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Pharmacoeconomics 101: How to Beat the High Cost of Prescription Medications – Resources for you and Your Patients Mark Cucuzzella MD FAAFP (West Virginia University) Heather Congdon, PharmD (University of Maryland)
The Old Timey Mountains Potomac R Shenandoah R Maryland W. Virginia Virginia FM
“ The education of a man  (or woman if Lee were around in 2006)  is never completed until he dies”   Robert E. Lee
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Your Mother ,[object Object],[object Object],[object Object],[object Object],[object Object]
$37.42 a day or $1122.60 a month ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prices from  Walgreens.com  Oct 2007
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Background - The Ongoing Crisis
Background – Knowledge is Power ,[object Object],[object Object],[object Object],[object Object]
Doctors Don’t Talk About Cost American J Managed Care Nov 2006 ,[object Object],[object Object],[object Object]
What costs more? ,[object Object],[object Object],[object Object]
Which Industry Had the Highest Profit as Percent of Sales or Assets 1995-2005? ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
2006 Fortune 500 Most Profitable Industries: Return on Revenues ,[object Object],[object Object],[object Object]
Background - Big Pharma Basics ,[object Object],[object Object],[object Object],[object Object]
Big Pharma Basics - “Me-Too” Drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Big Pharma Basics - Marketing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Big Pharma Basics –  Influence on Medical Profession ,[object Object],[object Object],[object Object],[object Object]
Big Pharma Basics – Influence on Government ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Perfect Storm Approaching Big Pharma ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
True or False ,[object Object],[object Object],[object Object],[object Object],[object Object]
True or False ,[object Object],[object Object],[object Object],[object Object],[object Object]
What does the drug manufacturer make from these patients?  Rank from highest margin to lowest ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What does the drug manufacturer make from these patients?  Rank from highest margin to lowest ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The cost of Medicare Part D over 10 years ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Journal  Heath Affairs  Feb 2006  Analysis from Centers for Medicare and Medicaid Services ,[object Object],[object Object],[object Object],[object Object]
How to Learn Drug Prices / Comparison Shopping ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to Learn Drug Prices / Comparison Shopping ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Future? ,[object Object],[object Object],[object Object]
Generic Medication ,[object Object],[object Object],[object Object]
Generic Medication ,[object Object],[object Object],[object Object],[object Object]
Generic Medication ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Generics- The Future Looks Sunny ,[object Object],[object Object]
How many generic drugs are awaiting FDA approval? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Generic Drugs Hit Backlog At FDA No Plans to Expand Review Capabilities ,[object Object],[object Object]
Which of the Following are Available Generic? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drugs Coming Off Patent 2007-2009 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What are these seniors doing? Hint….they are from Minnesota
Data from AARP
Data from AARP
Slicing Medications ,[object Object]
Slicing Medications $0.41 $327.47 80 mg $0.81 $323.47 40 mg $1.61 $322.27 20 mg $2.32 $232.07 10 mg Price per 10 mg Dose Price per 100 Tablets Lipitor Dose
Slicing Medications –  Which of the following  cannot  be split? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Slicing Bible
Same Class Medications ,[object Object],[object Object],[object Object],We really are comparing…
Same Class Medications -Nonsedating Antihistamines $60.19 Cetirizine Zyrtec $20.33 Loratadine Claritin $65.67 Desloratadine Clarinex $67.29 Fexofenadine Allegra Monthly Cost Generic Name Brand Name
Getting the Government to Help Your Patients Cartoon may be true when it comes to IT….. but the Gov’t can get cheap drugs
Veterans Programs ,[object Object],[object Object],[object Object]
Medicare and Medicaid ,[object Object]
Part D Basics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medicaid ,[object Object],[object Object]
The BIG Picture- Medicare and Medicaid
Pharmacy Assistance Sources ,[object Object],[object Object],[object Object],[object Object]
A 52 y.o. male presents to a family medicine clinic for a physical after not seeing his physician for 10 years. In the past, his employer did not provide health benefits, however, they recently started doing so. As part of his physical, he was given a lab slip for blood work and was found to have diabetes (FBG 350) and hyperlipidemia (LDL 145; trigs 700), and also was found to have a blood pressure of 156/96. Patient was given Rx’s for Avandamet 2/500 bid, Altace 5mg qd and Lipitor 20mg qd.  Patient then goes to pick up his prescriptions at the local Walgreens and the total amount is  $293 Although patient has recently received health benefits, his employer does not provide prescription coverage. How can we help this patient?
Pharmaceutical Company Programs ,[object Object],[object Object],[object Object]
Click here to begin
Select “L”, then Lipitor
Click here to link directly to application
 
