Pharmacist rebates: Another way to switch?
While drug-company owned pharmacy benefit management firms are incurring the wrath of consumer groups alleging pressure tactics and kickbacks to get their drugs in patient hands, two drug companies have launched rebate programs aimed directly at pharmacists.
Hoechst Marion Roussel’s Patient Health First program is marketed as a way to discourage prescription noncompliance, which the company says costs the health care industry $88 billion a year. When nursing home and hospital admissions rise due to noncompliance, pharmacy revenues are lost from unfilled prescriptions, and overall business productivity losses are combined.
Zeneca Pharmaceuticals’ Performance Incen-tive Reimbursement Contract, the PIRC program, also includes noncompliance aspects, educational mail intervention, and telephone or personal pharmacist intervention aimed at physicians and patients on the topics of prescription habits and the cost-effectiveness of certain drugs.
Both offer money to pharmacists who increase market share of the pharmaceutical manufacturers’ respective drugs. As marketing material from Hoechst’s Patient Health First program puts it, reimbursement is for "improved patient persistency" for a pair of Hoechst drugs. Zeneca Pharmaceuticals’ PIRC program leaves it up to the individual pharmacist on whether any reimbursement savings are passed along to consumers.
Pharmacists who sign up for either program can use the compliance and intervention materials offered for any drugs or for general use to reach patients, but the financial incentive is clearly based on moving each company’s drugs.
"Well, it is an opportunity for pharmacists to capture a part of the money pot, and it does cut out the middleman," notes Michael Deskin, president of the Scottsdale, AZ-based Pharmacy Benefit Management Institute. "I think the potential problem is if a drug company is trying to shift [market] share [for one drug], and then a PBM is trying to shift another, what is a hospital doctor or pharmacist to do?" This problem could easily emerge when a when a patient goes for a refill, for example.
"My attitude is take all you can get," echoes Patricia Wilson of the health care consulting firm Associates & Wilson in Rosemont, PA. "These rebate programs have been around, and they’re not necessarily a bad thing," she says, "except when a patient shouldn’t be taking those pills in the first place. And the interactions between medicines can be absurd, so more is not always better, and being compliant with something that’s not necessary or that is causing problems is not necessarily a benefit. Pharma-cists need to make sure they’re only targeting people who really need the medication to be compliant in the first place."
Wilson argues that this is the bigger problem. Take, for example, the use of cholesterol reduction agents. "If you’re 75 years old, why are you spending money on this or being pushed into it if you’re a low-risk patient? You should be spending your money on a vacation," she says.
"I wish drug companies would spend more effort on target marketing for whom is this a good product, which would allow pharmacists, doctors, and formulary developers to in turn target market to where the greatest value was delivered, but it doesn’t happen. If the formulary concept consists of rebates and competing products, the issue is how to meld the formulary with patient characteristics to help the consu-mer make choices of when is this a preferred product vs. trying to garner the whole marketplace," Wilson says.
Not switching, but choosing
For their part, both drug companies stress the programs are voluntary and allow a pharmacist to choose from the different aspects the programs offer. (Reimbursement is generally based on existing baseline sales and then growth within a pharmacy, along with overall volume and market share figures, making it difficult to estimate exactly how much reimbursement money is involved.) Both also say the drugs included in the program are centered on chronic illnesses for which compliance is an issue.
Based in Kansas City, MO, Hoechst Marion Roussel’s Patient Health First program targets Cardizen CD, for angina and hypertension treatment, and another hypertension drug, Altace.
"Basically, those two drugs are maintenance types of drugs for a chronic condition. Patients need to stay on the drugs for a long length of time or a lifetime, so noncompliance becomes a greater issue," says Robert Glenski, patient markets manager at Hoechst.
The company’s research shows that 51% of noncompliance occurs simply because patients think they don’t need the medicine, while another 21.7% occurs because patients don’t want to take it.
Rebates for consistency’
Hoechst’s program includes templates provided to pharmacists to copy, including patient reminder, refill, and past due letters and postcards; a letter to doctors advising them about the program; a health information booklet for patients; and Hoechst’s in-house publication Cardisense, which also can be sent to patients.
"If you look at the program, with pharmacy focusing on patients’ overall health and trying to work with patients to ensure they stay on drugs prescribed by the physician, this is not a market share program or a switch program," Glenski says. "We think we can work with a unified approach with pharmacists focusing on compliance and consistency with our two products."
Hoechst says its pharmacist reimbursement is based on how much patient persistence with Hoechst has improved, not on whether a pharmacist switches a patient to a Hoecsht drug.
At Wilmington, DE-based Zeneca Pharma-ceuticals, seven drugs are included in the PIRC program. Zestril, Zestoretic, and Sular, all cardiovascular drugs, initiated the program, followed by the asthma drug Accolate, morphine time-released capsules Kadian, breast cancer therapy drug Nolvadex, and advanced prostate cancer treatment Zoladex.
Steve Lampert, Zeneca’s director of communications, says other product lines will be included in the future. "Most pharmacist options revolve around patient compliance and education incentives. The contract offer has added incentives if a patient is not using our drugs and they switch," he says, adding that again it’s up to the pharmacist to pass along any savings or reimbursement to the customer, though the program is billed as one with "a variety of patient compliance programs and other incentives to lower the costs of the products," says Lampert, adding that it makes good business sense in the long run for pharmacists to pass along the savings, which will lead to long-term and possibly increased business.
Lampert says reimbursement depends on the amount of the contract and the size of a pharmacy chain, for example, and "what they can do to move specific market share of our products."
But like Glenski, Lampert says the program should not be likened to a PBM or the kind of techniques warranted or not they are getting criticized for.
"I think this is just the opposite because this program is available to everybody and anybody. The industry was criticized for discount or incentive programs just to large chains and for not offering it to the Mom and Pops. This program is available to anybody. If the owner of a single pharmacy calls, we’ll pursue a deal. It’s the antithesis of the criticism of PBMs, that it’s just to the big retail and managed care organizations," Lampert says.
He confirms that as of late summer, Zeneca had completed 64 contracts for the PIRC program, covering about 32,000 pharmacies.
And Glenski at Hoechst says it’s not like pharmaceuticals have just jumped into these programs. The company’s market research indicated that pharmacists were willing to assess the program, he explains.
Based on those two factors, the future and extent of similar reimbursement programs is squarely in the hands of the pharmacist.
[For more information, contact: Michael Deskin, President, Pharmacy Benefit Management Institute, P.O. Box 9427 Scottsdale, AZ 85252. Telephone: (602) 941-0328.
Patricia Wilson, Associated & Wilson, 1084 E. Lancaster Ave., Rosemont, PA 19010. Telephone: (610) 519-0602.
Julie Gladman, Hoechst Marion Roussel, P.O. Box 9627, Kansas City, MO 64134. Telephone: (816) 966-4274.
Steve Lampert, Director of Communications, Zeneca Pharmaceuticals, 1800 Concord Pike, Wilmington, DE 19850. Telephone: (800) 952- 7472.]
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