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Hines DM, Doshi R, Anupindi VR, Dai F, Russ C, Stellhorn R, Cheng D, Deeba S, Wang Y, DeKoven M. Payer approval and rejection of oral anticoagulant prescriptions and prescription abandonment patterns among patients with venous thromboembolism. J Manag Care Spec Pharm 2024; 30:441-455. [PMID: 38277234 PMCID: PMC11068657 DOI: 10.18553/jmcp.2024.23194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major public health condition that renders patients at risk of recurrent events, which significantly increases their morbidity, mortality, and health care costs. Apart from warfarin, direct oral anticoagulants, such as apixaban, dabigatran, or rivaroxaban, are approved for VTE treatment. Cardiovascular drugs are largely impacted by formulary restrictions; however, the impact on oral anticoagulants (including warfarin and direct oral anticoagulants) in VTE has not been well studied. OBJECTIVE To describe the extent of payer-rejected claims for oral anticoagulants for VTE and the factors associated with rejected claims. Prescription abandonment of oral anticoagulants and the time to an eventual fill for oral anticoagulant after rejection or abandonment were also evaluated. METHODS A retrospective cohort study was conducted among patients with VTE newly prescribed an oral anticoagulant (first claim was the index) between October 2016 and October 2021. Descriptive statistics were used to describe the proportion of patients with paid (ie, filled), rejected, or abandoned index oral anticoagulant prescription and journey to paid prescription among those with initial rejection. Multivariable logistic regression was used to identify factors associated with initial rejection. RESULTS Among the overall sample (N = 297,312), 74.3% had initial oral anticoagulant prescriptions approved, 9.1% had them rejected, and 16.7% abandoned them. Of the patients with initial rejection, 82.1% eventually filled their oral anticoagulant prescriptions; however, for 14.2% of these patients, the first fill was for an oral anticoagulant other than that initially prescribed. The mean time to a first fill for an oral anticoagulant after an initial rejection was 18.3 days. More than half of the patients with an initial rejected oral anticoagulant claim had at least 1 additional rejection during the follow-up period. Of the patients who abandoned their initial oral anticoagulant prescription, 83.9% filled an oral anticoagulant prescription during follow-up; the mean time to fill for the index oral anticoagulant was 15.6 days. Oral anticoagulant type, Medicare payer coverage, prescribing physician specialty, and VTE diagnosis setting of care were significantly associated with index oral anticoagulant claim rejection (P < 0.05). CONCLUSIONS Rejection and abandonment may delay access to oral anticoagulant treatment. Factors contributing to these scenarios should be understood and addressed for proper VTE management.
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Schackmann L, Koster ES, van Dijk L, Vervloet M, Heringa M. Communication skills-based training about medication switch encounters: pharmacy staff and patients' experiences. Int J Clin Pharm 2024; 46:439-450. [PMID: 38231348 DOI: 10.1007/s11096-023-01664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/24/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Non-medical medication switches can lead to difficult conversations. To support pharmacy staff, a communication training has been developed based on two strategies: 'positive message framing' to emphasize positive elements of the message and 'breaking bad news model' to break the news immediately and address emotions. AIM To assess how patients and trained pharmacy staff experience the application of communication strategies for non-medical medication switch conversations and which are barriers and facilitators for the application. METHOD The Kirkpatrick training evaluation model, level 3 'behavior', including barriers and facilitators and 4 'results' was used. Trained pharmacy staff registered switch conversation characteristics and asked patients to complete a questionnaire. Semi-structured interviews with trained pharmacy staff members were conducted. Quantitative data were analyzed descriptively and interview data were analyzed thematically. RESULTS Of the 39 trained pharmacy staff members, 21 registered characteristics of 71 conversations and 13 were interviewed; 31 patients completed questionnaires. Level 3: trained pharmacy staff self-reported they applied aspects of the strategies, though indicated this was not yet a standard process. Interviewees indicated signs of increased patient contact and job satisfaction. Time, face-to-face conversations and colleague support were facilitators. Level 4: pharmacy staff members were satisfied with most switch conversations (89%), particularly with addressing emotions (74%). Patients were (very) positive (77%) about the communication, particularly about clear explanations about the switch. CONCLUSION Pharmacy staff's learned behavior includes being able to apply aspects of the strategies. The training results show first signs of better patient-pharmacy staff relationships and increased job satisfaction.
