Mediscor Medicines Review 2011 Mediscor Client Workshop 2012 28 August 2012 Presented by: Madelein Bester Benefit Management Mediscor PBM
Content Background of the report Overall trends Expenditure per benefit type Provider type Originals vs. generics Therapeutic groups
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
Expenditure trends All medicines: 2009-2011 Key indicator % Change year-on-year 2011 vs. 2010 2010 vs. 2009 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 %
The role of item cost Single exit price / ingredient cost Dispensing fee Number of units dispensed Medicine mix
SEP of basket of medicines 1.8% 5.6% Max 7.4% 4.6% -1.0%
Utilisation trends Existing medicines % Change year-on-year Key indicator 2011 vs. 2010 2010 vs. 2009 Prevalence % Utilising beneficiaries 2.7 % 2.2 % Intensity Items per utilising beneficiary 2.8 % 3.6 %
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 (2007-2011). + 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 %
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 3.0 20.9
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
Changes per benefit category 2011 2010 Benefit % Expenditure % Volume % Expenditure % Volume Acute 38.8 50.1 43.1 54.4 PMB (CDL chronic) 32.3 28.6 28.6 24.9 Non-CDL chronic 9.8 8.2 10.9 8.8 Oncology 9.5 0.7 8.9 0.6 OTC 3.9 9.1 3.6 8.6 HIV/AIDS 2.7 1.2 2.4 1.3
Acute Non-CDL chronic HIV/AIDS Oncology Other OTC PMB Rand Percentage Benefit category Cost per item Prevalence 80 2 000 1 855 70 60 1 500 50 40 1 000 30 500 105 162 261 246 58 152 20 10 0 0
Changes per benefit category 2011 2010 Benefit Item cost (R) % Prevalence Intensity Item cost (R) % Prevalence Intensity Acute 105 73.5 11.8 107 78.1 12.9 PMB (CDL chronic) Non-CDL chronic 152 21.9 22.8 154 21.2 21.7 162 10.5 13.5 168 11.9 13.6 Oncology 1 855 0.7 16.2 1 940 0.7 16.5 OTC 58 29.8 5.3 57 31.0 5.1 HIV/AIDS 261 1.2 20.9 247 1.1 21.3
Percentage Expenditure per provider type % Expenditure % Volume 90 80 76.4 81.3 70 60 50 40 30 20 10 20.1 9.2 9.5 3.5 0 Retail pharmacies Courier pharmacies Dispensing doctors
Expenditure per provider type Benefit % Expenditure % Volume Item cost (R) % Prevalence Intensity Retail pharmacy 76.4 81.3 128 76.2 18.4 Courier pharmacy 20.1 9.2 299 5.4 29.4 General practitioners 3.2 9.4 47 20.0 8.1 Specialists 0.3 0.1 368 0.5 2.9
Percentage Expenditure per provider type 100 90 80 70 60 Acute OTC PMB 50 40 30 20 Non-CDL chronic HIV/AIDS Oncology Other 10 0 Retail pharm acies Courier pharm acies General practitioners Medical specialists
Rand Originals vs. generics Average Rand per item 250 R 222 200 R 135 150 100 R 89 50 0 Original with patent valid Original with patent expired Generic equivalents R 2.50 R 1.50 R 1.00
Generic utilisation 52.4% 2010: 50.0 % 28.4% Original with valid patent 19.2% Original with patent expired Generic equivalents
