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  • But I submit to you that the problem here is not that people want less innovation – in fact, they expect and demand more of it. The disconnect is that people simply have no idea that private firms are the ones inventing the new medicines in the first place. This shows you that the public only gives private industry 27% of the credit for discovering new medicines. But the NIH’s own reports show that private industry discovered and developed over 90% of the drugs that came out in the last decade. There are a number of reports that have looked at this and found similar results – the VA, the Government Accountability Office, and others have all found the same thing, that private industry discovers between 85% and 95% of new medicines. These aren’t estimates from us – they are independent evaluations. If people understood that, they might have a different view on regulating this industry.
  • But surely it is the profit motive that gets investors to put up over $30 billion a year in private money by big pharma alone in the US – even more than we put toward all scientific research through the NIH. Remember, most of the NIH money doesn’t go toward anything like drug-specific research, so really the vast majority of research into new medicines is paid for by private investors counting on a return on their investment. If the potential return on investment is reduced, then those investors will of course invest less. Our company is just a vehicle that investors use to put their money into biomedical research, so if the returns to that research are diminished they’ll take their money and put it elsewhere. That’s just Economics 101, and politicians have to realize that there is no way around it. So, the first question is, do we really want less private investment into pharmaceutical R&D? What would the consequences be?

Transcript

  • 1. Economic Issues in Health Care and the Pharmaceutical Industry MAHU Sales Congress February 3, 2005 Richard Manning, Pfizer Inc
  • 2. Total US Healthcare Spending 1960–2003 Millions of Dollars Source: Centers for Medicare and Medicaid Services; available at www.cms.gov. 2003
  • 3. Medical Progress Contributes to a More Healthy Population and an Aging Population Means More Spending on Health 300 250 200 150 100 50 0 1900 1920 1940 1960 1980 2000 2000 = 262 1900 = 46 Number of People Older Than 100, per Million Population Source: Caplow, Theodore, et al. The First Measured Century , Washington DC: AEI, 2001:9
  • 4. Outline
    • Pharmaceutical Prices, Spending and the Value of Medicines
    • Information, Marketing and Advertising
    • R&D, Profits and Incentives in the Pharmaceutical Industry
    • Should We Fill our Prescriptions in Canada?
    • The Road Ahead
  • 5. Public Overestimates the Amount of Healthcare Spending that Goes to Pharmaceuticals 40% 21% 20% 19% 50% or more of healthcare spending is spent on Rx drugs Less than 30% Unsure 30 – 40% Source: Gallup, “Pharmaceutical Image Survey”, 2003; N=1,011 “ What percent of the total healthcare spending do you feel is spent on prescription drugs?” Average estimate: 44%
  • 6. Consumers Pay a Greater Share for Medicines Than for Other Components of Health Care Note: Totals do not add up to 100% due to shares allotted to all other payors. Source: PhRMA. Coverage of prescription medicines in Private Health Insurance: lower level of coverage for medicines than for other items. Winter 2004. 20.6% 70.5% 10.1% 80.2% 7.6% 85.4% 2.5% 90.5% 37.2% 60.2% 0% 20% 40% 60% 80% 100% Prescription Drugs Hospital Inpatient Hospital Outpatient Emergency Room Physician Percentage Share Percent Covered by Private Insurance vs. Out-of-Pocket Among Insured Under Age 65 Out-of-Pocket Private Health Insurance
  • 7. Total US Healthcare Spending Excluding Prescription Medicines, 1960–2003 Millions of Dollars Source: Centers for Medicare and Medicaid Services; available at www.cms.gov. 2003
  • 8. Pharmaceuticals Account for Just Over 10% of Total US Healthcare Spending Share of National Health Care Spent on Each Category 1960-2003 Prescription Medicines Physician & Clinical Services Hospital Care Source: Centers for Medicare and Medicaid Services (CMS); available at www.cms.gov.
