A recent spate of studies about different aspects of health care, while embodying many contradictions, points to a period of ferment, the likes of which has not been seen since Medicare and Medicaid were put in place during the Johnson administration in the mid-1960s.

community pharmacy, health care, Jeffrey Woldt, spending on medications, IMS Institute for Healthcare Informatics, cost of prescription drugs, Murray Aitken, health care spending, Centers for Medicare and Medicaid Services, Medicare, Medicaid, Medicare Part D, Walgreens, prescription drug costs, Dan Luce, specialty medications, Prime Therapeutics, CVS Caremark, Larry Merlo, Affordable Care Act, Oregon Health Study, medication therapy, pharmacists

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Inside This Issue - Opinion

Fluid state of health care opens way for Rx

May 20th, 2013

A recent spate of studies about different aspects of health care, while embodying many contradictions, points to a period of ferment, the likes of which has not been seen since Medicare and Medicaid were put in place during the Johnson administration in the mid-1960s.

The IMS Institute for Healthcare Informatics reports that, for the first time ever, spending on medications has declined, albeit slightly, in the United States. On a per capita basis, total expenditures fell 3.5% last year, a development the study’s authors attribute to less utilization of branded drugs, more widespread availability of generics, smaller price increases and reduced spending on new medicines. The overall cost of prescription drugs in 2012 was $325.8 billion, a 1% decrease from the prior year.

“The ‘cost curve’ for medicines — if not for other elements of the U.S. health care system — was bent,” says Murray Aitken, executive director of the IMS institute. “For some, this will be good news and a harbinger of more efficient use of our health care resources. For others, this decline may indicate undertreatment and imbalance between prevention and care.”

Other studies, including those by researchers at Harvard University and the Kaiser Family Foundation, have examined the slowdown in overall health care spending. The rate of increase has declined steadily in recent years and stood at 3.9% in 2011, according to the Centers for Medicare and Medicaid Services. While experts differ as to how much weight should be assigned various factors, a consensus is emerging that some positive effects from structural shifts in the system are lasting and won’t be undone even after the economy fully recovers from the Great Recession.

The trend is encouraging, but much work needs to be done. Health care expenditures at current levels are still growing faster than GDP, a trajectory that is not sustainable over the long term.

Even if health care costs were suddenly to flatten out completely, they would remain burdensome for many patients.

A new study released by Walgreens shows that 37% of Medicare Part D beneficiaries are worried about prescription drug costs, and 20% of them have made such compromises as delaying filling a script or skipping doses, to cope.

“It’s important for everyone to be able to afford the prescriptions they need, and with recent changes to Medicare and other programs under health care reform, it’s critical for beneficiaries to fully understand their options and ways to make their health care dollars go further,” says Dan Luce, director of pharmacy affairs at the drug chain. “If cost is a contributor to patients not adhering to medication therapies, as the survey findings show, it’s always a concern because nonadherence can be a significant and costly barrier in treating illness.”

Another challenge to containing costs comes in the form of specialty medications. Those products represent the cutting edge of biomedical research and promise to one day effectively treat everything from cancer and heart disease to diabetes and dementia. They are also extremely pricey.

Two studies by Prime Therapeutics illustrate the issue. The pharmacy benefits management company found that specialty drug expenditures for people with rheumatoid arthritis and hepatitis C now account for more than half the total health care cost for such patients.

“As the pipeline of expensive specialty drugs continues to grow, we need to stay alert to cost of care trends to make sure patients and plan sponsors receive the best value and can manage the increasing cost burden these treatments bring,” notes Prime Therapeutics director of health outcomes Patrick Gleason.

CVS Caremark is addressing the challenge, which president and chief executive officer Larry Merlo says is one of its PBM clients’ biggest concerns. The company, which has had great success bending the cost curve for traditional medications, is, for example, developing programs to ensure that clinically appropriate treatments are provided to each individual, with the efficacy of lower-cost drugs assessed before specialty medications are used.

Some additional upward pressure on health care expenditures is likely to result from implementation of the Affordable Care Act, which, beginning in January, will bring health insurance to some 30 million people who currently don’t have it, many of them through expansion of Medicaid.

“The Oregon Health Study,” which appeared in the May issue of The New England Journal of Medicine, found that when individuals in that state were given access to the program they benefited from an enhanced sense of security but weren’t all that much healthier than members of a similar group that weren’t covered by Medicaid. If those results, which were compiled over the two-year course of the research, persist over an extended time frame, the expanded coverage won’t do much to lower the nation’s health care bill.

The fluid situation, which is characterized by the seemingly incompatible imperatives of expanding access and reducing expenditures, opens the way for chain drug stores and other community pharmacies to leverage their inherent strengths and assume a greater role. The New England Healthcare Institute has identified $290 billion a year in unnecessary spending that results from patients’ noncompliance with medication regimens. With their high standing for trust among the public and unparalleled accessibility, pharmacists are ideally positioned to address the problem through increased patient counseling and medication therapy management.

Expansion of the scope of pharmacy practice to include vaccinations for flu and other conditions over the last decade has been tremendously successful at making it easier for people to obtain immunizations, lower costs and free time-pressed primary care physicians to deal with more serious health problems. The same kind of results can be achieved by making it possible for pharmacists to perform routine diagnostic tests and, in the case of routine illnesses, prescribe medications.

The time is right for community pharmacy to step up and make a difference.