Rozerem) zaleplon (Sonata) zolpidem ER (Ambien CR) Zolpidem IR prior to Ambien CR, Lunesta, Rozerem, Sonata 17 Jan 07 18 Apr 07 (90 days) LIP1s 23 Oct 06 1 Feb 07 (90 days) atomoxetine, methylphenidate IR & ER, mixed amphetamine salts, IR & ER (Adderall XR), dextroamphetamine, methamphetamine modafinil, Na oxybate atorvastatin (Lipitor); ezetimibe/simvastatin (Vytorin); ezetimibe (Zetia); fluvastatin IR & ER (Lescol, Lescol XL); lovastatin IR & ER (Altoprev); niacin ER (Niaspan); niacin IR; niacin ER/lovastatin (Advicor) pravastatin; simvastatin dexmethylphenidate IR and ER (Focalin, Focalin XR) methylphenidate patch (Daytrana) rosuvastatin (Crestor) atorvastatin/ amlodipine (Caduet) latanoprost (Xalatan); timolol maleate soln 0.25% and 0.5% soln & gel-forming soln; brimonidine 0.2% & 0.15%; pilocarpine zolpidem IR (Ambien) methylphenidate IR & ER (specifically Concerta) amphetamine salts, ER (Adderall XR) simvastatin; pravastatin; niacin ER (Niaspan); ezetimibe/ simvastatin (Vytorin)
Definitions 30 day equivalent (30d equiv) Automated prior authorization (Auto PA) UF VARR 18 month look back Arbitrary for 6 months prior to statin decision 4
300,000 250,000 200,000 150,000 100,000 50,000 0 LIP 1 ADHD NF/3 rd Tier 30d equiv All POS ARB PPI LIP 2 NSH OGA 5ARI 5 6/30/06 7/31/06 8/31/06 9/30/06 10/31/06 11/30/06 12/31/06 1/31/07 2/28/07 3/31/07 4/30/07 5/31/07 6/30/07 7/31/07 8/31/07 9/30/07 10/31/07 11/30/07 Signing date Implementation date
140,000 120,000 100,000 80,000 60,000 40,000 LIP 1 20,000 0 NF/3 rd Tier 30 day Rxs Retail PPI ARB LIP 2 NSH 5ARI OGA ADHD 6 12/31/05 1/31/06 2/28/06 3/31/06 4/30/06 5/31/06 6/30/06 7/31/06 8/31/06 9/30/06 10/31/06 11/30/06 12/31/06 1/31/07 2/28/07 3/31/07 4/30/07 5/31/07 6/30/07 7/31/07 8/31/07 9/30/07 10/31/07 11/30/07 Signing date Implementation date
90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 LIP 1 0 NF/3 rd Tier 30 day Rxs MTFs ARB PPI LIP 2 NSH 5 ARI ADHD OGA 7 12/31/05 1/31/06 2/28/06 3/31/06 4/30/06 5/31/06 6/30/06 7/31/06 8/31/06 9/30/06 10/31/06 11/30/06 12/31/06 1/31/07 2/28/07 3/31/07 4/30/07 5/31/07 6/30/07 7/31/07 8/31/07 9/30/07 10/31/07 11/30/07 Signing date Implementation date
80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 LIP 1 ADHD NF/3 rd Tier 30 day Rxs Mail Order ARBs PPI LIP 2 NSH 5ARI OGA 8 6/30/06 7/31/06 8/31/06 9/30/06 10/31/06 11/30/06 12/31/06 1/31/07 2/28/07 3/31/07 4/30/07 5/31/07 6/30/07 7/31/07 8/31/07 9/30/07 10/31/07 11/30/07 0 Signing date Implementation date
400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 NF/3 rd Tier 30d Rxs By Point of Service Retail Mail Order MTF 9 6/30/06 7/31/06 8/31/06 9/30/06 10/31/06 11/30/06 12/31/06 1/31/07 2/28/07 3/31/07 4/30/07 5/31/07 6/30/07 7/31/07 8/31/07 9/30/07 10/31/07 11/30/07
35% 30% 25% 20% 15% 10% 5% 0% Retail % NF/3 rd Tier By POS 30d Rxs Mail Order Overall -26% MTF 10
$3.50 $3.00 $2.50 $2.00 $1.50 $1.00 $0.50 $- Cost Per Day by POS Retail Overall -14% Mail Order MTF 11
What affects utilization and cost Formulary decisions Drugs going generic Implementation of Auto PA Reality: Combination of all of the above Example classes Statins Newer Sedative Hypnotics PPIs ADHD 12
700,000 600,000 Statin Utilization All POS 30 day Equivalents ZOCOR & Generics 500,000 400,000 300,000 LIPITOR 200,000 VYTORIN ZETIA 100,000 CRESTOR - 13
160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 - Statin Utilization Retail 30 day Equivalents LIPITOR ZOCOR & Generics VYTORIN ZETIA CRESTOR 14
Statin Utilization MTF 30 day Equivalents 450,000 400,000 ZOCOR & Generics 350,000 300,000 250,000 200,000 150,000 100,000 LIPITOR VYTORIN ZETIA 50,000-15
120,000 Statin Utilization Mail Order 30 day Equivalents 100,000 ZOCOR & Generics 80,000 60,000 LIPITOR 40,000 VYTORIN 20,000 CRESTOR ZETIA - 16
