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Big pharma etching deeper mark on clinical support processes


Medication adherence is the common goal of many stakeholders. Pharma is willing to help.

NATIONAL REPORTS-Ranking number six in PricewaterhouseCoopers' top 10 issues to watch this year is big pharma's joining the healthcare delivery team. A greater alignment of incentives between pharmaceutical companies, payers and providers aims to produce better clinical effectiveness, product safety and compliance.

"PricewaterhouseCoopers' prediction is right on," says Eric Larson, MD, executive director, Group Health Research Institute in Seattle. "There is an intense pressure to lower costs and improve effectiveness, and not just by finding the next product but rather, improving upon what we have and how we take care of people."

As a public interest research group, the institute produces open-source research and shares it with manufacturers, academic universities and its affiliated health system, Group Health Cooperative. Some of its recent studies have targeted, for example, alternatives to hormone replacement therapy.

"Pharmaceutical companies and pharmacy benefit managers also are increasingly collaborating to share best practices as they develop materials and tools to help customers achieve better health," says Claire Marie Burchill, vice president of product and marketing for CIGNA. "Some examples include medication-adherence barrier assessments or educational materials that are used in smoking cessation programs."

Vogenberg also sees a trend toward manufacturers trying to sell their products' value through a more customer-focused strategy, such as by educating pharmacists on a drug's ability to enhance quality of life while providing good economic value. They are also discussing the science of drugs with physicians, playing up the economic benefits to insurers and empowering patient social-networking organizations to advocate their value with similar information.


Steve Miller, MD, chief medical officer of Express Scripts, a pharmacy benefits manager (PBM) based in St. Louis, is taking a middle-of-the-road stance on PwC's prediction by both agreeing and disagreeing with the prognosis.

"Our job is to help patients receive the lowest cost, most clinically acceptable medications even if those are generics," he says. "We don't support pharma in its efforts to push brand products."

He points to the PBM's December report confirming the safety of a generic seizure medication, which saved hundreds of thousands of dollars.

"On the flip side, we cooperate with pharmaceutical manufacturers-especially in promoting compliance to chronic disease medications," Dr. Miller continues.

The claims-based, case-control study by the PBM proves its contention that the use of generic, anti-epileptic drugs is a safe and effective cost-saving option for patients and plan sponsors seeking to reduce medication-related waste. The study found no evidence that switching between A-rated anti-epileptic drugs, including brand to generic substitution, was associated with increased emergency room visits or hospitalizations for epilepsy.


Mail order is an area that PBMs, payers and pharma identify as a solution for combating non-compliance. Dr. Miller says that mail service is particularly beneficial for those patients who procrastinate in refilling their prescriptions and cites a 15% improvement in adherence by using the home-delivery service. According to Express Scripts data reported in 2008, at the prevailing market penetration for mail-order home delivery, the healthcare system could save as much as $78.9 billion between 2006 and 2015 by opting for mail order.

The company recently announced plans to open a high-volume filling facility in St. Louis in April that will be able to dispense, package and ship 110,000 prescriptions per day. The facility will use advanced automation technology.

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