PEC Pipeline: Looking into the Crystal Ball LCDR Joe Lawrence, MSC, USN

PEC Pipeline:
Looking into the Crystal Ball
LCDR Joe Lawrence, MSC, USN
Dr. Julie Liss
DoD PEC Conference 2007
Promoting high quality, cost effective drug therapy throughout the Military Health System
PEC Pipeline 2007
Objectives
• Describe different strategies used to
identify a drug class review for the
Uniform Formulary
• Discuss key elements considered in
all Uniform Formulary decisions
• Identify online resources to support
the Uniform Formulary
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Strategies for Drug Class Review
• High expenditures
– “80 / 20 Rule”: 20% of the drugs comprise
80% of the drug expenditures
• Competitive forces
– Generic availability, pharmaceutical
detailing, new molecular agents
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Strategies for Drug Class Review
• Contract expiration
– DoD contract, DoD/VA joint contract, BPA
• Patent life expectancy
– Time to generic availability
• Uniform formulary mandate
– Requirement to review all drug classes
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Strategies for Drug Class Review
• Utilization patterns
– Evaluate usage at MTFs, TMOP, Retail
Network
– If one drug has 90% market share, can we
expect a shift to other drugs, if the market
leader is made non-formulary?
• Operational considerations
– Switches by pharmacy or MD, packaging
issues, contractor requirements
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Defining the Drug Class
•
•
•
Flexibility to assign drugs to a particular class
Drug class members are included based on
therapeutic uses (including off-label uses),
mechanism of action, market forces
Decide whether the drug class is a Basic Core
Formulary (BCF) vs. Extended Core Formulary (ECF)
candidate
–
–
–
–
Decide up-front which category will be appropriate
Requirement of UF Rule
BCF: likely to be used in primary care; ECF: used by
specialists
*MTF determines need / use of ECF class
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Strategies for Drug Class Review
Examples
• High expenditures across Military Health System
(MHS)
– Angiotensin Receptor Blockers (ARBs) Feb 05
– Proton pump inhibitors (PPIs) Feb 05
– ACE inhibitors (ACEs) Aug 05
– Calcium channel blockers (CCBs) Aug 05
– Antidepressants Nov 05
– Statins Aug 06
• Market competition within a class
– Overactive Bladder Drugs Feb 06: 3 new drugs approved
(Sanctura, Enablex, Vesicare)
– PDE-5s May 05: Viagra, Levitra, Cialis
– BPH drugs Aug 05: Uroxatral, Flomax
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Strategies for Drug Class Review
Examples
• Expiration / discontinuation of existing DoD
contract
– Gatifloxacin Nov 05 (Tequin) expired Feb 06
– Simvastatin Aug 06 (Zocor) expired Jan 07
– Zolmitriptan (Zomig) expires Jul 07
• Impending generic competition
– Nasal steroids Nov 05 (Flonase 1st qtr 06)
– Statins Aug 06 (Zocor June 06)
– Anti-emetics May 06 (Zofran 4th qtr 06)
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Strategies for Drug Class Review
Examples
• New drug likely to replace a highly utilized
generic and aggressive mfg marketing
– GABA drugs (gabapentin, pregabalin) Feb 06
– Oral contraceptives May 06
• Previous UF decision prompts new drug
class review
– Miscellaneous Anti-hypertensive drugs
(ACE/CCB combos; Lotrel) Feb 06
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Strategies for Drug Class Review
Examples
• Uniform Formulary development
– Requirement to review drug classes for
inclusion or exclusion
• Extended Core Formulary drug class
– Multiple Sclerosis drugs Aug 05
– Alzheimers drugs Nov 05
• H2 blockers Aug 06
• Older sedative hypnotics Nov 06
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Uniform Formulary (UF) Decision Process: A
Refresher Course
• Examine costs and effects of competing alternatives
• Based on best value to entire enterprise (MTF, TMOP
and Retail consideration)
• Decision path
– PEC completes analyses and provides recommendations to
DoD P&T
– DoD P&T considers all alternatives and forwards collective
recommendation to TMA director
– BAP comments on P&T Committee recommendations
– TMA Director concurs or non-concurs with Committee
recommendations.
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Uniform Formulary Class Reviews
Oct 05 – Sep 06
Drug Class Name
Antilipidemics
PPIs (Acid Blockers)
Antidepressants
Narcotic analgesics
Angiotensin Receptor Blockers
Thiazolidinediones
Calcium Channel Blockers
Sleepers (newer + older)
Nasal corticosteroids
Contraceptives
ACE Inhibitors
Alzheimers
ADHD/Narcolepsy
Multiple Sclerosis
Overactive Bladder
GABA Anticonvulsants
Ophthalmic glaucoma
α-blockers
Macrolides/Ketolide
Antiemetics
Misc Anti-Hypertension
PDE5 Inhibitors
5α-reductase Inhibitors
Growth hormone
H-2 and Misc GI
Topical Antifungals
MAOIs
Total of Completed or Scheduled Reviews
Rank
1
2
3
8
10
11
13
15
21
21
24
25
26
27
31
32
34
42
42
43
46
50
51
62
75
86
341
$Millions % to Total Spend
$650
$467
$323
$153
$143
$136
$117
$110
$69
$69
$60
$59
$58
$58
$54
$53
$51
~$40
$39
$38
$36
$32
~$31
$21
$10
$11
<$1
$2,888
10.51%
7.56%
5.23%
2.47%
2.31%
2.20%
1.90%
1.78%
1.11%
1.12%
0.98%
0.96%
0.95%
0.94%
0.87%
0.86%
0.83%
0.65%
0.63%
0.62%
0.58%
0.52%
0.50%
0.34%
0.16%
0.17%
0.00%
46.70%
$6,181
100.00%
Completed Drug Class Reviews
Tenatively scheduled for 2007
Total spend FY 06
Totals & rankings are approximate
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Upcoming UF Class Reviews
• Feb 07
– Monoamine oxidase
antidepressants (MAOIs)
– Glaucoma agents (topical)
– Narcotic analgesics
– Newer sedative hypnotics
• May 07 (tentative)
– Angiotensin receptor
blockers (ARBs)
– Proton pump inhibitors
(PPIs)
– Remaining anti-lipidemics
(fibrates, bile acid
sequestrants, fish oil)
– 5-alpha reductase
inhibitors
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
• Next 12 months
(tentative)
– Growth hormone
– RBC Growth Factors
– Tumor necrosis factor-α
blockers & similar agents
– Tricyclic antidepressants
(TCAs)
– Cough/cold medications
– Ophthalmic NSAIDs
– Ophthalmic antihistamines
& mast cell stabilizers
– Diabetes agents
Resources For Uniform Formulary
Websites
• RxNet
• PEC Website
• TMA website
• Formulary Search Tool
• Pharmacy Administration Cost Evaluation
Reports (PACER)
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Take Away Messages for MTF Pharmacy
Community
• Understand Pharmacy Program
Environment
• Know your contributions toward meeting
program objectives
• Educate those around you!
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil
Questions?
DoD Pharmacoeconomic Center
www.pec.ha.osd.mil