2010: Not such a good year for Politics , Physicians, Patients and Pharma

2010 may be one of those years that many of us in the US want to forget. Chief among those hoping for a better year ahead will be politicians, physicians and the Pharma industry.

In view of the festive season we’ve decided to leave the political review of the past 12 months to the excellent political satirists at JibJab.  They entitled their remorseless, but as usual, stunningly accurate review of the year Duet of Regret.  Word on Health is delighted to re-gift this to you. Enjoy!

It’s been an equally bad year for doctors.  In late November, physicians learned that the reimbursement they receive for Medicare patients would drop by 23%  in December and a further 2% in January. These cuts are the latest installment of the 1997 Balanced Budget Act and attempts to rein in spending on health care for the elderly.

This is not only bad news for doctors, many of whose practices are largely composed of Medicare patients but also for the baby-boomer patients just turning 65 who may find themselves without a doctor.  Critics predict, some physicians will see Medicare patients  less frequently, while others will stop seeing them altogether.  Cynics have gone so far as to call this “elder cleansing.”

Now, to top of the year, a report from Public Citizen found that pharmaceutical companies top the list when it comes to defrauding the government. In fact , over the past decade, the pharma  industry accounted for 25% of all federal fines charged under the False Claims Act.

According to the analysis, drug-makers were the focus of 165 major settlements and have paid $19.8 billion in fines and settlements since 1991.  Three-quarters of these charges occurring over the past five years. GlaxoSmithKline, Pfizer, Eli Lilly, and Schering-Plough accounted for $10.5 billion of all financial penalties imposed over that period.

Pfizer holds the record for the largest criminal fine in United States history, $1.3 billion, and the largest health care fraud case, $2.3 from a settlement last year involving its marketing of the painkiller Bextra and other drugs.
Another company joined the violators  list just last week. Irish drug maker Elan announced that it had agreed to pay $203.5 million, half in criminal penalties, half in a civil payment, to settle an investigation of its illegal off-label marketing of the antiseizure medicine Zonegran.

While Word on Health sadly can’t fix politics or physician payments, SRxA can certainly help pharmaceutical companies stay out of trouble.  To find out how, make it your New Year’s Resolution list to contact us.

Pharma’s Missing Millions

As Word on Health has previously reported, patients not taking or refilling medications on time costs the pharmaceutical industry billions each year.  The recent global economic crisis has helped write a whole new chapter in the adherence story.  Higher numbers of new prescriptions simply go unfilled because patients either cannot afford, or are unwilling, to pay for them.

In the U.S., the total number of prescriptions filled grew a modest 2.7% last year. Yet the rate of prescriptions submitted to a pharmacy but never picked up rose 24%.

According to Dea Belazi, a consulting practice leader for Wolters Kluwer Pharma Solutions,  “What’s peculiar is that the rate of increase among patients walking away is almost unprecedented. Over the last two years, pharma has been trying to understand the abandonment situation, particularly in which parts of the country patients tend to abandon more.”
Among commercial health plan patients, the abandonment rate for new prescriptions at the pharmacy reached 6.3% in 2009. The abandonment rate for new prescriptions of brand-name drugs alone was 8.6%, up 23% from 2008 and nearly 70% since 2006.

Rising co-pays are one reason.  However, macroeconomic factors such as the housing crisis, subsequent recession and lower household incomes are thought to be the main culprits behind rising price sensitivity and soaring abandonment rates.
Health plan denials compound the problem.  Taken together, patient abandonment and payer denials resulted in 14.4% of all new, commercial-plan prescriptions going unfilled in 2009, a 5.5% increase from 2008.
Where can pharma go from here? Abandonment varies geographically. It is highest in Delaware, North Carolina and Florida, whereas denial rates for new prescriptions of brand-name meds are highest in California, Delaware and Florida.

SRxA’s team of world class Health Outcomes experts can help create tactics and strategies to help pharmaceutical companies address abandonment, denial and compliance. Contact us to find out more.