  • 9. Copayments for Prescription Medicines Are Increasing Faster Than Rx Prices Note: The Consumer Price Index, or CPI, measures price changes in consumer goods and services. Calculations based on Kaiser Family Foundation data and Health Research and Education Trust, Employer Health Benefits: 2003 Annual Survey (Menlo Park, CA: KFF and HRET, 2003). Source: PhRMA. Focus on Health Policy . Spring 2004. Percentage Increase Average Annual Change In Copayments by Medicine Classification, vs. Price Increase, 2000-2003 14.3% 9.9% 6.6% 3.6% 0% 5% 10% 15% 20% Non-Preferred Brands Preferred Brands Generics Rx Drug Consumer Price Index
  • 10. Consumer Price Index Annual Rate of Change, December 2002 - December 2004 Source: BLS data, not seasonally adjusted
  • 11. Producer Price Index Annual Rate of Change, December 2002 – December 2004 Source: BLS data, not seasonally adjusted Note: PPI sampling for all drugs and pharmaceuticals, not only prescription drugs
  • 12. Innovative Medicines Have Turned the Tide Against HIV/AIDS First New Drugs Introduced, 1995 Highly Active Antiretroviral Therapy (HAART) Introduced, 1996–97 HIV Mortality Declined Dramatically After Introduction of First “Expensive” Antiretrovirals... AIDS Deaths per 100,000 Population Total: $1,811 Total: $1,521 Drug Costs Increase by 34% Other Costs Decrease by 41% … While Monthly Costs for AIDS Patients Decreased by 16% After HAART Introduced Source: Costs – Bozette S, et al. Expenditures for the care of HIV-infected patients in the era of highly active antiretroviral therapy. New England J of Medicine Vol. 344, No. 11, March 15, 2001; Mortality – Centers for Disease Control and Prevention; data on drug development from PhRMA and the NIH Office of Technology transfer Monthly Health Spending for AIDS Patients 18 15 12 9 6 3 0 Year 90 94 98 86 82 $0 $400 $800 $1,200 $1,600 $2,000 Rx drugs All other costs
  • 13. Evidence Suggests that New Drugs Are Not Just as Good as Old Drugs Drug Cost Increase Inpatient Savings Office Visit Savings Home Health Savings Outpatient Savings ER Savings Net Impact: $18 Investment Returns $129 in Savings – Ratio of $7 Saved for Every $1 Invested Source: Lichtenberg, F. “Benefits and Costs of Newer Drugs: An Update.” NBER Working Paper 8996, June 2002 -$18 $80 $24 $12 $10 $3 Estimated “Savings” From Use of Older Medications (Instead of Newer Ones), On Average for All Patients and All Conditions (Assumes Average “Age” of Drug Increases by 10 Years)
  • 14. Holding Other Things Constant, Mortality Rate Declined When Newer Medicines Were Used Source: Lichtenberg, F. “The effect of drug vintage on survival rates: evidence from Puerto Rico’s ASES program.” NBER Working Paper, November 2004
  • 15. It is Possible to Lower Medical Costs by Encouraging Appropriate Medication Use Avg Sick Days 12.6 6.0 8.5 7.3 7.7 6.4 Baseline Year 1 Year 2 Year 3 Year 4 Year 5 $5,394 $4,651 $5,882 $5,843 $5,210 $7,082 Source: Cranor C, Bunting B, Christenson D. The Asheville Project: long term clinical and economic outcomes of a community pharmacy diabetes care program. J of the Am Pharm Assoc , March/April 2003. $1,153 $1,614 $2,335 $2,599 $2,579 $3,095 $3,596 $3,508 $3,283 $2,815 $1,556 $5,929 All Other Medical Rx Expenses City of Asheville, NC, Created a Program Granting Diabetics Free Access to Prescription Drugs and Other Services if They Enrolled in a Care-Management Program. After Five Years, Program Is Paying Significant Dividends…
  • 16. Number Needed to Treat to Prevent a Cardiac Event with Statins, by Prevention Category Source: Ellis, J.J. Journal of General Internal Medicine, June 2004; 19: 639-646.
  • 17. Tendency to Remain on Statin Therapy Depends on Co-pay Level Source: Ellis, J.J. Journal of General Internal Medicine, June 2004; 19: 639-646. *Adjusted for all available covariates. The median time to discontinuation was 3.9+ years for $0 to <$10; 2.2 Years for $10<$20; and 1.0 years for $20+.
  • 18. Higher Co-payments Reduce Medication Use
    • May 2004 study published in JAMA showed that when copayments were doubled, there were substantial reductions in use of medicines for important conditions
    Source: Goldman D, Joyce GF, Escarce JJ, et al. Pharmacy benefits and the use of drugs by the chronically ill. JAMA. May 2004.
    • For patients with diabetes, asthma, and gastric disorder, reductions in medication use were associated with a 17% increase in annual ED visits and 10% increase in hospital days
  • 19. Outline
    • Pharmaceutical Prices, Spending and the Value of Medicines
    • Information, Marketing and Advertising
    • R&D, Profits and Incentives in the Pharmaceutical Industry
    • Should We Fill our Prescriptions in Canada?
