Prescription Drugs Spending Distribution and Cost Drivers. Steve Kappel January 25, 2007

Transcription

1 Prescription Drugs Spending Distribution and Cost Drivers Steve Kappel January 25, 2007

2 Introduction Why Focus on Drugs? Compared to other health care spending: Even faster annual growth Higher reliance on out-of-pocket spending Some health insurance doesn t cover drugs High cost-sharing requirements Caps and other benefit maximums Uninsured

3 Sources of Numbers Vermont-specific Department of Banking, Insurance, Securities and Health Care Administration National Total spending figures from Office of the Actuary, CMS Detailed information from Medical Expenditure Panel Survey (MEPS) conducted by the federal Agency for Healthcare Research and Quality (AHRQ)

4 All Other V e r m o n t 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Distribution of Health Care Spending by Type, Vermont, 2005 Physicians Drugs and Supplies Administration / Net Nursing Home Dental Other Professional Home Health Hospitals

5 Health Care Spending by Source of Funds, Vermont, % 40.0% 35.0% 30.0% 25.0% 20.0% Drugs and Supplies All Health Care 15.0% 10.0% 5.0% 0.0% Out of Pocket Insurance Medicaid Medicare All Other *

6 Health Care Spending Growth, Vermont, % 20.0% Change From Previous Year 15.0% 10.0% Drugs and Supplies All Other Health Care CPI 5.0% 0.0%

7 Drugs and Supplies as Percent of Total Health Spending, Vermont, % 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0%

8 Growth in Prescription Drug Spending, US, % Projected 18.0% 16.0% Change from Previous Year 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Year

9 Drug Spending in the US Population 64.4 percent have expense (2003) Mean $611, median $62 Top 10% 64.2 percent of all spending Top 30% 93.6 percent of all spending Bottom 50% 0.7 percent of all spending

10 Top-Selling Drugs In 2004, the top 10 drugs (based on total spending) accounted for 19.2% of all drug spending in the US Lipitor has been the top seller since Spending on this drug nearly tripled from 2000 to 2004.

11 Pharmacy Spending, Top 10 Conditions, United States, 2004 $Millions Total Prescribed Medicines Percent of Total Prescribed Total Medicines Meds % Total Hypertension $37, $22, % 11.5% 58.1% Mental Disorders $51, $21, % 11.1% 40.9% COPD & Asthma $48, $15, % 8.3% 32.7% Hyperlipidemia $21, $15, % 8.1% 72.1% Diabetes $30, $13, % 7.1% 44.4% Upper GI disorders $21, $12, % 6.3% 56.0% Other $20, $10, % 5.6% 51.6% Osteoarthritis $34, $8, % 4.3% 23.5% Heart Conditions $90, $7, % 4.2% 8.9% Infectious Diseases $14, $5, % 2.8% 36.7% GRAND TOTAL $963, $190, % Source: MEPS Note: these are the top 10 conditions ranked on spending on prescribed medication

12 Brand and Generic Between 1999 and 2003 spending on brand name drugs rose from $75.5 billion to $141 billion (88%). In the same period, generic spending rose form $18.8 to $36.6 billion (95%). Generic share increased slightly, from 24.9% to 26%.

13 COX-2 Inhibitors New type of analgesic, reportedly fewer GI complications, introduced in total spending on NSAIDs was $3.2 billion 2003 NSAIDs other than COX-2 had fallen slightly, to $3 billion (constant dollars). COX-2 spending was $5.5 billion Proportion of people using other NSAIDs fell from 10.9% to 8.2%, COX-2 users 4.7%

14 Health Care Cost Drivers Prices the amount paid for the same product over time Utilization the quantity of product purchased Intensity the mix of different products purchased Include new drugs here or separate?

15 Relative Contribution of Drivers Several studies have looked at this, with similar results Express Scripts does an annual Drug Trend Report the 2005 version was released in June of 2006 Different way of measuring drivers

16 Avg. Ann Inflation* 5.6% 7.5% 6.6% 6.0% 5.3% 6.2% Units / Script** 0.0% -0.1% 0.3% 0.2% 0.1% 0.1% Brand / Generic^ -1.4% -2.3% -2.6% -2.6% -2.7% -2.3% Therapeutic Mix^ 4.4% 5.3% 2.6% 3.7% 0.8% 3.3% COST / SCRIPT 8.7% 10.5% 6.8% 7.3% 3.4% 7.3% Utilization** 6.3% 6.3% 6.8% 2.9% 4.0% 5.2% SAME DRUGS 15.6% 17.4% 14.1% 10.4% 7.5% 12.9% New Drugs^ 1.0% 1.0% 0.5% 0.3% 0.4% 0.6% TOTAL 16.7% 18.6% 14.7% 10.7% 7.9% 13.7% Price* 5.6% 7.5% 6.6% 6.0% 5.3% 6.2% Utilization** 6.3% 6.2% 7.1% 3.1% 4.1% 5.4% Intensity^ 4.0% 3.9% 0.4% 1.3% -1.5% 1.6% Source: Express Scripts, 2005 Drug Trend Report, Exhibit 19

17 A Closer Look at Prices Tremendous variation U.S. and other countries Brand prices are usually higher in the U.S. Generic prices are usually lower in the U.S. Among payers in the U.S. The lowest prices are usually paid by the V.A., about 45% of list price Medicaid pays an estimated 60% of list price PBMs pay an estimated 80%

18 The Pharmaceutical Supply Chain Manufacturers Wholesalers Retail Pharmacies Chain Independent Mail-order Non-Retail Providers Hospitals HMOs Nursing Homes Consumers Source: CBO

19 Three Key Price Measures -1 Average Manufacturer Price Average price paid by wholesalers or retailers who purchase directly from manufacturers Real number Reported to CMS, used to calculate Medicaid rebates Value of rebates is excluded

20 Three Key Price Measures - 2 Wholesale Acquisition Cost (WAC) Manufacturer s publicized list price Probably closest to the price wholesalers charge retailers

21 Three Key Price Measures - 3 Average Wholesale Price (AWP) Published average list price paid by retailers who purchase from wholesalers Frequently used by Medicaid programs to calculate brand drug reimbursement Vermont pays AWP minus 11.9% plus a dispensing fee Most closely approximates retail price

22 Rebates Basic idea sell at a lower price, without lowering prices (just like cars) Medicaid Rebates guarantee that Medicaid will get the same price for each drug as the lowest price charged to any private purchaser. Calculation by CMS, no public information

23 Rebates Some Medicaid programs, including Vermont, have used preferred drug lists to negotiate supplemental rebates from manufacturers. These rebates are based on the ability of PDLs to move substantial volume from one manufacturer to another.

24 Rebates PBMs Pharmacy Benefit Managers (PBMs) also rely on rebates from manufacturers Concerns that PBMs do not always pass the full value of rebates onto their customers

25 Tomorrow Approaches to controlling pharmacy spending Evaluation of the effect of those approaches

26 Questions?