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Affiliation(s)
- Laura Schackmann
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
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Schackmann L, Vervloet M, van Dijk L, Heringa M, Koster ES. Communication during encounters about medication switching: Self-reported experiences of pharmacy technicians and patients. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100259. [PMID: 37091628 PMCID: PMC10114223 DOI: 10.1016/j.rcsop.2023.100259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Background During conversations about medication switches, pharmacy staff often deliver a message to patients that may lead to negative emotions. In these situations, clear and patient-centered communication is important. Aim To gain insight into pharmacy technician-patient experiences regarding the communication during medication switching encounters, and in specific to map the needs and preferences of patients and whether pharmacy technicians (PTs) meet these. Method PTs were invited to fill in a questionnaire via the Dutch Panel on practical research for Pharmacy Employees. Online questionnaires were distributed to adult chronic mediation users in two patient panels. Questionnaires contained questions on how PTs and patients experience the medication switch conversations at the moment (i.e. type of information patients need/receive, timing of information, channel, communication style), and whether the needs and preferences of patients are met. Results In total, 138 PTs and 4679 patients responded. PTs indicated that they regularly struggle with these conversations due to emotional or negative responses of patients. Most patients expressed the need for information about why the medication switch took place (68%) and about the (same) effect of the medication (61%), while fewer patients currently receive this information (21% and 39%, respectively). Patients also indicated they need verbal information during pick-up/delivery (45%), written information beforehand (29%) and during pick-up/delivery (25%), while patients more often receive verbal information during pick-up (58%), and less frequently receive written information beforehand (6%) and during pick-up/delivery (18%). Conclusion Communication during medication switch conversations generally goes well. However, there is a difference between what PTs claim they do and what patients experience, e.g. space for questions and patients' satisfaction about this aspect. Dealing with patient emotions is also difficult for PTs. Patients emphasize they need more information than they currently receive, preferably before switching. Matching these needs and preferences can improve patient-centered communication.
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Affiliation(s)
- Laura Schackmann
- Nivel, the Netherlands
- University of Groningen, the Netherlands
- Correspondence author at: Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands.
| | | | - Liset van Dijk
- Nivel, the Netherlands
- University of Groningen, the Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, the Netherlands
| | - Ellen S. Koster
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, the Netherlands
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Outcomes in Ixekizumab Patients Following Exposure to Secukinumab and Other Biologics in the CorEvitas Psoriasis Registry. Dermatol Ther (Heidelb) 2022; 12:2797-2815. [DOI: 10.1007/s13555-022-00834-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
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Under the Umbrella of Clinical Pharmacology: Inflammatory Bowel Disease, Infliximab and Adalimumab, and a Bridge to an Era of Biosimilars. Pharmaceutics 2022; 14:pharmaceutics14091766. [PMID: 36145514 PMCID: PMC9505802 DOI: 10.3390/pharmaceutics14091766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Monoclonal antibodies (MAbs) have revolutionized the treatment of many chronic inflammatory diseases, including inflammatory bowel disease (IBD). IBD is a term that comprises two quite similar, yet distinctive, disorders—Crohn’s disease (CD) and ulcerative colitis (UC). Two blockbuster MAbs, infliximab (IFX) and adalimumab (ADL), transformed the pharmacological approach of treating CD and UC. However, due to the complex interplay of pharmacology and immunology, MAbs face challenges related to their immunogenicity, effectiveness, and safety. To ease the burden of IBD and other severe diseases, biosimilars have emerged as a cost-effective alternative to an originator product. According to the current knowledge, biosimilars of IFX and ADL in IBD patients are shown to be as safe and effective as their originators. The future of biosimilars, in general, is promising due to the potential of making the health care system more sustainable. However, their use is accompanied by misconceptions regarding their effectiveness and safety, as well as by controversy regarding their interchangeability. Hence, until a scientific consensus is achieved, scientific data on the long-term effectiveness and safety of biosimilars are needed.
