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Factors Influencing Prescription Drug Trend within Medicare

Factors Influencing Prescription Drug Trend within Medicare. Sharon Glave Frazee, PhD., MPH Michael Looney, MBA (ARS Response Card: Channel 41). Disclosure.

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Factors Influencing Prescription Drug Trend within Medicare

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  1. Factors Influencing Prescription Drug Trend within Medicare Sharon Glave Frazee, PhD., MPH Michael Looney, MBA (ARS Response Card: Channel 41)

  2. Disclosure “I, Sharon Frazee and Michael Looney, are employees of Express Scripts, Inc. which provides Medicare drug benefit management services. The research presented herein was funded solely by Express Scripts, Inc.”

  3. Learning Objectives • Analyze pharmacy cost and utilization trends in a Medicare population compared to those in a commercially insured population • Identify the physician characteristics associated with a higher Generic Fill Rate

  4. Express Scripts Research 25 Year Proven History • First Drug Trend Report • Annual Outcomes Conference • Over 70 Peer-Reviewed Articles http://www.express-scripts.com/research/research/ • Award-Winning Research

  5. Challenging Intuition with Science “Implementation of 3-tier copayments will lead to increased medical costs.” “Implementing a PA for PPIs in a Medicaid population will lead to unintended medical consequences.”

  6. Background • Nationwide there are over 47 million (and growing) Medicare beneficiaries1 • 29 million Medicare beneficiaries enrolled in Part D2 • Prescription medications represent 12% of Medicare spending • January 2011 – first of the Baby Boomers turned age 65 • Express Scripts manages benefits for over 2 million Medicare beneficiaries (57% MADP, 28% PDP, 15% Other (EGWP, Secondary to Part D and PACE) 1 Kaiser Family Foundation: State Health Facts 2011 http://www.statehealthfacts.org/comparemaptable.jsp?yr=200&typ=1&ind=290&cat=6&sub=74&sortc=1&o=a 2 Kaiser Family Foundation: The Medicare Prescription Drug Benefit November 2011. Available at http://www.kff.org/medicare/upload/7044-12.pdf

  7. Express Scripts Medicare Trend: 2010 - 2011

  8. Medicare Trend vs. Commercial Trend - Traditional Medicare Cost trend is lower than Commercial Cost Trend Generic medications played a key role

  9. Generic Pipeline: More Than $65 Billion Over Five Years 9

  10. Cost Differential – Brand vs. Generic

  11. Top 10 Traditional Medications Ranked by PMPY Cost 2011

  12. Top Medications by Disease Category: Ranked by PMPY Utilization - 2011

  13. Geographic Variation Source: http://www.dartmouthatlas.org/

  14. Question What influence do prescriber geographic and demographic characteristics have on generic prescribing patterns?

  15. Methodology

  16. Results

  17. Antihypertension Model

  18. Hypertension Prescriber GFR, Multivariate Least Squares Regression

  19. Hypertension – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  20. Hypertension – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  21. Hypertension – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  22. Hypertension – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  23. Antihyperlipidemia Model

  24. Hyperlipidemia Prescriber GFR, Multivariate Least Squares Regression

  25. Hyperlipidemia – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  26. Hyperlipidemia – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  27. Hyperlipidemia – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  28. Hyperlipidemia – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  29. diabetes Model

  30. DiabetesPrescriber GFR, Multivariate Least Squares Regression

  31. Diabetes – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  32. Diabetes – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  33. Diabetes – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  34. Diabetes – Cont’dPrescriber GFR, Multivariate Least Squares Regression

  35. Model Results – Summary

  36. Conclusions • Higher Generic Fill Rate for prescribers who have a high concentration of Medicare Patients • Lower GFR in NY, NJ, PA relative to the rest of the country; higher in New England • Higher income areas have a lower GFR • Rural areas have about a 1-2 point lift in GFR relative to urban areas • Specialists who prescribe diabetes and lipid medications have a lower generic fill rate.

  37. Assessments

  38. Assessment Question 1 Which of the following have been most useful in managing Medicare prescription drug trends? Cost sharing Formulary management Generic medications Physician prescribing

  39. Assessment Question 2 Which of the following are physician characteristics not associated with better Generic Fill Rate? Physician Gender Physician Region Concentration of Medicare Patients All are associated

  40. Questions?

  41. Contact Information For more information please contact: Dr. Sharon Frazee, Vice President Research and Analytics Express Scripts Inc. sefrazee@express-scripts.com Mike Looney, Senior Director Medicare and Medicaid Express Scripts Inc. mlooney@express-scripts.com

  42. Presentation EvaluationPlease get your ARS Response Card ready

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