Generics Grab Big Share Of Medicare Part D: Study
3 CommentsBy Ed Silverman // June 23rd, 2008 // 12:07 pm
That donut hole seems to be where all the action takes place. For those not familiar with the terminology, that refers to a coverage gap that requires plan participants to pay all out-of-pocket expenses for a prescription. That’s when generics become popular, according to a study by Wolters Kluwer Health.
For example, before Medicare Part D began in January 2006, the generic-to-brand ratio was even with 50 percent of MPD patients overall using generics and 50 percent using brands. By the end of 2006, within the MPD population, that split increased to 56 percent for generics and 43 percent for brands. By 2007, 63 percent of all MPD scrips went to generics versus 37 percent for brands, WKH found.
Other findings, according to WKH: Patients are willing to stay on a branded med while in the coverage gap for the first 60 to 90 days. However, with the average stay in the gap increasing to more than 100 days and the overall cost of branded meds rising, many patients are choosing to replace their branded drugs with generics.
What else? Claims for generics climbed to 63 percent of all MPD claims, up 6 percent from 2006; Among those in the coverage gap who discontinue their brands, only 6 percent returned to their branded med after leaving the gap.
For patients in the gap, drugs experienced extraordinary price disparity between brands and generics, WKH reports. Among cholesterol meds, there is a $72 difference between the cost of a 30-day supply to the patient between a brand and a generic.
In 2007, Medicare patients paid, on average, $21.99 for a 30-day supply of branded drugs in the top 10 therapeutic categories compared to $17.58 in 2006, representing an increase of 25 percent, WKH found.
But among commercial plans, patients in 2007 paid an average of $26.31 for a 30-day supply, just $4.32 more than MPD patients. In 2006, commercial plan patients paid an average $37.54, suggesting commercial plans decreased their costs on average by $11.23 in 2007, according to WKH.
Sam
This report is correct, but the vast majority of Plan D insurance
companies demand generic use. Even brand drugs maybe
rejected with a message from the Plan saying physician should
use a 2 step procedure requiring the physician to try a generically
available drug used for the same condition.
It has been my experience that about 12% of the patients would
prefer the brand. Other patients make sure the physician writes
“Brand only”. Many times the Plan D insurance and other insurances
will require a “prior authorization”. This mean the physician has to
call a telephone number and discuss with a rep from the insurance company as to why the brand drug is necessary. This can mean a
2 to 3 day delay in making the drug available — If approved!
Bob Freeman
Perhaps this is why the industry is fighting at the states’ level to change mandatory generic substitution laws. It’s certainly not a public health issue; simply a way to game the reimbursement system. What the industry doesn’t realize is that their ploy, should it become relatively successful, is a natural justification for reference pricing at the therapeutic category or product level.
Just A Thought
As I see it, a change in suppliers is a change in suppliers… be it one excipient or a completed medication, either can create problems.
My last scrip was written for a generic… no substitutions. When the pharmacy filled it for the branded product they were refused a sale until they fixed it. Heck, I have 3 months worth of the branded stuff sitting right here. I cannot take it.
This just wouldn’t fly where generics are concerned…
“However, the criteria Pfizer used was not requested by the FDA to show bioequivalence and was different from the FDA criteria, according to an FDA spokeswoman. She adds that the FDA was unable to review the study protocols before Pfizer proceeded and the agency doesn’t know why Pfizer chose different acceptance criteria. Nonetheless, the agency did approve the new Dilantin.”
http://www.pharmalot.com/2008/05/a-new-version-of-dilantin-is-giving-pfizer-fits/
I do appreciate that, in an effort to disprove generics, they are held to a fairly high standard.
Double edged sword ain’t it?