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From The
University Record, July 9, 2001
Editor's note: Late in 2000, Provost Nancy Cantor and Robert
Kasdin, executive vice president and chief financial officer,
charged the Prescription Drug Work Group 2002 with examining
prescription drug coverage in University health plans. To
better understand the needs of the University community,
the Work Group gathered input from focus groups composed
of faculty, staff and retirees. A summary of what transpired
in those focus groups follows.
By Kate Kellogg
Human Resources and Affirmative Action
Employers
are struggling to maintain top-quality prescription drug
benefits without passing increased costs on to employees.
During 2000, the University spent about $30.7 million for
prescription drugs for approximately 89,000 employees÷a
20 percent increase over 1999 amounts, according to the
Report of the Prescription Drug Work Group 2002.
The
University is considering options for improving the quality
and cost effectiveness of the drug benefit plan. Members
also can take steps to control costs while maximizing their
benefit.
Generics
and OTCs
Use of generic drugs can save money on prescriptions without
sacrificing quality.
Generic
drugs are unbranded versions of brand-name drugs for which
patents have expired; once off patent, competition keeps
their prices down. Generics cost about 40 percent less,
on average, than brand-name drugs.
Generics
have the same active ingredients as their brand-name equivalents
and are regulated by the U.S. Food and Drug Administration
(FDA), but some people have concerns about the safety of
generic drugs.
A
recent FDA review of the bioequivalence of the 273 generic
drugs approved in 1997 found just a 3.5 percent difference,
on average, between generic and branded drugs, according
to the July issue of Consumer Reports.
Physicians
sometime write Dispense as Written (DAW) for a very few
brand-name drugs that have a narrow therapeutic index, says
John E. Billi, associate dean of clinical affairs in the
Medical School and a member of the Work Group. But the vast
majority of generic drugs are perfectly safe for anyone.ä
Consumers
shouldn't assume that physicians and pharmacists always
make generic substitutions.
Most
health plans encourage, if not require, pharmacists to offer
generic substitutions for brand-name prescriptions as long
as the physician has not written DAW. Pharmacists generally
comply, says Duane Kirking, professor of pharmacy and member
of the Work Group.
Prescription
drug plans with three-tiered copay systems provide a great
incentive to the patient to check for generic substitutions,
Kirking says. If generic drugs are on the lowest copay tier,
patients are more likely to request generic equivalents
when available.
Another
alternative to brand-name drugs is nonprescription drugs.
Some over-the-counter (OTC) drugs are just as effective
for certain conditions as prescription drugs and less costly
for both the health plan and the patient.
Nonprescription
antacids can work more quickly for some cases of acid reflux
(heartburn) than prescription drugs,ä Kirking says. If you're
paying a $14 copay for brand-name prescriptions, you save
a lot of money by going with an OTC.
The
power of advertising
Many health professionals believe direct-to-consumer (DTC)
advertising contributes to high drug costs. Critics say
pharmaceutical companies spend excessive amounts on marketing
that encourages consumption of high-priced drugs. The 11
firms in the Fortune 500 drug-industry category spent just
12 percent of revenues on research and development and 30
percent on marketing and administration, according to Consumer
Reports June issue.
On
one hand, I applaud the industry for educating the public
about the potential role pharmaceuticals can play in treating
serious problems like high cholesterol,ä Billi says. But
television advertisements often don't clearly inform patients
of all the potential side effects.
These
ads lead patients to expect their doctors to prescribe the
medication advertised, even if a less expensive alternative
will work just as well for them.
More
cost-saving strategies
Another way patients and physicians can work together to
manage drug costs is through dose optimization. Multiple-dose
prescriptions not only keep costs high, but sometimes interfere
with compliance, Billi said.
Most
people find it easier to remember to take a drug once a
day rather than several times a day, Billi says. People
should check with their doctors and pharmacists to see if
they really need split doses.
With
antibiotics, a number of studies have shown that most respiratory
infections are not caused by bacteria and therefore are
not treatable with standard antibiotics, Billi says.
Yet
doctors frequently feel pressured to prescribe antibiotics
because the patient is under the misconception that antibiotics
will speed the recovery process, Billi says. This is not
just a cost issue; it is a significant public heath hazard.
The more antibiotics people take, the more likely they are
to experience side effects and build up a resistance.
Information
sharing is an essential part of prescription drug management.
The Mayo Clinic recommends that people periodically review
all the medications they are taking with their primary care
physician. The doctor then can determine whether they still
need all the medications and whether lower-cost alternatives
are available. |
