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A study by Express Scripts, a mail-order prescription drug provider, said Tuesday that an “estimated $163 billion in health care spending could be saved each year if patients took their medicines as prescribed, chose generic drugs and other low-cost alternatives, and had their prescriptions delivered by mail,” the St. Louis Post-Dispatch reports.

Express Scripts released its report at a two-day conference for clients in St. Louis. “According to the report, Illinois – along with New York, California, and Texas – was among the states with the highest percentage of wasteful health care spending per capita. … For the first time, Express Scripts’ annual study, called the ‘Drug Trend Report,’ focused on behavioral factors that influence the wasteful spending of health care dollars, rather than focusing on market forces” (Doyle, 4/21).

“Doctors are increasingly prescribing medications electronically, abandoning the traditional paper scripts that can result in drug errors due to hard-to-read writing or coverage denials by a patient’s insurer.” E-prescribing tripled last year to 191 million according to the online prescribing leader Surescripts. One-quarter of physician practices now have the ability to e-prescribe. The number is also sure to grow now that the Drug Enforcement Administration has said it will allow doctors to prescribe narcotics, antidepressants and other controlled medicines electronically in the near future, a reversal compared with past policy.

“Doctors transmit e-prescriptions via a secured Internet network directly to pharmacies from their computers or hand-held devices. Nearly all chain drug stores and 62% of independent pharmacies now accept e-prescriptions that are uploaded directly to their computers. For medical practices, the cost of e-prescribing software and hardware, such as laptops, as well as training can range from about $1,000 to $1,750 per physician, according to software makers” (Martin, 4/20).

April 15, 2010 (Toronto) – Statin drugs (cholesterol-lowering medications) show promise for the treatment of multiple sclerosis (MS), a small, preliminary study suggests.

Statin drugs are best known for their cholesterol-lowering effects. But the drugs “have anti-inflammatory effects on immune cells as well, which is why we figured they could be beneficial in MS,” says study leader Scott Zamvil, MD, PhD, associate professor of neurology at the University of California, San Francisco.

MS is an autoimmune disease in which the body’s own immune cells mistakenly recognize cells in the brain and spinal cord as foreign and attack them. This leaves behind scars or lesions and disrupts the ability of nerves to transmit information, resulting in disability.

In the new study of people with early forms of multiple sclerosis, the statin drug Lipitor cut the risk of developing new brain lesions by about 50% compared with placebo. New lesions are reliable indicators of future MS attacks, according to the researchers.

The study was presented at the annual meeting of the American Academy of Neurology.

Lipitor Cuts Risk of Developing New MS Lesions

The researchers had intended to study more than 150 people who had their first MS attack, but enrollment was stopped due to slow recruitment after 81 patients entered the trial.

The study failed to meet its primary goal, which was to show that Lipitor could prevent a second attack or the development of three or more new brain lesions as viewed on MRI scans within a year.

That was “because we didn’t have sufficient patients to show such an effect,” Zamvil tells WebMD. “But on an important imaging measure, we were able to show a significant benefit,” he says.

Specifically, the study showed that over a 12-month period, 55% of people given Lipitor had no new brain lesions compared with 28% of the placebo group.

Statins and MS: Where Do We Go From Here?

So should the research proceed to a larger study? Zamvil says that it would be difficult to embark on another study pitting statins against placebo, as several oral medications that attack MS at its roots have been shown to be effective since this study was undertaken.

But, says Nicholas G. LaRocca, PhD, it might be worthwhile to mount a study using statins in combination with the new MS drugs, known as cladribine and fingolimod. LaRocca, vice president for health care delivery and policy research at the National Multiple Sclerosis Society in New York City, was not involved with the study.

“We don’t want to miss out on something beneficial just because the primary [goal] was not met,” Zamvil says.

Statins have the benefit of being “very, very safe,” he says. And once Lipitor’s patent expires in 2011, it will also be inexpensive, he says.

Based on the current findings, no one should consider taking statins — alone or in combo with other drugs — as a treatment for MS, LaRocca and Zamvil stress.

Asked if all statin drugs have the same anti-inflammatory effects, Zamvil says that studies in the lab suggest that Lipitor and Crestor outperform other statins on this measure.

This study was sponsored by the National Institute of Allergy and Infectious Diseases with support from Biogen-Idec, the Nancy Davis Foundation, and Pfizer Pharmaceuticals, the maker of Lipitor.

A new study presented at the Academy of Managed Care Pharmacy’s 22nd Annual Meeting finds that one in six cancer patients with high out-of-pocket (OOP) costs abandons their medication. The study by Prime Therapeutics (Prime), a thought leader in pharmacy benefit management, found patients with an OOP cost greater than $200 were at least three times more likely to not fill their prescription than those with OOP costs of $100 or less. The study suggests higher OOP costs for these oncology medications may negatively impact patient health as well as long-term health care costs.