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Patel PV, Purvis CG, Hamid RN, Feldman SR. Non-Medical Switching in Dermatology: Cost-Conscious Policy or an Affront to Patient Safety? J DERMATOL TREAT 2022; 33:2707-2710. [PMID: 35924458 DOI: 10.1080/09546634.2022.2110360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Non-medical switching is when a patient's therapy is switched for reasons unrelated to health outcomes. Dermatologists are regularly affected by non-medical switching, as many of their complex patients are on expensive medications, which become first-line targets for cost-containment. This commentary examines the literature on non-medical switching and explores the push and pull factors used to drive medication regimen changes. The system-level cost savings of this practice are substantial and could be used to fund treatment for more vulnerable patients. While there is no substantiated evidence of worse outcomes post-switching, patients may suffer negative psychosocial consequences. Negative patient expectations, which are in part fueled by prescriber suspicion of non-medical switching, seem to contribute to this effect. While non-medical switching is not ideal for all patients, it has the potential to reduce cost while maintaining patient outcomes. The decision to switch should be made only after careful evaluation of the individual patient and their physical and psychological reserve.
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Affiliation(s)
- Palak V Patel
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caitlin G Purvis
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ramiz N Hamid
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston- Salem, North Carolina.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Addressing Autoimmune and Immune-mediated Skin Disease Burden in Women. Womens Health Issues 2022; 32:322-326. [PMID: 35300917 DOI: 10.1016/j.whi.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
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Maksabedian Hernandez EJ, Graf M, Portelli A, Shafrin J. Estimating the impact of biosimilar entry on prices and expenditures in rheumatoid arthritis: a case study of targeted immune modulators. J Med Econ 2022; 25:1118-1126. [PMID: 35965481 DOI: 10.1080/13696998.2022.2113252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To model changes in prices, utilization, and expenditures of targeted immune modulators (TIMs) for rheumatoid arthritis, accounting for biosimilar entry. METHODS Using IQVIA National Sales Perspective data between 2013 and 2019, we examined sales and expenditures of biologics and non-biological complex molecules, 20 quarters before and after patent exclusivity milestones. We estimated the impact of a molecule's exclusivity milestones and biosimilar entry on prices, using a regression discontinuity design (RDD). We then combined the RDD estimate with historical trends to assess the impact of adalimumab's exclusivity milestones on future TIM expenditures. RESULTS Changes in average molecule prices were associated largely with biosimilar uptake. For molecules with relatively high biosimilar uptake (>60%), prices fell considerably (-21.2% to -59.3%) one year after exclusivity milestones, whereas molecules with lower biosimilar uptake (<10%) experienced smaller price decreases (-2.4% to -8.4%). Average price reduction at the molecule level after biosimilar entry was not significant (-18.6%; p = .657). When applying the RDD results after adalimumab's exclusivity milestones, its projected share of total TIM market expenditures decreased from 48.0% in 2019 to 26.0% in 2025, whereas expenditures on Janus kinase inhibitors increased from 4.0% to 34.0%. CONCLUSIONS Biologics facing biosimilar competition may experience price decreases, potentially offering substantial savings to payers, patients, and society, although the magnitude of these estimates depends on biosimilar uptake. Formulary placement, along with manufacturer-payer dynamics, may also play a role in determining the impact on price and market uptake of biosimilars.
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Hillhouse E, Mathurin K, Bibeau J, Parison D, Rahal Y, Lachaine J, Beauchemin C. The Economic Impact of Originator-to-Biosimilar Non-medical Switching in the Real-World Setting: A Systematic Literature Review. Adv Ther 2022; 39:455-487. [PMID: 34780028 PMCID: PMC8799532 DOI: 10.1007/s12325-021-01951-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION To save costs to the healthcare system, forced non-medical switch (NMS) policies that cut drug coverage for originator biologics and fund only less expensive biosimilars are being implemented. However, costs related to the impact of NMS on healthcare resource utilization (HCRU) must also be considered. This study aims to summarize the evidence on the economic impact of an originator-to-biosimilar NMS. METHODS A systematic literature review (SLR) was conducted. Publications reporting on HCRU or costs associated with originator-to-biosimilar NMS in the real-world setting were searched in MEDLINE and EMBASE from January 2008 to February 2020. In addition to hand searching the reference lists of relevant publications and SLRs, key conference websites, PubMed, and various government sites were also searched for the 2 years preceding the search (2018-2020). RESULTS A total of 1845 citations were identified, of which 49 were retained for data extraction. Most studies reporting on the HCRU associated with NMS reported on post-NMS HCRU alone without a comparison pre-NMS. However, four studies described a difference in HCRU (i.e., investigations pre- vs post-switch or between non-switchers vs switchers), all of which reported a relative increase in HCRU, including laboratory testing, imaging, medical visits, and hospitalizations, amongst patients who underwent an originator-to-biosimilar NMS. Most studies reporting on the costs associated with NMS reported significant savings following NMS on the basis of drug costs alone. However, four studies specifically reporting on the difference of costs following originator-to-biosimilar NMS all demonstrated an increase in HCRU-related costs associated with NMS (increase in HCRU-related costs of 4-37% or 148-2234 2020 Canadian dollars). CONCLUSION Amongst the studies that reported on the difference in HCRU pre- vs post-switch or between non-switchers and switchers, all showed an increase in HCRU and related costs associated with NMS, suggesting that the expected overall savings due to less costly drug prices may be reduced as a result of an increase in HCRU and its associated costs post-switch. Nevertheless, more real-world studies that include NMS-related healthcare costs in addition to drug costs are needed.
