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In this issue: • Therapeutic Interchange • Step Therapy • Generics Update Arxcel, Inc. 4390 Quinby Dr. Suite D Hamburg, NY 14075 (716) 646-9292 (716) 646-6985 Fax www.arxcel.com info@arxcel.com ARXCEL can help with: Plan Design Proposals Clinical Analysis Sales & Marketing |
| Fall 2002 |
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THERAPEUTIC INTERCHANGE
STEP THERAPY
The management of any drug benefit program results in the identification of opportunities to keep total cost increases within the national standards. In 2001, drug costs rose approximately 17%, driven by issues including utilization, consumer demand influenced by advertising, new drugs and inflation.1
Working with pharmacy budgets requires that all aspects be analyzed to keep them in line with the rest of the industry.
A very important tool in pharmacy benefit management is therapeutic interchange. In therapeutic interchange, a patient receives a drug that is the therapeutic equivalent of the drug originally prescribed. Drugs can be labeled as therapeutically equivalent if they can be expected to produce the same clinical effectiveness and outcomes.
An example of a therapeutic interchange program would be for non-steroidal anti-inflammatory drugs (NSAIDs). Below is chart for step prescribing:
| Medication - NSAID Step Program | |
FIRST LINE NSAIDS |
SECOND LINE NSAIDS |
| Ibuprofen (Motrin) | Diclofenac sodium/misoprostol (Arthrotec®) |
| Indomethacin (Indocin®) | Nabumetone (Relafen®) |
| Naproxen (Naprosyn®) | Celecoxib (Celebrex®) |
| Diclofenac (Voltaren®) | Rofecoxib (Vioxx®) |
| Ketoprofen (Orudis®) | Meloxicam (Mobic®) |
| Sulindac (Clinoril®) | Valdecoxib (Bextra®) |
| Etadolac (Lodine®) | |
| Flurbiprofen (Ansaid®) | |
| Oxaprozin (Daypro®) | |
1 Medco Health
Therapeutic Interchange vs Generic Substitution
Therapeutic interchange is different from generic substitution. In therapeutic interchange, one drug is interchanged with another in the same therapeutic class. The drugs will have a different composition, but will produce the same clinical outcomes. This is different from generic substitution, which, is the substitution of products that contain the same active ingredients and are chemically identical.
Step Therapy Program
An example of a step therapy program would be the use of NSAID's and COX II Inhibitors. The goal is to have the first line therapy prescribed for those patients who do not clinically require the more costly second line agent. Criteria that are clinically based can be set up to eliminate those patients who require the second line agent.
Examples of those criteria could be to rule out patients who are over age 65, have failed on previous first line therapy and/or have a history of gastric problems. For patients other than these, the plan would want to have the first prescription filled with the therapeutic alternative.
Using a step therapy program such as this for therapeutic interchange helps to manage the utilization of the drugs. A plan would benefit from the program by:
- Reducing inappropriate utilization of second line prescriptions
- Program cost savings
- Lower costs than traditional prior authorization programs if automated
GOVERNMENT NEWS
President Bush pushes for Generic legislation
Recently (Oct 21, 2002), President Bush proposed regulations that would make generic drugs available more quickly. The proposed regulations would limit the ability of brand name manufacturers to delay generic drug production.
Currently, brand manufacturers file patent lawsuits that delay the introduction of generics. This action can extend current patents up to 30 months while the litigation proceeds.
President Bush's proposal would limit the manufacturers to one automatic 2.5-year patent extension while they go through litigation with the generic manufacturers.
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