Study findings question claims of significant savings from pharmacy dose consolidation programs

09/23/04

ST. LOUIS, SEPTEMBER 23, 2004 – Previously published research suggests that programs encouraging physicians to prescribe once-daily strength tablets instead of two lower-strength tablets when the per tablet cost is the same – thus doubling the cost – would save money.

However, in a study published today by the Journal of Managed Care Pharmacy, while savings opportunities from these programs were found, the savings may not be enough to justify the costs plan sponsors would incur educating physicians and patients on the benefits of changing to a single, less expensive dose, also known as dose consolidation.

In the study, researchers at pharmacy benefit manager Express Scripts examined pharmacy claims for more than 500,000 members of a large mid-Atlantic health plan from November 2002 to February 2003. They sought to determine if physicians that prescribed twice-daily doses of certain medicines for plan members would prescribe more efficient once-daily doses for medications where Food and Drug Administration (FDA) dosing recommendations allow once daily doses.

Doctors and a group of their patients were sent a letter detailing the benefits of changing from twice-daily to once-daily dosing. This is called dose consolidation. Although the twice-daily dosages had a lower strength, they each cost the same – per tablet, capsule or caplet – as the higher strength single dose, thus doubling the cost.

The researchers found that approximately 9% of the physicians who received dose consolidation letters changed their patients' prescriptions to a once-daily dose. The study also found that 4% of physicians switched their patients to a once-daily dose even without being contacted – representing a natural dose consolidation rate. These additional physicians were part of a randomly assigned control group that did not receive letters.

Financial modeling showed that the plan sponsor would save only $0.02 to $0.03 per member per month (PMPM), or approximately 0.08% of PMPM drug costs when taking into account program costs, naturally occurring dose consolidation and members who would have stopped taking the prescriptions.

This is the first study to examine the cost-effectiveness of a dose consolidation program. There have been other studies on dose consolidation, but none considered the plan sponsor's costs for implementing the program, or adequately assessed the rate of consolidation that would have occurred naturally without physician contact, as this study did.

While the consolidation program found cost-savings opportunities for certain therapy classes, such as calcium blockers, antihypertensives and antihyperlipidemics, the number of prescriptions was too small to justify implementing a program for those classes. Conversely, in therapy classes with a significant number of prescriptions, such as anti-inflammatories, anti-ulcers and antidepressants, the cost savings were too small to justify implementing a program because of the availability of generic or over-the-counter (OTC) drugs in the class.

"This is another example of how Express Scripts provides relevant, objective research to help assist plan sponsors in making informed decisions around management of the pharmacy benefit," said Brenda Motheral, vice president of Research and Trend Management, Express Scripts.

Source: Eurekalert & others

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