Managed Care - April 2008 - (Page 54) MEDICATION MANAGEMENT Insurers Increasingly Direct Members Toward OTC Products Over-the-counter medications can be a good thing for the patient, the insurer, and the pharmaceutical company that developed the product By Martin Sipkoff ealth plans encourage patients to use over-the-counter alternatives to prescription drugs of similar therapeutic value, and, as self-medication is increasingly common in this country, patients are responsive. With 2006 sales of more than $15 billion, our OTC market is the biggest in the world, according to the Consumer Healthcare Products Association, the OTC trade organization . “We inform our members about OTC alternatives through our Maximize Your Benefits program,” says Matthew Palmgren, PharmD, Humana’s director of clinical pharmacy. “We work with the manufacturers to offer coupons for alternatives, but only when it’s financially advantageous to the patient.” Manufacturers’ coupon programs for OTC drugs are not always advantageous. The most recent switch is Zyrtec (cetirizine hydrochloride), which was approved for OTC status in November. Humana was able to find sources for the OTC that saved its members $50 a purchase, based on pill count, over the manufacturers’ coupons — and informed them where such savings were available rather than offer the coupon. “Switching drugs to over-the-counter availability reduces insurers’ prescription drug costs but increases the costs for most patients,” says Joshua P Cohen, senior research fellow at Tufts Center for the Study of Drug Development (CSDD). “But insured patients faced with high copayments on their prescriptions may also benefit financially from over-the-counter availability.” Cost was the main motive behind the switching of the antihistamine loratadine to over-thecounter status in the United States, according to H “We work with the manufacturers to offer coupons for alternatives, but only when it’s financially advantageous to the patient,” says Matthew Palmgren, PharmD, Humana’s director of clinical pharmacy. a Tufts CSDD study. In what Tufts called “an unprecedented move,” the health plan WellPoint petitioned the Food and Drug Administration to switch three antihistamines (loratadine, cetirizine, and fexofenadine) while they still had patent protection. The FDA recommended the switch in 1998. However, the recommendations are not binding. Manufacturers have to voluntarily initiate a switch. Loradatine’s manufacturer (ScheringPlough) didn’t make the switch until its brand Claritin went off patent in 2002. As noted, cetirizine went OTC a few months ago. (Fexofenadine, under the brand name Allegra, has not gone OTC.) The number of drugs being switched from prescription to over-the-counter availability is likely to continue to rise, according to Tufts. Five widely prescribed drugs that are candidates for switching will lose patent protection by 2008 (esomeprazole, lansoprazole, pravastatin, simvastatin, and zolpidem). On average, copayments for third-tier drugs (i.e., nonpreferred brands) exceed $30 per month. The lower prices of OTC drugs compared with competing prescription drugs have persuaded some health plans to add certain switched drugs to their formularies, often in a new tier that is subject to a very modest copayment (e.g., $5). According to a recent survey, 31.5 percent of managed care plans cover at least some OTC medicines. Blues move That percentage may grow as an increasing number of drugs go OTC. Blue Cross Blue Shield of Michigan announced last September that it would start paying for the OTC acid reflux drug Prilosec. It is doing so to move patients off prescription Nexium, company officials say. The switch could create member Contributing Editor Martin Sipkoff is a long-time health care journalist. 54 MANAGED CARE / APRIL 2008
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