TRxADE Rx Guru. Blog for Independent Pharmacies, Pharmacist, and Pharmacy Technicians

Is the Concept of Biosimilars Feasible

Is the Concept of Biosimilars Feasible?

Is the Concept of Biosimilars Feasible?

With the introduction of the Biologics Price Competition and Innovation Act that was included in the Patient Protection and Affordable Care Act, drug prices have been changing. This legislation allows companies to produce medications that are similar to brand drugs and use these medications interchangeably. There must be clinical evidence that the biosimilar product produces the same medical result as the brand medication.

In March of 2015, Zarxio, a biosimilar for Neupogen, was the first biosimilar medication approved by the FDA. These medications are granulocyte colony stimulating factors (G-CSF) that treat Neutropenia. A PBM estimates that the introduction of this biosimilar could reduce US Drug costs by $5-7 billion over the next ten years. The release of Zarxio has now been put on hold due to the U.S. Court of Appeals approving an injunction to block the launch of this medication due to a possible patent infringement.

In the short-term drug prices may go down, but as seen with the wave of generics, this could result in drug prices spiking in the long term. The price of biosimilars could increase as the generic drug prices have increased. Is this really an effective way to control drug costs? Short term it is a great solution! It makes sense… Immediate gain for all! Long term, the old saying “learn from your mistakes” (aka generic pricing all over the place) comes to mind. Will this just be another round of smoke and mirrors of steps taken to help lower drug costs?

Will Manufacturers play the same games to control the cost of biosimilars as they have with generics? Only time will tell although combined with new proposed legislations and a big push for industry transparency, we are hopeful that these positive changes will take place!

References:
Burki, T., (2015). First biosimilar drug approved in the USA. Lancet Oncology, 16 (4), 161. Retrieved from: http://proquest.com
Maas, A. (2015). Biosimilars update: appeal date is set; FDA finalizes guidance. Speciality Pharmacy News, 12 (5). Retrieved from: http://aishealth.com | http://www.dpc.senate.gov/healthreformbill/healthbill70.pdf

You Have a Friend in Trxade

Did you know that Trxade is a pharmacist-led team of business and technology professionals working together to help independent pharmacies save money and improve cash flow by taking back control of their profit margins? We understand first-hand the issues independent pharmacies experience and work together with our members and industry partners to do our part to ensure independent pharmacies thrive by saving thousands at no cost.

If there is anything that we can do to help, as a member of the Trxade family we will do our part to go above and beyond to help. Just let us know how we can help. We care about your pains, and most importantly we genuinely care about your success. That is what motivates us! Share with us what Trxade has done for your Pharmacy. We love to make a difference and hear success stories.

How PBM’s Control Formularies and Affect Market Pricing

How PBM’s Control Formularies and Affect Market Pricing

How PBM’s Control Formularies and Affect Market Pricing

Independent Pharmacies at a Disadvantage

As you all know, Formularies are lists of drugs that are preferred by a health plan or employer. ‘Closed’ formularies are lists of drugs that are available for coverage by the organization. Coverage for medications not on the list may be available only if the physician believes that the drug is clearly preferable and obtains a waiver” (Huskamp, Epstein, & Bluementhal, 2003).

Financial incentives can be offered to physicians and patients for prescribing and taking medications, respectively, that are on the formulary (Huskamp, Epstein, & Bluementhal, 2003). Is this ethical? How does this affect independent pharmacies that have no say in what medications are offered? It puts independent pharmacies at a disadvantage and unfairly dictates what medications they sell and the high prices they have to pay to stock those medications.

Negative Reimbursements

We won’t even get started on the topic of negative reimbursements and a PBM’s role in that process. Or lack of… But since we know you are thinking about it we have to at the very least mention it. We have posted blogs about the frustrations of PBMs and negative reimbursements. Keep in mind that is one way Trxade can save you a lot of money. Review the drugs you are getting negative reimbursements on now and comparison shop on Trxade.

If you could buy the drugs you get negative reimbursements on cheaper, you would right? We all would… That is one major way Trxade helps Independent Pharmacies thrive. If you have a minute watch this quick testimonial from Shellman Pharmacy in Georgia addressing this very issue where they are now seeing PROFITS on drugs they were getting negative reimbursements on by using Trxade.

What Do You Think?