While only 4.9 percent of members with an OOP expense of $100 or less abandoned their medication, that number climbed to 6.5 percent for patients with an OOP expense between $101-$200, 16.1 percent for patients with an OOP expense of $201-$500 and 28.8 percent for patients with an OOP expense greater than $500 (p<0.001). In the study, one in five patients had an OOP expense greater than $100.

“Cancer patients are faced with difficult financial choices, and this study suggests that high out-of-pocket costs may discourage many patients from filling their prescriptions,” said Pat Gleason, PharmD, FCCP, BCPS, Director of Clinical Outcomes Assessment with Prime. “As these medications work to cure active cancer, it is important to ensure these patients take their medications as prescribed to receive the health benefits and potentially avoid future costly hospitalizations and medical procedures.”

Oral oncology medications are considered specialty drugs, which are high-cost therapies that often require complex care. While specialty drugs account for a small percentage of overall pharmacy spending today, costs are rising rapidly. In 2009, based on Prime Therapeutics’ book of business, the average paid for a one-month supply of a brand oral oncology medication was $2,942, a 17.6 percent increase over 2008. Because of the rapid increase in costs, insurers have looked for opportunities to best manage spending, including increased OOP costs.

“The results of this study suggest that increasing out-of-pocket costs for these oncology patients may actually have an adverse impact on patient health and therefore long-term costs,” said David Lassen, PharmD, Chief Clinical Officer, VP Clinical Services. “Through benefit design that takes into consideration the potential impact of out-of-pocket costs, plan sponsors may have a significant impact on patient care and on the total cost of health care down the road.”

For the study, Prime researchers reviewed claims from more than seven million members from eight commercial Blue Cross and Blue Shield Plans in the Midwest and South to identify members with a new claim for an oral oncology medication from July 2006 through June 2008. Patients with new claims were then classified as either initiating (defined as a paid oral oncology medication claim) or abandoning therapy (defined as an oral oncology medication claim which was subsequently reversed with no evidence of a paid oncology medication claim in the following 90 days).

The study looked at patients taking oral oncology medications including Gleevec®, Iressa®,  Nexavar®, Sprycel®, Sutent®, Tarceva®, Tasigna® and Tykerb®. Members were then placed into one of the four following OOP expense categories: $0-$100, $101-$200, $201-$500, or >$500 to determine the proportion of patients abandoning therapy in each.

Gleason PP, et al. Oral Oncology Prescription Abandonment Association with High Out-of-Pocket Member Expense. J Manag Care Pharm 2010;16:161-162.

Prime Therapeutics is a pharmacy benefit management company dedicated to providing innovative, clinically-based, cost-effective pharmacy solutions for clients and members. Providing pharmacy benefit services nationwide to approximately 14.7 million covered lives, its client base includes Blue Cross and Blue Shield Plans, employer and union groups, and third-party administrators. Headquartered in St. Paul, Minnesota, Prime Therapeutics is collectively owned by 12 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those Plans.

Source: Prime Therapeutics LLC

More and more Americans are landing in the hospital due to poisoning by powerful prescription painkillers, sedatives and tranquillizers, according to a report released today. City-living middle-aged women seem particularly vulnerable.

“People have seen the headlines related to Heath Ledger, Michael Jackson, Anna Nicole Smith and they think that’s tragic but maybe contained to Hollywood,” Dr. Jeffrey H. Coben of West Virginia University School of Medicine in Morgantown told Reuters Health.

“But the fact of the matter is we are seeing, across the country, very significant increases in serious overdoses associated with these prescription drugs,” Coben warned.

Between 1999 and 2006, US hospital admissions due to poisoning by prescription opioids, sedatives and tranquillizers rose from approximately 43,000 to about 71,000.

That increase of 65 percent is about double the increase observed in hospitalizations for poisoning by other drugs and medicines, Coben and colleagues found.

Opioids — examples include morphine, methadone, OxyContin and the active ingredient in Percocet — are powerful narcotic painkillers that can be habit-forming. Some examples of sedatives or tranquillizers include Valium, Xanax, and Ativan.

What’s behind the rise in poisoning by prescription painkillers, sedatives and tranquillizers? “There is not any single cause,” Coben said. “There is increasing availability of powerful prescription drugs in the community and attitudes toward their use tend to be different than attitudes toward using other drugs, especially among young people, who report that prescription drugs are easy to obtain, and they think they are less addictive and less dangerous than street drugs like heroin and cocaine.”

Accidental – or unintentional — poisoning by opioids, sedatives and tranquillizers rose by 37 percent during the 7-year study period, while unintentional poisonings by other substances increased by just 21 percent.