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Affiliation(s)
- Erin Hillhouse
- PeriPharm Inc., 485 McGill St. Suite 910, Montreal, QC, H2Y 2H4, Canada
| | - Karine Mathurin
- PeriPharm Inc., 485 McGill St. Suite 910, Montreal, QC, H2Y 2H4, Canada
- University of Montreal, Montreal, QC, Canada
| | - Joëlle Bibeau
- PeriPharm Inc., 485 McGill St. Suite 910, Montreal, QC, H2Y 2H4, Canada
| | | | | | - Jean Lachaine
- PeriPharm Inc., 485 McGill St. Suite 910, Montreal, QC, H2Y 2H4, Canada
- University of Montreal, Montreal, QC, Canada
| | - Catherine Beauchemin
- PeriPharm Inc., 485 McGill St. Suite 910, Montreal, QC, H2Y 2H4, Canada.
- University of Montreal, Montreal, QC, Canada.
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Uyen-Cateriano A, Herrera-Añazco P, Mougenot B, Benites-Meza JK, Benites-Zapata VA. Non-medical switching of prescription medications, brand-name drugs and out-of-pocket spending on medicines among Peruvian adults. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
This study evaluated the association between non-medical switching of prescription medications (NMSPM) with brand-name drugs and out-of-pocket spending (OPS) on drugs among Peruvian adults.
Methods
We conducted a secondary analysis of the National Survey of User Satisfaction Health using an analytical cross-sectional design. We included 3155 adults who went to drugstores and pharmacies with prescriptions. The independent variable was the self-reported NMSPM. The outcomes were brand-name drug purchase and OPS on drugs. We calculated crude and adjusted prevalence ratios (PR) with their respective 95% confidence intervals (CIs), and the OPS on drugs was analysed using linear regression with crude and adjusted β and their 95% CIs.
Key findings
The rate of NMSPM was 6.7%, the proportion of brand-name drug purchases was 55.7% and the average spending on drugs was US$1.73. In the adjusted analysis, the proportion of brand-name drug purchases with NMSPM was higher than without (73.3% versus 54.5%; P < 0.001), with a statistically significant association (adjusted PR = 1.38; 95% CI = 1.29 to 1.47; P < 0.001), and the association between NMSPM and OPS on drugs was statistically significant (adjusted β = 0.23; 95% CI = 0.16 to 0.30; P < 0.001).
Conclusions
There is a greater probability of brand-name drug purchases and OPS on drugs when NMSPM exists among adults who go to drugstores and pharmacies in Peru.
