The next big data visualization graphic: This week Express Scripts published its annual drug report. The big news: the cost of nonadherence. Indeed, $317 billion of the $408 billion in pharmacy-related waste accumulated in 2011 was due to failed medical adherence, more money than the combined drug costs associated with treating diabetes, congestive heart failure and cancer – combined. Working towards solutions for nonadherence obviously frees up a lot of resources that might be devoted to the coverage of new specialty medicines. (For pharma, it might even be a way to structure a risk-sharing contract. But we digress.)
According to a piece in the Wall Street Journal on the growing importance of Big Data, one emerging strategy—and business opportunity—at payers, pharmacy benefit managers, and even providers, is the development of analytic capabilities. Mark it under the mantra “you control what you don’t measure.” Key data intensive areas include not just patient adherence, but also probability of relapse, as well as cost (especially total cost of care). How are different stakeholders using the data?
As WSJ spells out, providers such as Health Management Associates and the California physicians group Heritage Provider Network are trying to predict—and hopefully eliminate or avoid—unnecessary hospital readmissions. Express Scripts wants to improve adherence to medications, especially in costly primary care areas like diabetes. And we’ve told you about Wellpoint’s tie-up with IBM’s Watson to create decision support tools. This emphasis on eliminating waste is hardly surprising. It’s politically tenable and low hanging fruit that frees up money for other coverage decisions. Certainly former CMS administrator Donald Berwick reached a similar conclusion in this week’s issue of the Journal of the American Medical Association.
- The Express Scripts annual report is here.
- WSJ weighs in on BIG DATA.
- Donald Berwick’s editorial in JAMA can be found here.
Covert co-pay cards? Results from research conducted by the National Coalition on Health Care suggest that co-pay coupons have been used by over 2 million seniors. In a recent survey of 1,000 seniors enrolled in Medicare Part D– a small fraction of the 42 million Medicare enrollees—up to 6% of respondents reported using co-pay cards to purchase brand-name prescription drugs. The report notes that if similar usage is applied across all Medicare enrollees, coupon use would exceed 2 million seniors. Why does this matter? For starters, the issuance of coupons for brand-name drugs is banned by Medicare and other federal programs as part of anit-kickback legislation. (One wonders if such usage could also begin to trigger debates on best pricing.) Another nugget of note: according to the report, physicians were the most frequently cited source of information on co-pay cards. Moreover, almost none of the seniors knew that Medicare does not permit the use of co-pay cards. Since the pharmacy system that processes the coupon use is separate from Medicare even tracking use is difficult. The NCHC suggests pharmaceutical companies issuing co-pay cards should have some accountability for misuse; while many of the coupons include statements that they are not permitted in Medicare, Medicare and drug sponsors must share responsibility for appropriate coupon use says the organization.
- Read the NCHC press release here.
- The Pink Sheet analysis of the situation is here.
- Real Endpoints’s review of the co-pay debate.
A week of prostate cancer news: One might think that as the third wealthiest man in the world, Warren Buffet would pay for the most effective prostate cancer treatment no matter the price. On the other hand, for patients over 70, many argue that treatment is largely unnecessary based on currently available evidence.
In the midst of the debate on the relevance of PSA as a surrogate marker and treatment options, a study from the Journal of the American Medical Association suggests that the best treatment is in fact not the most expensive. The paper reports on a comparative study of non-metastatic prostate cancer treatments, suggesting that many of the new and quickly adopted radiation treatments come with little increased efficacy despite greater costs. The study looked at data from over 10,000 Medicare patients from 16 cancer registries diagnosed with prostate cancer between 2000 and 2007.
The paper compared the usage and known efficacy of three forms of treatment: conformal radiation therapy, intensity-modulated radiation therapy (IMRT) aimed to limit damage to the surrounding organs, and the far more expensive proton beam radiation. Over the eight year period, there were benefits in the use of IMRT relative to older forms of radiation therapy. But it was a different story for proton therapy, with data suggesting patients treated via this method tended to have more stomach problems than IMRT patients. What the study lacks, and it comments on this very point, is a proper assessment of clinical outcomes. Part of the problem is claims files used in studies like these “are not designed to provide clinical information, so the data may be subject to misclassification.”
- The JAMA article is available here.
- Two WSJ stories outlining prostate cancer treatment options can be found here and here.
- Wise choices can come with age when deciding on prostate cancer treatment. (Reuters)
- What we can learn from Warren Buffett’s prostate cancer. (NPR)
Is There Balm in Gilead? What happens when two pharmas won’t work together to develop a combination therapy because each has competing pipeline products that make the obvious, nearer term tie-up complicated? We’ll probably see very soon, given a surprisingly effective hepatitis C may remain in the lab because Bristol-Myers Squibb and Gilead Sciences don’t plan on further work together. One of the big news items at this year’s European Association for the Study of Liver Disease (EASL) was Phase II data showing that once daily treatment with Bristol’s declatasvir plus Gilead’s GS-7977 demonstrated a 100% early cure rate for genotype 1 patients and a 91% cure rate for genotype 2/3 patients. Adam Feuerstein at The Street offered an assessment that was only partly tongue in cheek: “Obviously, the results can’t get better than that.” Thing is, Gilead doesn’t want to proceed into a Phase III study, according to a Bristol spokesperson. In an $11 billion deal earlier this year, Gilead acquired Pharmasset– the original owner of GS-7977–in hopes of dominating the future of the Hep C treatment market. Going forward with Bristol would probably dilute the profits given it has earlier stage compounds that might eventually be used in combination. On the other hand, Bristol has a backup plan that involves its own iteration of the combo-drug. It will be interesting to see what hepatitis C advocates do with the knowledge and whether they begin to put pressure on Gilead to stay the course.
Image courtesy of flickrer Benimoto via creative commons.