How sufficient is this process? Can we trust big PBM’s to do what is best for us, our patients, and our businesses? What do you think is their main driver in including a medication on the formulary… Money, or the health of the patient? I don’t know about you, but I’d be curious to see what incentives they receive.

How Do PBM’s Determine What Medications Are Listed on the Formulary?

Formularies are just one way that Pharmacy Benefit Managers (PBM’s) control and manage drug benefits for insurance companies. After a drug has been approved by the U.S Food and Drug Administration (FDA) PBM’s then follow a multi-step process to determine what medications are listed on the formulary.

One large PBM follows a 3-step process:

  1. The first step is to evaluate the safety, dosage, and effectiveness of a medication, taking into account the negative side effects.
  2. The second step is to review the findings in the first step and compare cost with other clinically comparable drugs.
  3. The last step is to review the findings from the first two steps, decide whether the drug will be listed on the formulary, and if so, determine what tier the drug will be placed in. (http://www.mass.gov/anf/employee-insurance-and-retirement-benefits/manage-your-health/prescription-drugs/drug-formularies-are-determined-through.html).

References:

Huskamp, H., Epstein, A., & Bluementhal, D. (2003). The impact of a national drug formulary on prices, market share, and spending: lessons for Medicare? Health Affairs, 22 (3), 149-158. Retrieved from: http://search.proquest.com.ezp.waldenulibrary.org/nursing/docview/204641530/59440EC7C1EE4A2FPQ/2?accountid=14872

http://www.mass.gov/anf/employee-insurance-and-retirement-benefits/manage-your-health/prescription-drugs/drug-formularies-are-determined-through.html

Primary Medication Compliance

Stay Ahead of the Game of Primary Medication Non-Adherence Measurements

Quality Metric of Measurement for Non-Compliance Rates

Non-compliance is a known issue in the pharmacy world. For example in a study done by Schousboe, Dowd, Davison, & Kane (2010) about non-compliance among patients taking a fracture-prevention medication, only 30%-60% of patients taking this medication were still taking it a year later. This non-compliance can land patients in the hospital with fractures and other injuries. What can we do to prevent these hospitalizations and non-compliance?

The Pharmacy Quality Alliance (PQA) developed a quality metric of measurement for non-compliance rates. This non-compliance is referred to as Primary Medication Non-Adherence (PMN). The Proportion-of-Days Covered (PDC) metric stats are based on claims data that looks at the number of pills a patient has from one fill to the next refill and compares this to the days the patient should actually be on the medication. This has created a rapidly growing force that is creating IT tools to track patient-by-patient non-compliance.

Independent Pharmacies at the Forefront

This metric will be used in our community-based, independent pharmacies first, and is expected to grow to PBM’s. The drawback to this metric is that it can only be calculated after two fills. The patient must fill the RX once, and then come back for a refill. This excludes the “first fill factor”. An example of this is when a patient is prescribed an antibiotic for a bacterial infection, but they do not take the entire amount prescribed. This can result in a relapse for the patient and more treatment.

E-Prescriptions

The PMN metrics are now focusing on certain target medications that treat chronic conditions and they are tracking this information via e-prescriptions. This could result in an increase in incentives of e-prescriptions and other preventive measures that could be taken to avoid non-compliance. There are several proposed interventions and research shows that non-compliance can be reduced by patient education done by pharmacists. “These interventions include an array of medication management services that providers, pharmacies, and payers are increasingly offering to targeted patients.” (Adams, Hubbard, Stolpe, & Cranston, 2015).

Patient education can improve relationships between patients and pharmacy staff, and also reduce hurdles that patient’s face that can cause non-compliance.

References: Primary Medication Non-Adherence Measurements
Adams, A., Hubbard, T., Stolpe, S., & Cranston, L. (2015). The first fill factor: a threat to outcomes, quality, and payment goals. Project HOPE. Retrieved from healthaffairs.org. Schousboe, J., Dowd, B., Davison, M., & Kane, R. (2010). Association of medication attitudes with non-persistence and non-compliance with medication to prevent fractures. Osteoporosis International, 21 (11), 1899-1909. DOI: 10.1007/s00198-009-1141-5.

New Member Video Testimonial

Courtney with Shellman Drug Co Pharmacy | Shellman, GA 39886

Drug Formularies and Insurance PDL's

Patient Experience: Drug Formularies and Insurance PDL’s

Relief Is On The Way… Well… Not Quite… Teamwork Time!