“Unintentional poisoning is now the second leading cause of unintentional injury death in the US,” Coben and colleagues note in their report. Among people 35 to 54 years old, unintentional poisoning surpassed motor vehicle crashes as the leading cause of unintentional injury death in 2005.

Even people who take opioid painkillers for legitimate medical reasons are at risk of overdosing. In a study reported by Reuters Health earlier this year, researchers followed nearly 10,000 adults who had received at least three opioid prescriptions within 90 days to treat chronic pain like back pain. Of these, 51 experienced at least one overdose, and six died as a result. The researchers also found that the higher the painkiller dose, the more likely the patients were to overdose.

In the current study, Coben’s team found that intentional poisonings – suicide, self-inflicted poisoning, or poisoning someone else — from prescription opioids, sedatives, and tranquillizers more than doubled, from about 10,000 in 1999 to nearly 24,000 in 2006. That compared to just a 53 percent increase in intentional poisonings from other substances.

The biggest percent increase in hospitalizations for poisoning for a specific drug was a quintupling for methadone, according to the team’s report published in the American Journal of Preventive Medicine. This may be due to the more than 10-fold increase in overall retail sales of this drug from 1997 to 2006, they state.

Poisoning by benzodiazepines such as Xanax and Ativan — drugs that possess sedative, hypnotic, anti-anxiety, anticonvulsant and muscle relaxant activities — rose 39 percent over the study period.

Poisoning by barbiturates, which also have sedative, hypnotic and anti-anxiety actions, actually fell 41 percent, as did hospitalizations for poisoning by antidepressants (a decrease of 13 percent).

Hospitalizations from prescription drug poisonings most often involved women 35 to 54 years old living in urban settings and most of the cases were unintentional, “although the intent of a large number of cases was undetermined,” Coben and colleagues note in their report.

Their findings stem from a comprehensive look at the US Nationwide Inpatient Sample, a database that contains records for roughly 8 million Americans hospitalized annually.

“A multifaceted approach is needed” to stem the tide in poisoning by opioids, sedatives and tranquillizers, Coben said. “Doctors need to perhaps rethink the types and quantities of medications they are prescribing,” he told Reuters Health. “And we need to get better messages out to the public in terms of the dangers associated with these medications and combinations of these medications that are being used.”

“We also need to think about law enforcement strategies with regard to illegal markets for distributing prescription drugs,” Coben said.

SOURCE: American Journal of Preventive Medicine, April 2010.

© Copyright (c) Reuters

The number of deaths and hospitalizations caused by prescription drugs has risen precipitously in the past decade, with overdoses of pain medications, in particular opioids, sedatives and tranquilizers, more than doubling between 1999 and 2006, according to a new study.

In fact, by 2006, overdoses of opioid analgesics alone (a class of pain relievers that includes morphine and methadone) were already causing more deaths than overdoses of cocaine and heroin combined.

“Teens and others have different attitudes in using these drugs,” often presuming the prescription substances are safer and less addictive than illegal drugs such as cocaine or heroin, says Jeffrey Coben, a professor of emergency and community medicine at the West Virginia University School of Medicine in Morgantown and lead author of the new study. “I think that’s a false assumption. Aside from the fact they can be taken orally rather than injected…[many prescription drugs] really are every bit as powerful, addictive and dangerous as heroin,” he notes, adding that, “when you combine them with other sedatives, that mix can become particularly lethal.”

Using data collected by the Nationwide Inpatient Sample, which gathers hospital patient information for about 8 million people every year, Coben and his colleagues were able to assess what drugs were implicated in the majority of poisonings—and in many cases whether the poisonings were intentional or not. The team selected opioids, sedatives and tranquilizers as the focus of the analysis because these substances are “contributing the majority of prescription drug overdose deaths,” Coben says. These categories of prescription drugs can kill and injure people by suppressing breathing, depriving the body of oxygen.

For prescription opioids, sedatives and tranquilizers—commonly prescribed for pain management—the number of hospitalizations for poisonings increased 65 percent between 1999 and 2006 (the first and last years, respectively, for which data were comparable and collected). The number of hospitalizations for all poisonings, including illegal drugs, other prescription medications and miscellaneous substances, increased during this time period as well, but that jump (33 percent) was about half the rate of those for the prescription pain drugs.

Unintentional poisonings from these drugs climbed 37 percent during the seven-year period, the researchers found. Intentional overdoses, in which people meant to inflict self-harm or death, jumped 130 percent (a far cry more than the 53 percent increase of intentional poisoning from other substances in the same time period). Intent was not listed in all cases and can be subject to reporting error. The results are detailed online April 6 in the American Journal of Preventive Medicine.

