Abstract
Background: Because of their increasing use and high unit costs, biologics pose challenges to payer costcontainment efforts. Creative approaches are needed to assure clinical appropriateness and eliminate unnecessary costs related to biological medications. The biologic etanercept has been approved for treatment of chronic moderate to severe plaque psoriasis in certain adults; however the costs can be over $2,000 per month. Objective: The objective of this study was to evaluate the outcomes of a specialty pharmacy’s retrospective drug utilization review (rDUR) pilot program designed to identify patients with plaque psoriasis who were prescribed a dose of etanercept inconsistent with the manufacturer recommended dosing for plaque psoriasis. Methods: This descriptive analysis evaluated a pharmacist-initiated, provider-oriented rDUR pilot program for plaque psoriasis patients using etanercept. We assessed the rDUR program’s impact on annual cost. A retrospective descriptive analysis was undertaken to assess the rDUR program’s impact on annual cost associated with changes in dosage in prescribed amounts of etanercept for patients with plaque psoriasis. We examined prescription “fills” and cost per patient pre- and post-program implementation using wholesale acquisition costs (WAC). Retrospective DUR review criteria were based on dosing information contained in the prescribing label. Results: The rDUR targeted 388 providers with 444 plaque psoriasis patients; prescriber response rate to faxed reminder letters was 65.5%. Annual costs for etanercept patients had an upper range of $37,638, and annual payer savings associated with reduced dosing regimens were projected to be an average of $22,062 per patient per year. Conclusion: Proactive therapy management approaches are necessary for specialty medications to help eliminate unnecessary health-care expenses related to unintended prescribing in excess of the manufacturer’s recommended dosing. Pharmacist-led programs to provide information regarding manufacturer dosing recommendations can effectively be incorporated into specialty pharmacy, and can significantly and positively influence prescribing and control costs.
Highlights
Specialty medications, of which biological agents are a subset, are associated with long-term patient benefits, such as lower inpatient utilization [1], and improved quality of life [2]
Pharmacist-led programs to provide information regarding manufacturer dosing recommendations can effectively be incorporated into specialty pharmacy, and can significantly and positively influence prescribing and control costs
The retrospective drug utilization review (rDUR) pilot program identified 444 plaque psoriasis patients who were taking more than 50 mg of etanercept weekly, yet beyond the 3 month induction period
Summary
Of which biological agents are a subset, are associated with long-term patient benefits, such as lower inpatient utilization [1], and improved quality of life [2] Because of their increasing use and high unit costs these agents represent the fastest growing segment of drug spending by payers, and pose challenges to payers’ cost-containment efforts [3,4]. The biological, etanercept, was first approved for the treatment of chronic moderate to severe plaque psoriasis in certain adults in 2004 (please note that approved drug information, including any applicable boxed warning, is available at: http://dailymed.nlm.nih.gov/dailymed) Because of their increasing use and high unit costs, biologics pose challenges to payer costcontainment efforts. The biologic etanercept has been approved for treatment of chronic moderate to severe plaque psoriasis in certain adults; the costs can be over $2,000 per month
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