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Affiliation(s)
| | - Percy Herrera-Añazco
- Universidad San Juan Bautista, Lima, Peru
- Red Internacional en Salud Colectiva y Salud Intercultural, Mexico, Mexico
- Instituto de Evaluación de Tecnologías en Salud e Investigación, EsSalud, Lima, Peru
| | - Benoit Mougenot
- Facultad de Ciencias Empresariales, Universidad San Ignacio de Loyola, Lima, Peru
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Jerry K Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Vicente A Benites-Zapata
- Red Internacional en Salud Colectiva y Salud Intercultural, Mexico, Mexico
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Kheloussi S, Johns A, Parente V, McLay W, Gionfriddo MR. Cost and clinical impact of a nonmedical DPP-4 inhibitor switch in patients with diabetes. J Manag Care Spec Pharm 2021; 27:846-854. [PMID: 34185559 PMCID: PMC10390945 DOI: 10.18553/jmcp.2021.27.7.846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Nonmedical formulary switches (NMFS) routinely occur in managed health care plans and involve changing preferred medications for reasons outside of clinical considerations. The cost implications of NMFS are infrequently published and the clinical outcomes rarely assessed. OBJECTIVE: To assess the real-world clinical and cost implications of an NMFS involving sitagliptin and linagliptin. METHODS: An NMFS was made to the Geisinger Health Plan (GHP) commercial, health care reform, and Medicaid formularies on February 1, 2018, involving a change in preferred medication from sitagliptin to linagliptin. Claims data from GHP and clinical information from electronic health records of the Geisinger Health System were used to evaluate the cost and clinical impact of this change. Patients aged 18 years or older who were continuously enrolled in a GHP commercial, health care reform, or Medicaid plan throughout the entire study period and had at least 1 fill for sitagliptin during the preswitch phase were included in the study. We investigated the differences in various clinical and economic outcomes from pre- to postswitch among those who switched and remained adherent to the new preferred therapy throughout the 12-month postperiod ("linagliptin switch" group) and patients who did not ("other switch" group). Clinical outcomes included all-cause hospitalization, diabetes-related hospitalization, and glycosylated hemoglobin (HbA1c), while economic measures included changes in per member per month (PMPM) spending. The negative binomial regression model was used to estimate utilization counts. A generalized linear model with a log link and gamma distribution was used to analyze cost data. RESULTS: 1,203 patients met the inclusion criteria. Of these, 501 (41.6%) individuals switched to and remained at least 80% adherent to linagliptin in the postperiod, while 702 (58.4%) did not. No difference between groups was found when comparing the pre- to postswitch change in all-cause hospitalization (incidence rate ratio (IRR) = 1.46, 95% CI = 0.66-3.23, P = 0.3436) or diabetes-related hospitalization (IRR = 1.39, 95% CI = 0.62-3.10, P = 0.4203). Additionally, no difference was found between groups regarding the change in HbA1c 12-month postswitch compared with baseline (difference between groups = -0.10%, 95% CI = -0.39%-0.19%, P = 0.4962). Total PMPM spending was 43% higher in the other switch group compared with the linagliptin switch group (IRR = 1.43, 95% CI = 1.25-1.63, P < 0.0001). This trend was driven by 92% higher medical PMPM spending in the other switch group compared with the linagliptin switch group (IRR = 1.92, 95% CI = 1.58-2.33, P < 0.0001) but was offset by 12% lower pharmacy PMPM spending in the other switch group (IRR = 0.88, 95% CI = 0.82-0.95, P = 0.0009). CONCLUSIONS: An NMFS from sitagliptin to linagliptin resulted in overall health plan savings with no significant changes in health outcomes. DISCLOSURES: Funding for this study was provided by Geisinger Health System, which had no role in the study outside of a final review of the submitted manuscript. Johns and Gionfriddo are Geisinger employees. The authors report no financial conflicts of interest.
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Affiliation(s)
| | - Alicia Johns
- Geisinger Center for Health Research, Department of Population Health Sciences, Danville, PA
| | | | - William McLay
- Wilkes University, Nesbitt School of Pharmacy, Wilkes-Barre, PA
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Afzali A, Furtner D, Melsheimer R, Molloy PJ. The Automatic Substitution of Biosimilars: Definitions of Interchangeability are not Interchangeable. Adv Ther 2021; 38:2077-2093. [PMID: 33745111 PMCID: PMC8107170 DOI: 10.1007/s12325-021-01688-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
In the USA, an interchangeability designation provides biosimilar sponsors with a pathway for achieving what is standard for small-molecule generics: pharmacy-level auto-substitution for an innovator. No other major health authority links interchangeability to automatic substitution, as all require the involvement of the prescriber or patient in a medication change. This editorial considers the clinical impact and practicality of auto-substitution. First, interchangeability is linked to non-medical switching (NMS), the practice of switching treatment in patients with stable disease for non-clinical reasons. NMS may generate negative sentiment in those unwilling or reluctant to switch, which can adversely impact treatment outcomes (i.e., nocebo effect). Indeed, in real-world studies of tumor necrosis factor inhibitors, discontinuation rates have been shown to be higher in patients switched to biosimilars for non-medical reasons than in historical cohorts maintained on innovators. Second, interchangeability may impede pharmacovigilance and traceability, as not all jurisdictions require innovators and biosimilars to have distinct biologic names. Third, an interchangeability designation from the US Food and Drug Administration only permits a biosimilar to be automatically substituted for its innovator, not other biosimilars (if available). Pharmacist education would be needed to avoid off-label, automatic substitution among biosimilars of a single innovator. Last, once granted, an interchangeability designation exists in perpetuity under current US federal law. However, the supply chains of innovators and biosimilars are maintained independently, with no requirement for reconfirmation of biosimilarity or interchangeability. We feel that additional guidance is needed for the auto-substitution of biosimilars and innovators to become a reality.