No accident
Poisonings, from prescription drugs and other substances, are classified in medical records as injurious or accidental deaths. But regardless of whether the incidents are listed as unintentional or intentional, they are rarely true mistakes, noted Leonard Paulozzi, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention, in congressional testimony in 2007. “Most unintentional drug poisoning deaths are not ‘accidents’ caused by toddlers or the elderly taking too much medication,” he noted. “These deaths are largely due to the misuse and abuse of prescription drugs.”

Accidents overall were the fifth most common cause of death in the U.S. as of 2005 (accounting for 117,809 deaths—4.8 percent—that year), according to the National Vital Statistics Report [pdf]. Of injury deaths, poisoning is the second most common cause of death in the U.S., having doubled between 1985 and 2004, according to a 2007 Department of Health and Human Services analysis [pdf]. Among people 35 to 54 years old, poisoning is the most common accidental death—even more so than auto-related deaths.

Many experts think that the sheer prevalence of many of these drugs recently has contributed to the drastic increase in poisonings. Although growing illegal markets and distribution of these drugs might be a driving factor in their increasingly large role in poisonings and deaths, perfectly legal prescriptions are probably playing a role as well, Coben says.

“I think the whole issue of the availability of these drugs and whether they’re being over-prescribed” should be investigated, says Susan Baker, a professor at Johns Hopkins Center for Injury Research and Policy, who was not involved in the new study but coauthored a 2009 report in the same journal about recent trends in injury mortality.

Many people do rely on pharmacological treatment for withdrawal, anxiety or chronic pain, but when communities have access to an overabundance of these medications, abuse appears to become more likely. If doctors prescribe too much medication or too many refills, excess drugs “are going to be sitting in people’s medicine cabinets for someone else to take advantage of,” Baker explains. For example, methadone poisonings were four times as frequent in 2006 as they were in 1999, a time period during which retail sales grew more than 1,000 percent, Coben and his team found.

Antidote unknown
Although the new report details the stark increase in the reported poisoning data, the true number of deaths and hospitalizations in which prescription drugs have played a role might be even higher, the researchers pointed out. The new analysis assessed cases only in which prescription drug overdose was listed as the primary diagnosis. Some prescription drug–related hospitalizations might be classified under other primary categories, and those who abuse the drugs were not always labeled as having been poisoned. Additionally, the researchers explained, many common terms such as overdose, misuse and abuse are not well standardized in hospitals.

“I don’t have any sense that it’s getting any better,” Coben says. With drug companies reporting strong overall sales (including a 5.1 percent increase in U.S. sales in 2009 to $300.3 billion for 3.9 billion individual retail prescriptions), in fact, the problem might be getting worse.

The researchers noted that the details surrounding these hundreds of thousands of overdoses are unknown. The medical data used for the analysis did not include full toxicology reports that would reveal drug-drug interactions. And although the researchers found that the majority of the people hospitalized for poisoning with these prescription drugs were women, they did not have enough other demographic data to propose possible reasons for the overdose increases.

“What we really need is something other than the coded data,” Baker says. She notes that researchers need to know more about the circumstances in which people are overdosing before effective prevention measures can be put into place.

“There’s a need to have informational interviews with people who have had overdoses and survived them,” Coben says. He hopes that future research will “raise some opportunities for interventions with these people.”

Prescription drug spending in the United States rose 5.1 percent in 2009, acording to a new report from IMS Health., a data collection company.

The Wall Street Journal: Though the rise is higher than the previous two years, “the data pointed to concerns for branded drug makers. The number of prescriptions dispensed for generic drugs rose 5.9% last year, but those for branded drugs declined 7.6%. Of all prescriptions dispensed, 75% were for generics last year, up from 57% five years earlier. … Making matters difficult for brand-name drug makers, several of their top-selling medicines, including Pfizer Inc.’s popular Lipitor, are scheduled to lose patent protection over the next few years” (Rockoff, 4/2).

The Associated Press/Forbes: “IMS Health attributed the turnaround to increased filling of prescriptions, which grew at a 2.1% pace compared to 1% in 2008.” The increase comes despite the recession. “In response to the economic downturn, drugmakers have been offering co-pay coupons and other programs to help patients pay for their prescriptions. Those programs combined with offers on low-cost generic drugs from Wal-Mart, Walgreens and other retailers to drive sales. … Also boosting sales were pharmaceutical price increases 3% to 4%, roughly even with historical hikes” (Perrone, 4/1).

BusinessWeek: “Higher sales of antidepressants including Eli Lilly & Co.’s Cymbalta and tumor-fighting therapies such as Roche Holding AG’s Avastin helped bolster pharmaceutical revenue to $300.3 billion. … Antipsychotics, such as Lilly’s Zyprexa and Bristol-Myers Squibb Co.’s Abilify, remained the top-selling class of medicines” (Tirrell, 4/1).