    • The Road Ahead
  • 20. Information Is a Good Much Like Any Other Price Quantity Demand for Information
  • 21. Physicians reported largely positive impact of advertising on their interaction with patients Ref: Page C6, C8 No: 44 % No: 85% Yes Saw Positive Impact Yes Saw Negative Impact 56% 15% Ref: Page MA6, MA8 No: 34 % No: 91% Yes Saw Positive Impact Yes Saw Negative Impact 66% 9% Did the fact that the patient saw an advertisement … have a positive impact on the interaction? … have a negative impact on the interaction? High Cholesterol Mood/Anxiety Disorder 1 FDA Talk Paper, FDA Releases Preliminary Results of Physician Survey on Direct-to-Consumer Rx Drug Advertisements, January 12, 2003.
  • 22. Physicians reported that patients asked about products that were appropriate for them and their condition
    • 85% 1 of physicians reported that patients inquired about a medicine that was appropriate for them
    • 72% 1 of physicians found the discussion to be a valuable part of the office visit.
    • 83% 1 of physicians reported that patients inquired about a medicine that was appropriate for them
    • 76% 1 of physicians found the discussion to be a valuable part of the office visit.
    High Cholesterol Mood/Anxiety Disorders 1 Rated 5,6,7 on a 7-point scale (Ref Page: C13,C&; MA13,MA7)
    • When a patient asked about a drug, 88% of the time they had the condition that the drug treated
    • 80% of physicians believed patients understood what condition the drug treats
    • The vast majority (91%) of physicians said patients did not attempt to influence their treatment in a way that would be harmful
    2 FDA Talk Paper, FDA Releases Preliminary Results of Physician Survey on Direct-to-Consumer Rx Drug Advertisements, January 12, 2003. FDA Survey of Physicians 2
  • 23. Most Patients Are Not Taking Medicines Properly High Cholesterol High Blood Pressure
    • Nonacceptance 10% 15% 11%
    • Nonpersistence
      • At 12 months 34% 38% 37%
      • At 18 months 47% 49% 51%
    • Noncompliance 47% 46% 46%
    Diabetes
    • Source: Integrated Healthcare Information Services, Inc. (IHCIS)
      • (30 health plans, 11 million members; HL analysis: Age 25–64, N=8839;
      • HTN analysis: Age 25–64, N=11,422; Diabetes analysis: Age 18–64, N=6090).
    Note: acceptance means patient filled original prescription; persistence means patient remains on therapy by a given date; and compliance means the patient is taking the medicine appropriately.
  • 24. Patient-Reported Reasons for Non-Adherence I just forget (54.9%) Other (3.6%) Don’t like being dependent on drugs (7.3%) Don’t like being told what to do (0.6%) Too expensive (1.8%) If I don’t take them, supply will last longer (1.3%) Side effects (6.4%) Don’t think drugs are working (3.4%) Hate taking drugs (7.1%) Don’t think it’s always necessary (13.7%) Cheng JW, et al. Pharmacotherapy . 2001;21:828-841. Source: Cheng JW, Kalis M, Feifer S. Patient-reported adherence to guidelines of the Sixth Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Pharmacotherapy . 2001. Accessed at: http://www.medscape.com/viewarticle/409745 on July 12 , 2004.
  • 25. US Government Finds Pharmaceutical Industry Spends 50% More on R&D than Marketing *Total promotion includes DTC, retail value of samples, office & hospital promotion, and professional journal advertising. Source: U.S. General Accounting Office (GAO). FDA Oversight of Prescription Drug Advertising Has Limitations. October 2002. 30.4
  • 26. Product Samples Are a Significant Share of Total Promotional Spending Sources: GAO Report. October 2002. $30.30 R&D Retail Value of Samples Office Promotion Direct-to-Customer Advertising Hospital Promotion Journal Advertising $10.50 $4.80 $2.70 $0.70 $0.40 Expenditures in Billions ($) Pharmaceutical Industry’s Annual R&D Investment Far Exceeds the Total Value of Marketing Spending, as Reported by GAO Marketing
  • 27. Undiagnosed and Untreated Diseases Remain Significant Treated 50% 60% 65% 70% 50% 40% 35% 30% Depression HIV Cholesterol Anxiety Untreated Source: NHANES; Internal Analysis
  • 28. Outline
    • Pharmaceutical Prices, Spending and the Value of Medicines
    • Information, Marketing and Advertising
    • R&D, Profits and Incentives in the Pharmaceutical Industry
    • Should We Fill our Prescriptions in Canada?