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Maintaining Clinical Freedom Whilst Achieving Value in Biologics Prescribing: An Integrated Cross-Specialty Consensus of UK Dermatologists, Rheumatologists and Gastroenterologists. BioDrugs 2021; 35:187-199. [PMID: 33635522 PMCID: PMC7952361 DOI: 10.1007/s40259-020-00464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Biologics are now key drugs in the management of immune-mediated inflammatory diseases. However, the increasingly complex biologics environment and growing cost pressures in the UK have led to variability in drug commissioning and inequity of patient access across regions. OBJECTIVES Our objectives were to provide consensus recommendations for enhancing the current situation in biologic prescribing in the UK by balancing clinical freedom with equitable distribution of biologics given the limited availability of resources. METHODS A modified Delphi approach was used to reach integrated, cross-specialty consensus among dermatologists, rheumatologists and gastroenterologists practising within the English National Health Service (NHS). RESULTS We describe the concepts of clinical freedom and clinical judgement and demonstrate how, together with patient choice, they can be exercised in the context of biologic prescribing in the NHS. We highlight that in England, local variations occur that are at odds with National Institute for Health and Care Excellence (NICE) guidance; these variably limit the degree to which clinicians can exercise clinical freedom and impact on equity of patient access to treatments. We define factors encompassing a drug's value and identify challenges to the measurement and interpretation of this concept, which can raise barriers to the freedom of clinical choice and appropriate prescribing decisions allowing practices of holistic and personalised medicine. Cross-specialty consensus recommendations on ensuring equitable access to biologics in the NHS while protecting appropriate and individualised drug selection for patients are provided. We have also provided strategies for improving physician-commissioner communication to harmonise equity of patient access to biologics across England and improve patient outcomes. Commentary from patient advisory groups indicates that they welcome our exploration that value does not equal cost and agree that there should be an emphasis on shared decision making, which requires the clinician to practice clinical freedom by aligning the patient's needs and preferences with available treatment choices. CONCLUSIONS This consensus highlights the need to strike a balance between clinical freedom and short-term cost restrictions to support equitable resource distribution within the English NHS. Consideration of these recommendations may help to harmonise local, regional and national services and balance equity of patient access to biologic treatments with excellence in the NHS.
