Drug Topics- August 11, 2008

30 DRUG TOPICS AUGUST 11, 2008 www.drugtopics.com Cover Story Brand drugs with generic equivalents most commonly need prior authorization While responding to a question in a Drug Topics survey on the issue of prior authorization, pharmacist respondents said that the drugs that most frequently require PA are brand drugs that have generic versions available (80%), followed by specialty drugs (74%), and lifestyle drugs (60%). Category of drug Brand drugs that have generic versions available Specialty drugs Lifestyle drugs Off-label drugs HIV drugs Controlled substances that are often abused Other Number of respondents 462 430 345 177 119 103 145 Percentage of respondents selecting this answer 80% 74 60 31 21 18 25 well: The average weekly prescription volume in respondents’ pharmacies was 1,417, resulting in a large portion of time spent on preauthorization, regardless of prescription volume. Part of the frustration is that, although pharmacists are placed in the middle between physicians and health plans, they feel they aren’t being adequately compensated. More than nine of 10 respondents (93%) strongly agree or agree that drug plans and pharmacy benefit managers should adjust their remuneration rates to pharmacists for solving prior authorization problems. “Doctors’ offices don’t seem staffed well enough to do prior authorization quickly,” a respondent said. “Pharmacists should be able to do more of the leg work and also be paid for their time.” To what extent do you agree that drug plans and PBMs should adjust their remuneration rates to pharmacists for resolving prior authorization problems, based on the amount of time that this service takes? Strongly agree Agree Somewhat agree Disagree Strongly disagree 68% 25 4 1 2 t to people who are being released from the hospital after life-altering procedures, such as a patient whose medications are not covered after a kidney transplant, or a heart attack patient who requires injectable anti-thrombotic medicine,” another respondent said. Even when no apparent harm is done by prior authorization requirements, the process alienates patients and pharmacists, respondents said. More than half (53%) said that several times a day they have patients who become upset because of delays due to prior authorization. Another third (37%) face that problem several times a week. How often do you encounter patients who are upset because their drugs required prior authorization and they could not get their prescriptions filled quickly? Several times a day Several times a week Several times a month At least once a month Rarely 54% 38 8 1 1 Another issue for pharmacists is that they have a limited amount of faith that prior authorization is actually an effective tool for cost savings. Only one in five (20%) said it is very effective or effective in controlling cost; 24% said it is not effective or not at all effective. Most (56%) said it is only “somewhat effective.” “The solution is to let doctors prescribe what they feel is best for their patients and force the PBMs (pharmacy benefit managers) to get rid of formularies altogether,” according to a respondent who believes the entire process is basically corrupt. “Health care should not be driven by the desire for CEOs to get rich.” How effective is prior authorization in controlling drug costs? Very effective Effective Somewhat effective Not effective Not at all effective 4% 17 57 18 5 Widespread frustration The frustration of pharmacists and their patients with the current system cuts across practice settings. Independent pharmacies, chains, food and box store pharmacies all reported that they are spending more time than ever on obtaining prior authorization. The size of the practice makes little difference as “The concept of prior authorization is in large part a legal way for insurers to sidestep paying for what is in the best interest of the patient,” a pharmacist said. “Maybe one in four prior authorizations are really legiti- http://www.drugtopics.com

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Drug Topics- August 11, 2008 Contents Latebreakers Letters DEA Proposes Rule To Allow Electronic Prescriptions for Controlled Substances Merger, Medicare Reform Could Mean Broader E-Prescribing Adoption New Combination Pill Approved for Type 2 Diabetes New Eczema Guildlines Promote Use of Emollients, Then Topical Corticosteroids Agencies Flush Original Strategies in Favor of Promoting Drug Take-Back Programs JP at Large: You Laughing at Me? Pharmacists Find Themselves at Mercy of Prior Authorization State Law Requiring PBM Transparency See Some Gains, Some Losses Global Counterfeiting Still Growing, Says U.S. Commerce Official FDA Saftey Page: Prophylthiouracil Still Confused with Purinethol (mercaptopurine) New Products Bring Lice Treatment to a Head NACDS Marketplace Showcases New Product that Fill Unmet Needs Update on Respiratory Tract Infections Execs Share War Stories About Adopting Technology in their Stores New Products Advertisters Index Classified Viewpoint: Medicare Part D Revisions sorely needed

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