$4.00 Statins Ave Cost/Day All POS $3.50 CADUET $3.00 $2.50 24 Oct: signing date 1 Feb Implementation Date LIPITOR $2.00 $1.50 $1.00 CRESTOR VYTORIN ZETIA Class Average -33% $0.50 PRAVACHOL & Generics $- ZOCOR & Generics 17
30d E q uiv in m illions 1.35 1.30 Statin 30d Equiv trend - All POS All drugs 1.25 1.20 1.15 1.10 1.05 1.00 0.95 +12% 18 M ay-06 Ju n -06 Ju l-06 Aug -06 Sep -06 N o v-06 D ec-06 Jan -07 M ay-07 Ju n -07 Ju l-07 Aug -07 Sep -07 N ov-07
100,000 90,000 80,000 Newer Sedative Hypnotic Utilization All POS 30 day Equivalents AMBIEN & Generics May 1: signing date Aug 1: Auto PA initiated 70,000 60,000 50,000 40,000 30,000 AMBIEN CR 20,000 10,000 ROZEREM LUNESTA SONATA - 19
Newer Sedative Hypnotic Utilization Retail 30 day Equivalents 60,000 May 1: signing date Aug 1: Auto PA initiated 50,000 AMBIEN & Generics 40,000 30,000 20,000 AMBIEN CR LUNESTA 10,000 - ROZEREM SONATA 20
Newer Sedative Hypnotic Utilization MTF 30 day Equivalents 40,000 35,000 May 1: signing date Aug 1: Auto PA initiated 30,000 AMBIEN & Generics 25,000 20,000 15,000 10,000 5,000 - SONATA AMBIEN CR ROZEREM LUNESTA 21
10,000 9,000 8,000 7,000 Newer Sedative Hypnotic Utilization Mail Order 30 day Equivalents AMBIEN & Generics May 1: signing date Aug 1: Auto PA initiated 6,000 5,000 4,000 3,000 AMBIEN CR LUNESTA 2,000 1,000 ROZEREM SONATA - 22
Newer Sedative Hypnotic Ave. Cost/Day All POS $3.50 $3.00 LUNESTA May 1: signing date Aug 1: Auto PA initiated AMBIEN CR $2.50 SONATA $2.00 ROZEREM $1.50 $1.00 AMBIEN & Generics Class Average -47% $0.50 $- 23
New Sedative Hypnotic 30d Equiv trend - All POS All drugs 170,000 160,000 150,000 140,000 130,000 +22% 120,000 110,000 100,000 24 M ay-06 Ju l -06 O ct-06 N o v-06 D ec-06 Jan -07 Mar -07 Ap r -07 M ay-07 Ju l -07 O ct-07 N o v-07
300,000 250,000 200,000 150,000 100,000 50,000 PPI Utilization All POS 30 day Equivalents Jul 24: Signing Date ACIPHEX OMEPRAZOLE PREVACID PROTONIX 24 Oct : Auto PA initiated NEXIUM - ZEGERID 25
100,000 90,000 PPI Utilization Retail 30 day Equivalents Jul 24: Signing Date 24 Oct : Auto PA initiated 80,000 70,000 60,000 50,000 40,000 30,000 PROTONIX PREVACID NEXIUM OMEPRAZOLE ACIPHEX 20,000 10,000 - ZEGERID 26
200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 PPI Utilization MTF 30 day Equivalents PREVACID ZEGERID ACIPHEX Jul 24: Signing Date PROTONIX 24 Oct : Auto PA initiated OMEP NEXIUM - 27
60,000 PPI Utilization Mail Order 30 day Equivalents 50,000 Jul 24: Signing Date 24 Oct : Auto PA initiated NEXIUM 40,000 30,000 20,000 10,000 PREVACID ACIPHEX PROTONIX OMEP - ZEGERID 28
PPI Ave Cost/Day All POS $4.00 $3.50 Jul 24: Signing Date 24 Oct : Auto PA initiated $3.00 ZEGERID $2.50 $2.00 $1.50 PREVACID Class Average ACIPHEX PROTONIX NEXIUM $1.00 $0.50 OMEPRAZOLE $- 29
800,000 780,000 760,000 740,000 720,000 700,000 680,000 660,000 640,000 620,000 600,000 PPI 30d Equiv trend - All POS All drugs +11% 30 M ay-06 Ju l-06 Sep -06 O ct-06 D ec-06 Jan -07 M ay-07 Ju l-07 Sep -07 O ct-07
ADHD Utilization All POS 30 day Equivalents 40,000 35,000 30,000 CONCERTA 25,000 20,000 15,000 10,000 5,000 ADDERALL XR Jan 7: Signing Date STRATTERA Apr 17 : Implementation date - 31
ADHD Ave Cost/Day All POS $3.50 $3.00 STRATTERA FOCALIN XR Jan 7: Signing Date Apr 17 : Implementation date $2.50 ADDERALL XR $2.00 CONCERTA $1.50 Class Average +8% $1.00 $0.50 $- METHYLPHENIDATE ER METHYLPHENIDATE IR ADDERALL & Generics 32
110,000 ADHD 30d Equiv trend - All POS All drugs 100,000 90,000 +10% 80,000 70,000 33
Caveats Limited number of classes 18 month time frame Conservative estimates VARR savings not included Conservative estimates 34
Significant savings with aggressive formulary management Growth in utilization of each class Conclusions Formulary management techniques don t appear to be inhibiting use of benefit Step therapy is guiding utilization to most desired drug product Medical requirements and class makeup may prevent significant savings 35
Questions? 36