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Mazzoni D, Vener C, Mazzocco K, Monzani D, Pravettoni G. The Psychological Risks Associated With the Non-medical Switch From Biologics to Biosimilars. Front Psychol 2021; 12:605643. [PMID: 33584474 PMCID: PMC7873288 DOI: 10.3389/fpsyg.2021.605643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Claudia Vener
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Ogundipe O, Mazidi M, Chin KL, Gor D, McGovern A, Sahle BW, Jermendy G, Korhonen MJ, Appiah B, Ademi Z, De Bruin ML, Liew D, Ofori-Asenso R. Real-world adherence, persistence, and in-class switching during use of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis involving 594,138 patients with type 2 diabetes. Acta Diabetol 2021; 58:39-46. [PMID: 32809070 DOI: 10.1007/s00592-020-01590-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022]
Abstract
AIMS Medication adherence and persistence are important determinants of treatment success in type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis evaluated the real-world adherence, persistence, and in-class switching among patients with T2DM prescribed dipeptidyl peptidase-4 (DPP4) inhibitors. METHODS MEDLINE, EMBASE, Cochrane Library, PsychINFO, and CINAHL were searched for relevant observational studies published in the English language up to 20 December 2019. This was supplemented by manual screening of the references of included papers. Random-effects meta-analysis was performed. RESULTS Thirty-four cohort studies involving 594,138 patients with T2DM prescribed DPP4 inhibitors from ten countries were included. The pooled proportion adherent (proportion of days covered (PDC) or medication possession ratio (MPR) ≥ 0.80) was 56.9% (95% confidence interval [CI] 49.3-64.4) at one year and 44.2% (95% CI 36.4-52.1) at two years. The proportion persistent with treatment decreased from 75.6% (95% CI 71.5-79.5) at six months to 52.8% (95% CI 51.6-59.8) at two years. No significant differences in adherence and persistence were observed between individual DPP4 inhibitors. At one year, just 3.2% (95% CI 3.1-3.3) of patients switched from one DPP4 inhibitor to another. Switching from saxagliptin and alogliptin to others was commonest. CONCLUSIONS Adherence to and persistence with DPP4 inhibitors is suboptimal but similar across all medications within the class. While in-class switching is uncommon, saxagliptin and alogliptin are the DPP4 inhibitors most commonly switched. Interventions to improve treatment adherence and persistence among patients with T2DM prescribed DPP4 inhibitors may be warranted.
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Affiliation(s)
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Ken Lee Chin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Deval Gor
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois At Chicago, Chicago, USA
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Exeter Medical School, The Institute of Biomedical and Clinical Science,, Exeter, UK
| | - Berhe W Sahle
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Maarit Jaana Korhonen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Bernard Appiah
- School of Public Health, Texas A&M University Health Science Center, TAMU, College Station, TX, USA
- Centre for Science and Health Communication, Accra, Ghana
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark.
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Ribaldone DG, Vernero M, Astegiano M. Effectiveness and safety of switching to adalimumab biosimilar ABP 501 in Crohn's disease: the extrapolation concept. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:155. [PMID: 33207912 DOI: 10.17235/reed.2020.7253/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We sincerely thank Viscido et al. for their appropriate and sharable comments on our recent study on adalimumab biosimilar ABP 501 in Crohn's disease (CD). The use of a biosimilar in inflammatory disorders is one of the current main topics, given the great opportunity to save resources that can be invested in innovative drugs and the ethical problems that non-medical switching can generate.
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Affiliation(s)
| | - Marta Vernero
- Internal Medicine, IRCCS Policlinico San Matteo. University of Pavia
| | - Marco Astegiano
- General and Specialist Medicine, Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, It
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Tuleu C, Hughes DA, Clapham D, Vallet T, Ruiz F. Acceptability of generic versus innovator oral medicines: not only a matter of taste. Drug Discov Today 2020; 26:329-343. [PMID: 33217597 DOI: 10.1016/j.drudis.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/22/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022]
Abstract
Optimum use of generic products would require equivalence, not only in terms of quality, safety, and efficacy in clinical studies, but also patient acceptability to not jeopardize treatment success because of non-adherence which would de facto limit the potential cost saving anticipated by their use. Although acceptability is a requirement for the authorization of pediatric innovator products, a survey of European Union (EU) regulatory authorities showed that few have a formal process for assessing patient acceptability of generic products during the registration processes. The current International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) focus on unifying guidance for the development and scrutiny of generics but should include acceptability alongside the other factors being considered for harmonization.
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Affiliation(s)
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - David Clapham
- Independent Pharmaceutical Consultant, Bishops Stortford, UK.
