Speaker: Gary M. Owens, MD, Vice President, Patient Care Management, Independent Blue Cross, Philadelphia, Pennsylvania.

Dr. Owens discussed the drivers for pharmaceutical costs. While health care costs are still rising, managed care growth has flattened and employer-based coverage is declining. And the increase in pharmacy costs exceeds other health care costs. The primary driver of increased pharmacy costs is increased utilization. The growing research and development (R&D) budgets and faster FDA approval have led to more new products in the marketplace. The drivers for prescription drug spending include new drugs, biotechnology products, genomic/proteomic therapies, lifestyle drugs, and DTC advertising. The dilemma for health plans then becomes how to balance the desires of members and providers for the coverage of new pharmaceuticals versus the scientific evidence supporting their use. Health plans must be able to evaluate new pharmacy products as they come to market and understand the impact of new products in the marketplace and pharmacoeconomics (i.e., economic, clinical, and humanistic outcomes vs. cost). When using pharmacoeconomic steps and models, emphasis must be placed on real-world scenarios, value propositions, applicability to the plan, the ability to verify information, and understanding limitations. Limitations can include assumptions that are difficult to validate; a model creating multiple scenarios; the lack of a standardized format for pharmacoeconomic studies; and claim and pharmacy data that are not easy to merge. In addition, plan experts must review and understand the pharma-coeconomic studies; models will change and need refinement; and assumptions or the population might change for the plan.

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Speaker: Joseph Eichenholz, MA, Managing Director, Trigenesis Management Systems, Chatham, New Jersey.

Mr. Eichenholz outlined data in the Aventis Managed Care Digest Series to review managed care trends and their implications for the pharmacy. He noted that the major trends in health care were an increase in consumer power, a redefinition of the patient-physician relationship, an increasing sophistication of physician groups, a redefinition of relationships among stakeholders, changes in information and technology, a continued integration of “virtual” providers into organized delivery systems, and more aggressive employers and pharmacy benefit managers (PBMs).

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Health Care Coat of Arms

Speaker: Jeffrey Lenow, MD, JD, Medical Director of JeffCARE, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

Dr. Lenow, President of the P&T Society, opened the meeting by recounting some of his experiences in teaching medical school residents. These future doctors of America participated in an activity called the “Coat of Arms” exercise. In this exercise, participants outlined their vision of the most important parts of health care today and in the future. The main themes, which were illustrated in hand drawings of a coat of arms, were balance of cost and quality, the costs of pharmaceutical care, hope for unity inter-industry, the importance of new technology, the culture of safety/error management, social needs for improved access, a new era of accountabilty, and the new consumers.

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Health care budgets are limited and, therefore, new therapies are increasingly required to demonstrate both clinical and economic benefits. In the case of PMO, demographic trends indicate that in the coming years a larger proportion of the population will be at risk of PMO because of advancing age, thereby placing an increased burden on MCOs to provide PMO care.

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Over the three-year period, risedronate produced greater reductions in fractures compared to alendronate. Patients treated with risedronate experienced 23 hip and 111 vertebral fractures (134 total fractures) per 1,000 patients (Table 3). In contrast, a total of 28 hip fractures and 115 vertebral fractures per 1,000 patients (for a total of 143 fractures) were experienced with generic alendronate. Among the 1,000 patients in the untreated cohort, there were 58 hip fractures (three-year risk of 5.8%) and 217 vertebral fractures (three-year risk of 21.7%). Treatment with risedronate also resulted in higher QALYs than alendronate (2,359 versus 2,356 per 1,000 patients, respectively) and placebo (2,321 per 1,000 patients). The total costs were lowest for the untreated cohort, followed by risedronate and alen-dronate.

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Vertebral Fracture

As with hip fracture, vertebral fracture rates for the general population were adjusted to reflect a PMO population. Efficacy values (in terms of relative risk of fracture) of 0.51 and 0.53 were used for patients treated with risedronate tablet or alendronate, respectively. These efficacy rates were obtained from randomized clinical trials with similar patient populations as the base case cohort. Excess mortality caused by vertebral fractures was not incorporated because of the lack of comprehensive data on the degree of increased risk of death.

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Patient Population

Our base case analysis consisted of a hypothetical cohort of 65-year-old-women with low bone mineral density (BMD) (i.e., BMD of 2.5 or more standard deviations [SD] below the young adult mean) and a prevalent vertebral fracture. We assume that 21% of 65-to 69- year-olds fall into this study population.

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