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 11.6 12.2 272 1 506 129 18.0 11.7 2 Cytostatics 6.7 0.3 156 24 888 3 051 0.6 8.2 3 Anti-diabetic agents 5.3 3.6 125 2 303 198 5.4 11.6 4 Anti-depressants 4.5 3.6 106 929 171 11.4 5.4 5 Hypolipidaemic agents 4.5 5.0 105 969 122 10.9 7.9 6 Gastric acid reducers 4.2 3.1 98 551 184 17.8 3.0 7 Anti-viral agents 3.2 1.5 76 1 705 286 4.4 6.0 8 Bronchodilators 2.8 2.1 67 613 187 10.9 3.3 9 10 Beta-lactam antibiotics Non-steroidal antiinflammatory drugs 2.8 3.7 66 177 103 37.0 1.7 2.6 3.6 61 230 98 26.7 2.4
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 1 6 2 1 3 2 4 3 5 9 Lantus SoloSTAR 100IU/ml Nexiam 40mg Tab Prexum Plus Tab* Gleevec 400mg Tab Herceptin IV Soln Insulin 0.9 0.2 4 204 673 0.5 6.2 Proton pump inhibitor ACE inhibitor and diuretic combination 0.9 0.3 875 414 2.4 2.1 0.8 0.7 1 166 171 1.7 6.8 Cytostatic 0.8 <0.1 266 862 29 350 <0.1 9.1 Cytostatic 0.8 <0.1 182 348 30 660 <0.1 5.9 6 4 Celebrex 200mg Cap Selective COX2 inhibitor 0.8 0.5 485 235 4.0 2.1 7 5 8 7 9 12 10 11 NovoMix 30 Flexpen 3ml Crestor 10mg Tab MabThera 500mg Vial Prexum 4mg Tab* Insulin 0.8 0.2 5 139 708 0.4 7.3 Statin 0.8 0.5 1 549 227 1.2 6.8 Cytostatic 0.6 <0.1 64 281 17 726 <0.1 3.6 ACE inhibitor 0.6 0.6 828 136 1.6 6.1 * Generic equivalent
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 1 72.2 22.2 6 207 645 1.4 9.6 Oral anti-diabetic agents 2 27.0 77.3 688 69 4.9 9.9 Other anti-diabetic agents 3 0.8 0.5 1 129 324 0.1 3.5 Incretin-based therapies: Exenatide (GLP1 analogue) - 2010 Vildagliptin (DPP-4 inhibitor) - 2011
Cytostatics 2 nd in 2010, 2 nd in 2009, 3 rd in 2008 & 5 th in 2007 6.7% 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
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 4 12.5 1.3 266 862 29 350 <0.1 9.1 Trastuzumab 5 12.5 1.2 182 348 30 660 <0.1 5.9 Rituximab 9 9.2 1.6 64 281 17 726 <0.1 3.6 Docetaxel 29 4.7 1.1 51 614 13 110 <0.1 3.9 Bortezomib 41 4.1 0.3 178 977 37 433 <0.1 4.8 Oxaliplatin 51 3.8 1.3 41 589 8 591 <0.1 4.8 Azacitidine 67 3.3 0.3 163 781 38 537 <0.1 4.3 Bevacizumab 73 3.2 0.5 110 243 20 606 <0.1 5.4 Rituximab 80 3.1 1.3 27 609 7 027 <0.1 3.9 Xeloda TM 500 Tab Capecitabine 81 3.1 2.4 16 573 3 992 <0.1 4.2
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) 85.5 70.5 Antacids and combinations 8.4 19.6 Cytoprotective agents 4.6 3.7 H2 receptor antagonists 1.4 6.2
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 2011 682 223 12.3 3.1 2010 705 226 13.1 3.1 2011 121 79 6.8 1.5 2010 137 83 7.7 1.7 2011 319 227 1.4 1.4 2010 333 232 1.7 1.4 2011 69 43 2.0 1.6 2010 67 42 2.4 1.6
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 2011 - 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) 90.1 95.6 895 115 10.6 7.8 Fibrates 5.7 3.0 1 688 232 0.4 7.3 Other 4.2 1.3 1 500 381 0.3 3.9
34.1% of expenditure Hypolipidaemics Statins - % volume Active ingredient 2011 2010 2009 2008 2007 17.3% of expenditure Atorvastatin 31.0 31.7 33.5 34.6 34.8 Simvastatin 44.9 45.2 45.6 47.1 49.6 Rosuvastatin 20.1 18.9 16.1 12.4 8.5 Other 3.9 4.1 4.8 5.9 7.1 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)
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
Thank you For more information please contact Madelein Bester +27 12 674-8006