So much emphasis has been put on patient education in the last decade. The World Health Organization has created several initiatives to encourage providers and staff to fully educate their patients, and empower patients to learn more and take part in the decision-making process of their own healthcare.  “Engaging patients intelligently in managing their conditions has been shown to improve clinical outcomes” (Barach, et al., 2013).

This includes educating patients on the process of getting their prescriptions and bridging the gap between patient, pharmacist, and insurance companies. I recently interviewed a patient with multiple disabilities that happens to work for an insurance company. The discussion I had with her reminded me of the emotions involved with the “Patient Pain Relief Experience”. Many of us know our patients needs in retrospect, although it is human nature to get caught up in our own daily tasks and go through the motions of our every day. We are human! It happens…

Stories like this are a great reminder of how we are a community and together, we can solve issues faster than just going through our processes and relying on that the process will not fail (this time). I hope this story helps you in some way as for me, it was a good reminder.

In Her Own Words:

This patient had recently moved to a new state and while going through the process of getting a new doctor she found herself doing research for her Fibromyalgia as the pain had been getting worse and more widespread. During her research she came across a few case studies that recommended Lyrica and she could not wait to talk to her new doctor about it.

“This was my last hope at finding pain relief that didn’t include narcotics.”

The day of her doctor’s appointment finally arrived, and her doctor gave her the great news that she was going to prescribe Lyrica and send the prescription to the pharmacy that day! She was ECSTATIC! And then… Sigh… She arrived at the pharmacy and the Pharmacist apologized that the medication is not on the drug formulary, then explained that they would have to fax information to her doctor, she would have to wait although they would call her with an update as soon as possible.

“Initially I was devastated. I held out as long as I could which was not very long, but I broke down in tears out of frustration. All I wanted was relief. I was so excited that this could be the solution that I so desperately needed and now I had to wait, and even then without really thinking about it my emotional reaction was, will I even be able to get this prescription filled.”

What we didn’t mention, is that luckily she works for an insurance company and knows the Authorization process.

“I had to check my emotions and remind myself that I knew this process well… I composed myself and took it upon myself to immediately call my doctor’s office and request they submit a Prior Authorization to my insurance. I knew if the doctor sent it that day, I could have my medication within 72 hours. Working for an insurance company, I speak with patients every day that struggle to get their medications filled due to Drug Formulary and Authorization constraints. Many of the patients I talk to have no idea that Drug Formularies and Insurance PDL’s exist. I can hear it in their voice, they are defeated! Many of them go to chain pharmacies which unfortunately do not have or make the time to go above and beyond and educate their patients on what they can do to expedite this process so they call us for answers. If the patients just understood the process and contacted their doctor right away, the turnaround time for getting their prescriptions filled would be drastically reduced.”

Educated Patients are Empowered Patients:

Because she was educated on the approval process and she communicated with her pharmacist and her doctor on the spot, she felt empowered in a situation that most feel they have no control. She was able to pick up her prescription the next day when the Authorization was approved. The takeaway from this story is to please take the time to educate your staff on the insurance processes, and encourage them to take the time to educate your patients. Patients can help expedite the process. It can really make a difference in your patients’ lives and help reduce the anxiety of the unknown. Many times they put partial blame on the Pharmacy due to not fully understanding the process. Do not let them walk away thinking you had a hand to do with them not getting immediate relief.

When a patient feels (even somewhat) in control of their own destiny, they don’t feel helpless in the process. Even when the outcome is not a desired one, they feel they had a hand in the process and they understand it better versus leaving open to their own perception which can vary from patient to patient. This alone leads to a happier and healthier patient. What is important is that they feel that you care about their immediate relief to the extent that you will “almost” give them a little bit of “insider information” to get faster results. They will remember you, speak about you to others, and you earn the trust of your community one patient at a time. This reminds me of one of my favorite quotes…

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ― Maya Angelou

References:

Barach, P., Bettinger, J., Charpak, Y., Delnoji, D., Hafner, V., Kutaj-Wasikowska, H., et al.. (2013). Exploring Patient Participation in Reducing Health-Care-Related Safety Risks. Copenhagen, Denmark: World Health Organization, Europe.