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Salam T, Duhig A, Patel AA, Cameron A, Voelker J, Bookhart B, Coleman CI. Communication of Medication Nonmedical Switching Policies and Procedures by Insurance Companies: Results of an E-Survey. Clin Ther 2020; 42:1077-1086. [PMID: 32418669 DOI: 10.1016/j.clinthera.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Nonmedical switching is defined as a change in a stable patient's prescribed medication to a clinically distinct, nongeneric alternative for reasons other than lack of clinical response, adverse effects, or poor adherence. Nonmedical switching often results from formulary changes implemented by insurers to lower medication costs. We sought to survey randomly sampled physicians to elicit their opinions regarding insurers' communication about nonmedical switching. METHODS We performed an online, cross-sectional survey of licensed, practicing physicians who were >2 years but <30 years out of residency and/or fellowship, who practiced in an internal medicine, family medicine, or specialist setting, spent ≥10% of their work time providing direct patient care, and had received at least 1 request for a nonmedical switch for ≥1 patient in the prior 12 months. The survey was fielded from November to December 2018. We report weighted percent responses categorized from 5- or 7-point Likert scale questions. FINDINGS E-mail invitations were sent to 13,117 randomly sampled physicians, and 1818 opened the e-mail and followed the embedded survey link to participate. Of these, 1010 total physicians (55.5%), 606 primary care and 404 specialists, who treated patients experiencing nonmedical switching in the prior 12 months completed the survey. A few physicians were notified about nonmedical switches by insurers; more frequently physicians learned about them from pharmacies serving their patients. Notification frequently occurred at or after a refill came due. Notification via electronic medical record or insurer letter was less frequent. Few thought that insurers clearly communicated information about alternative medications when a nonmedical switch was required, and most disagreed that insurers provided clear procedures, timelines, and methods to track challenges. Nearly all agreed that insurers should provide supporting documentation or rationale for nonmedical switches and specifics on alternatives. Respondents overwhelmingly agreed that steps to improve communication and physicians' and patients' ability to navigate nonmedical switches or challenge procedures should be implemented. IMPLICATIONS This survey of primary care and speciality physicians suggests that physicians believe that insurers' current level of communication regarding nonmedical switching is suboptimal. Respondents suggested that insurers did not optimally communicate information about alternative medications when a nonmedical switch was required and did not provide clear procedures, timelines, and methods to track challenges. A preponderance of physicians agreed that steps to improve physician-insurer communication to aid in the navigation of nonmedical switch and to challenge procedures should be implemented. If not addressed, these identified nonmedical switch communication issues may have a negative effect on achieving the quadruple aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care practitioners and their staff.
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Affiliation(s)
- Tabassum Salam
- Medical Education, American College of Physicians, Philadelphia, PA, USA
| | - Amy Duhig
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | | | - Ann Cameron
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | | | | | - Craig I Coleman
- University of Connecticut School of Pharmacy, Storrs, Connecticut, USA; Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA.
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Costa OS, Salam T, Duhig A, Patel AA, Cameron A, Voelker J, Bookhart B, Coleman CI. Specialist physician perspectives on non-medical switching of prescription medications. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1738637. [PMID: 32284826 PMCID: PMC7144249 DOI: 10.1080/20016689.2020.1738637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 05/31/2023]
Abstract
Introduction: A non-medical switch is a change to a patient's medication regimen for reasons other than lack of clinical response, side-effects or poor adherence. Specialist physicians treat complex patients who may be vulnerable to non-medical switching. Objectives: To evaluate specialist physicians' perceptions regarding the frequency of non-medical switch requests, and the impact on their patients' outcomes and healthcare utilization. Methods: An online survey of randomly sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. Results: Among 404 specialist physicians surveyed, non-medical switch requests were reported as very frequent or frequent by 35.0% of oncologists (for injectable cancer agents) and up to 80.3% of endocrinologists (for injectable anti-hyperglycemics). Respondents reported decreased medication effectiveness (25.0% of oncologists to 75.0% of dermatologists) and increased side-effects (32.5% of oncologists to 66.7% of psychiatrists). Most specialists reported very frequent or frequent increases in non-office visits (52.5% of oncologists to 75.3% of endocrinologists) and calls with pharmacies (57.5% of oncologists to 80.5% of rheumatologists) due to non-medical switching. Conclusions: Receipt of non-medical switching requests were common among specialist physicians. Non-medical switching may lead to negative effects on patient care and require increased healthcare utilization.
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Affiliation(s)
- Olivia S. Costa
- School of Pharmacy, University of Connecticut, Storrs, CT, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA
| | - Tabassum Salam
- Medical Education, American College of Physicians, Philadelphia, PA, USA
| | - Amy Duhig
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | - Aarti A. Patel
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, PA, USA
| | - Ann Cameron
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | - Jennifer Voelker
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, PA, USA
| | - Brahim Bookhart
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, PA, USA
| | - Craig I. Coleman
- School of Pharmacy, University of Connecticut, Storrs, CT, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA
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