    • The Road Ahead
  • 29. Public Does Not Believe That Private Industry Invents New Medicines Public Perception Percent of credit assigned to pharma by public for discovery of new medicines* Reality Percent of new medicines discovered and developed by private industry * Survey participants allocate 100% across seven stakeholders Source: Consensus Research, “Stakeholder Value Research”, General Publics, Phase II, July 2003; N=1,000; PhRMA estimate, 2003
  • 30. Private Companies and the NIH Invest Billions of Dollars in Research Every Year
  • 31. Pharmaceutical Companies Spend More as a Share of Sales on R&D Than Any Other Industry Research-Based Pharmaceutical Cos 1 Industrial Sector Comparison 2 1 “Research-Based Pharmaceutical Companies” based on ethical pharmaceuticals sales and ethical pharmaceutical R&D only, tabulated by PhRMA. 2 “Standard and Poor’s Compustat” – 4-digit SIC codes. Source: PhRMA Pharmaceutical Industry Profile 2000: Research for the Millennium. 17.0% 10.5% 8.4% 7.8% 4.7% 3.9% 1.2% 3.9% 0% 2% 4% 6% 8% 10% Domestic Research & Development Computer and Software Services Electrical and Electronics Office Equipment and Services Leisure Time Products Automotive Metals and Mining All Industries 12% 14% 16% 18% 5.3% Telecommunications 3.8% Aerospace and Defense 0.7% Paper and Forest Products
  • 32. New Product Development – A Risky and Expensive Proposition Net Cost: $802 Million Invested Over 15 Years Compound Success Rates by Stage 16 14 12 10 8 6 4 2 0 Phase II 100–300 Patient Volunteers Used to Look for Efficacy and Side Effects Phase III 1,000–5,000 Patient Volunteers Used to Monitor Adverse Reactions to Long-Term Use FDA Review Approval Additional Post-Marketing Testing Phase I 20–80 Healthy Volunteers Used to Determine Safety and Dosage Preclinical Testing Laboratory and Animal Testing Discovery (2–10 Years) Years Source: PhRMA Pharmaceutical Industry Profile 2003, Chapter 1: Increased Length and Complexity of the Research and Development Process. And DiMasi, JA, Hansen, RW, Grabowski, HG. “The Price of Innovation: new estimates of drug development costs.” J of Health Economics . 2003:22:151-185. 5,000–10,000 Screened 250 Enter Preclinical Testing 5 Enter Clinical Testing 250 Enter Preclinical Testing 1 Approved by the FDA 0 2 4 6 8 10 12 14 16 Compound Success Rates by Stage 5,000–10,000 Screened
  • 33. Ongoing Research Investment Depends on Healthy Returns For a Handful of Successful Products $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th New Products Grouped in Tenths According to Financial Success Average R&D Cost* Value of After-Tax Net Lifetime Sales of New Drugs ($ Millions) * After tax H. Grabowski, J. Vernon, and J. DiMasi, “Returns on Research and Development for 1990s New Drug Introductions”, Pharmacoeconomics 20 (2002)
  • 34. Wall Street Journal Finds That Pharmaceutical Stocks Have Lagged for Five Years, Ranking 65 th of 76 Major Industries Source: Leaders and Laggards: The Best and Worst of the Rankings. The Wall Street Journal. March 8, 2004 (R4). 29.3% 28.8% Office Equipment Pharmaceuticals Airlines Drug Retailers Five-Year Average Compound Annual Total Returns for Selected Industry Groups, Through Year-End 2003
  • 35. Operating Environment Has Led to Significant Industry Evolution Pharmaceutical Industry Consolidation, 1980–2003 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 7 6 5 4 3 2 1 American Cyanamid American Home Products Hoffman Roche Hoechst Roussel Marion Merrill Dow Rhone Poulenc Squibb Myers Bristol Sandoz Geigy Ciba Glaxo Wellcome French Smith Kline Beecham PLC Pfizer Parke Davis Warner-Lambert Monsanto Upjohn Pharmacia Wyeth LaRoche-Syntex Marion Merrill Dow Rhone Poulenc & Fissons Hoechst Squibb Bristol-Myers Sandoz Ciba Geigy Glaxo Wellcome French Beecham PLC SmithKline Pfizer Warner-Lambert Monsanto Pha and Upjohn Hoechst Roussel (MMD) Rhone Poulenc & Fissons Bristol-Myers Squibb Novartis Beecham PLC Glaxo Wellcome SmithKline French Pfizer Pharmacia Wyeth Hoffman LaRoche Aventis Bristol-Myers Squibb Novartis Glaxo Wellcome SmithKline Beechman Pfizer Wyeth Hoffman LaRoche Sanofi- Aventis Novartis Glaxo SmithKline Pfizer 28 27 Sanofi Synthelabo Sanofi-Synthelabo Wyeth Hoffman LaRoche Sanofi-Synthelabo Bristol-Myers Squibb Sanofi- Synthelabo
  • 36. Effect of Generic Entry on Prices Share of New Prescriptions for Zantac & Generic Rantidine Source: IMS Share of Sales (%) Generics Zantac 100 0 20 40 60 80 Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun 1997 1998 1999
  • 37. Outline
    • Pharmaceutical Prices, Spending and the Value of Medicines
    • Information, Marketing and Advertising
    • R&D, Profits and Incentives in the Pharmaceutical Industry
    • Should We Fill our Prescriptions in Canada?