Requires account
 
 
Drug Discount Programs ,[object Object],[object Object]
Click Here Click here
 
Rx outreach income requirements
Income requirements
$4 generic drug program ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
$4 Generic Drug Program – Medication Classes Covered ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Happy Days or a Big Mystery?
Who Can Get Part D Coverage? ,[object Object],[object Object],[object Object]
Medicare Part D 2007 Phase 3 :  YOU PAY $2.15 FOR EACH GENERIC, OR $5.35 FOR EACH BRAND NAME, OR 5% OF  THE  TOTAL OF EACH PRESCRIPTION, WHICHEVER IS THE HIGHER NUMBER. EXAMPLE: A $200 DRUG COSTS YOU $10.00. THIS 5% ARRANGEMENT CONTINUES ONLY UNTIL DECEMBER 31, 2007
 
Drugs NOT Covered by Medicare ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Help for People with Limited Income and Resources Apply for extra help through social security office: www.socialsecurity.gov 1-800-772-1213
Low-Income Assistance ,[object Object],[object Object],[object Object],[object Object],[object Object]
Back to the Sample Patient… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object]
Your Primary Toolbox ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
The End

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Zweig powerpoint on Palliative Care in Nursing Homes for Theme Session co-sponsored by Groups on Geriatrics and Pain Management & Palliative Car

  • 1. Pharmacoeconomics 101: How to Beat the High Cost of Prescription Medications – Resources for you and Your Patients Mark Cucuzzella MD FAAFP (West Virginia University) Heather Congdon, PharmD (University of Maryland)
  • 2. The Old Timey Mountains Potomac R Shenandoah R Maryland W. Virginia Virginia FM
  • 3. “ The education of a man (or woman if Lee were around in 2006) is never completed until he dies” Robert E. Lee
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  • 37. What are these seniors doing? Hint….they are from Minnesota
  • 40.
  • 41. Slicing Medications $0.41 $327.47 80 mg $0.81 $323.47 40 mg $1.61 $322.27 20 mg $2.32 $232.07 10 mg Price per 10 mg Dose Price per 100 Tablets Lipitor Dose
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  • 45. Same Class Medications -Nonsedating Antihistamines $60.19 Cetirizine Zyrtec $20.33 Loratadine Claritin $65.67 Desloratadine Clarinex $67.29 Fexofenadine Allegra Monthly Cost Generic Name Brand Name
  • 46. Getting the Government to Help Your Patients Cartoon may be true when it comes to IT….. but the Gov’t can get cheap drugs
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  • 51. The BIG Picture- Medicare and Medicaid
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  • 53. A 52 y.o. male presents to a family medicine clinic for a physical after not seeing his physician for 10 years. In the past, his employer did not provide health benefits, however, they recently started doing so. As part of his physical, he was given a lab slip for blood work and was found to have diabetes (FBG 350) and hyperlipidemia (LDL 145; trigs 700), and also was found to have a blood pressure of 156/96. Patient was given Rx’s for Avandamet 2/500 bid, Altace 5mg qd and Lipitor 20mg qd. Patient then goes to pick up his prescriptions at the local Walgreens and the total amount is $293 Although patient has recently received health benefits, his employer does not provide prescription coverage. How can we help this patient?
  • 54.
  • 55. Click here to begin
  • 57. Click here to link directly to application
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  • 65. Rx outreach income requirements
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  • 69. Happy Days or a Big Mystery?
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  • 71. Medicare Part D 2007 Phase 3 : YOU PAY $2.15 FOR EACH GENERIC, OR $5.35 FOR EACH BRAND NAME, OR 5% OF  THE  TOTAL OF EACH PRESCRIPTION, WHICHEVER IS THE HIGHER NUMBER. EXAMPLE: A $200 DRUG COSTS YOU $10.00. THIS 5% ARRANGEMENT CONTINUES ONLY UNTIL DECEMBER 31, 2007
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  • 74. Help for People with Limited Income and Resources Apply for extra help through social security office: www.socialsecurity.gov 1-800-772-1213
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