    • The Road Ahead
  • 38. Prices Differ for Most Products Between Canada and the US, Not Just Medicines Source: Fraser Institute (Canada), Public Policy Sources: Prescription Drug Prices in Canada and the US – Part 2, 2002. US vs Canada – Income and Prices 0% 50% 75% 100% Average Income Market Basket Average AOL Quicken Software Brand Name Drugs US Canada 25%
  • 39. Many Automobiles Are Much Less Expensive In Canada Source: MSRPs from Manufacturer websites Exchange rate as of 13 May 2004: $1=CAN$0.7177 accessed at quote.yahoo.com Buying one of these cars in Canada would save $4,442 on average $5,431 $24,649 $30,080 Astro Minivan LT Chevrolet $3,966 $21,309 $25,275 F150 XLT Ford $3,427 $11,573 $15,000 Cavalier Chevrolet $3,521 $17,874 $21,395 Malibu Chevrolet $3,599 $18,876 $22,475 Century Buick $4,573 $22,676 $27,249 XL-7 Suzuki $6,605 $30,430 $37,035 Avalanche 4x4 Chevrolet $5,098 $19,037 $24,135 L300 Wagon Saturn $28,640 $23,885 US Price Price Difference: US - CAN Canadian Price (in US$) Model Make $3,707 $24,933 Regal Buick $4,489 $19,396 L300 Sedan Saturn
  • 40. As a Practical Matter, Canadian Drug Supply Too Small to Serve US Need Source: IMS Health. Total Prescriptions Filled in US vs Canada, in Millions - 2002 >3.4 Billion 331 Million After exhausting all Canadian supplies, still would need to supply medicines for 3.1 billion prescriptions
  • 41. Canadian Association of Retired Persons (CARP) and Other Groups Have Concerns About Canadian Supply Integrity “… There is no way that a pharmaceutical supply chain built to meet the needs of 32 million Canadians can meet the needs of more than 300 million Americans. Canadians will pay the price if this practice continues,&quot; said Dr. Jeff Poston, Executive Director of the Canadian Pharmacists Association. &quot;As a pharmacist, I also have serious concerns about safety. Medications are potent and patients need proper care to ensure they are used correctly. Drugs are a therapy, they should not be treated as a commodity to be bought from anywhere in the world at the cheapest price.&quot; From the October 22, 2004 statement from CARP, “Canada must stop cross-border exports”: Available at www.50plus.com ; accessed Dec 20, 2004.
  • 42. Counterfeit vs. Authentic: Can You Tell the Difference? Authentic Counterfeit
  • 43. Cross-Boarder Sales from Canada Have Increased but Quality Is Questionable Source: FDA News July 13, 2004 FDA test results of prescription drugs from bogus Canadian website showing products were substandard (http://www.fda.gov/bbs/topics/news/2004//NEW01087.html) “ Canadian Pseudo-Generics” Three Imported Drugs Tested by the FDA for Quality FAIL FAIL PASS Purity Test FAIL FAIL PASS Dissolution FAIL FAIL FAIL Potency PASS PASS PASS Drug Present Viagra Lipitor Ambien Drug
  • 44. In Other Countries, Majority of Potential Savings From Importation Captured by Middlemen Source: Kanavos P. The Economic Impact of Pharmaceutical Parallel Trade: A Stakeholder Analysis. London School of Economics, 2004. Share of Economic Gains Captured by Importers vs Payers in Other Countries Where “Reimportation” is Allowed
  • 45. Those Under Price Controls Have to Wait for New Therapies 86% 78% 73% 58% 53% 52% 36% 31% Percentage of Global New Medicines Reaching Country* Average Delay for Products That Are Launched (number of months between initial global launch and launch in country) USA Germany Sweden Spain France Italy Poland Portugal 4.2 8.8 7.8 15.7 14.9 17.2 20.5 22.1 * Percent of 85 global launches 1994–1998 that were launched in each country by end of 1999. Source: Danzon P, et al. The impact of price regulation on the launch delay of new drugs. NBER Working Paper 9874, July 2003. Canada 12.2 66% US Consumers Get More Medicines, and Get Them More Quickly
  • 46. Outline
    • Pharmaceutical Prices, Spending and the Value of Medicines
    • Information, Marketing and Advertising
    • R&D, Profits and Incentives in the Pharmaceutical Industry
    • Should We Fill our Prescriptions in Canada?
    • The Road Ahead
  • 47. Keeping Focused on the Opportunity Ahead 600 400 200 0 Major Cardiovascular Diseases (Heart Disease, Stroke, High Blood Pressure) Number of Deaths per 100,000 Population per Year 1900 = 345 1997 = 352 1997 = 201 1900 = 64 Cancer 1900 2000 1920 1940 1960 1980 Source: Caplow, Theodore, et al. The First Measured Century , Washington DC: AEI, 2001:137
  • 48. An Aging Population Will Demand More Cures 300 250 200 150 100 50 0 1900 1920 1940 1960 1980 2000 2000 = 262 1900 = 46 Number of People Older Than 100, per Million Population Source: Caplow, Theodore, et al. The First Measured Century , Washington DC: AEI, 2001:9
  • 49. Florida – A Healthy State Program Milestones and Performance Metrics Patients Under Care Mgmt June ’ 01 June ’ 02 Sept ’ 02 Dec ’ 02 March ’ 03 June ’ 03 Sept ’ 03 17,700 4,800 Clinical Changes Reduced Need for Services Behavior Changes
    • 39% of patients improved medication compliance
    • 54% of patients improved mental health scores
    • Heart Failure:
      • 43%–47% reduction in number of patients with most severe HF
    • Hypertension:
      • 48% of patients lowered blood pressure
    • Utilization:
      • Inpatient Days:  12.6%
    • Year 1 Savings and Investment:
      • $15.9M
    Medicaid Event with Gov. Bush Release Clinical Outcomes Announce Extension Agreement Announce Yearly Savings $15.9M Cost Savings
  • 50. Closing Points
    • Health Care Spending Is Rising and Probably Will Continue to Do So
      • Prescription Drugs Are not the Primary Reason
    • Health Care Is a Highly Valuable Dynamic Good
      • Patients and Society Have Reaped Exceptional Returns from Medical Innovation and have an Enormous Stake in Continued Progress
    • Challenge of the Future is More than Controlling Costs
      • Continue Progress Against Illness
      • Use Health Care Resources Appropriately
      • Establish Financing Mechanisms that Encourage Appropriate Utilization of Medical Resources and Make the Fruits of Medical Progress Widely Available
  • 51. BACK UP SLIDES
  • 52. Inspection Activities Are Not Without Cost * The blitz operations were FDA and Canadian Boarder Patrol conducted short-term intensive evaluations of drug products that were entering the U.S. through specific international mail facilities. November 2003 $264.10 $267.90 Average Cost of Examining and Processing Each Package 2.78 2.82 Average Hours Spent Per Package (Including Support Activity) (300 Packages Examined) 834 846.25 Total Hours (Mail Facility and Support/Follow-Up) 790 757.5 Hours (Spent in Support/Follow-Up Including Processing Detentions) 3 9 FDA Staff (Full or Part-time Outside of Mail Facility) 44 88.75 Hours (Working at Facility on Blitz) 3 6 FDA Staff (Full or Part-Time at Mail Facility) 11/4-6/2003 11/4-7/2003 Days of Blitz* Southwest Import District Office Seattle District Office Illustration of Two Districts
  • 53. Survival Curves for Discontinuation of Statin Therapy, by Prevention Category* *Adjusted for all available covariates. The median time to discontinuation was 3.7 years for secondary prevention and 3.4 years for primary prevention. Source: Ellis, J.J. Journal of General Internal Medicine, June 2004; 19: 639-646.
  • 54. Role of Medicines in Employers’ Annual Premium Increases is Modest 2005 Forecasted Premium Increases for Plans With and Without Rx Coverage Source: Segal Health Plan Cost Trend Survey, 2005 edition, October 2004.