Using the Pharmacy & Therapeutics Process to Develop Sound Business Strategies CDR Ted Briski, MSC,...
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Using the Pharmacy & Therapeutics Using the Pharmacy & Therapeutics Process to Develop Sound Business Process to Develop Sound Business Strategies Strategies CDR Ted Briski, MSC, USN
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Using the Pharmacy & Therapeutics Process Using the Pharmacy & Therapeutics Process to Develop Sound Business Strategiesto Develop Sound Business Strategies
CDR Ted Briski, MSC, USN
PEC ActivitiesPEC Activities
DoD P&T Committee SupportDoD P&T Committee Support
• Role of the PEC: – Completing drug class reviews and developing of
clinical criteria for procurement strategy decisions
– Evaluating drugs recently approved by the FDA– Collecting and analyzing requests from DoD
healthcare professionals for changes to the Basic Core Formulary
– Gathering input from providers regarding the acceptability of various formulary decisions
– Disseminating minutes and other Committee information to the field
Why bother with Pharmacy and Why bother with Pharmacy and Therapeutics?Therapeutics?
• Keep people gainfully employed and it gets them out of clinic once in a while
• Provide good collateral duty bullets for FitReps and OERs
• Appease patients who spend way too much time reading on the internet
• Assure safe and efficacious pharmacotherapy– Credentials process (M&M, peer review, etc.)
• Provide a range of pharmacotherapy choices– Then who needs a formulary
““Business” is not a dirty wordBusiness” is not a dirty word
• Webster’s 9th defines business as…..– “Activity concerned with the supplying and exchange
of commodities”
• Commodities– Medicines sold to DoD by Pharmaceutical Companies– Pharmacotherapy provided by DoD MTFs– Outcomes are what patients are paying for
• DoD MTFs purchase the raw materials of medicines, cognitively transforms them to deliver pharmacotherapy, which results in a positive outcome that patients “customers” value
““Strategy”Strategy”
• Webster’s 9th
– “The science and art of military command exercised to meet the enemy in combat under advantageous conditions”
– “The art of devising or employing plans or stratagems toward a goal”
• DoD’s Primary Pharmacy and Therapeutic Goal– Minimize the money spent on medicines– Maximize the outcomes
Unique Users & TRICARE Unique Users & TRICARE Pharmacy Points of ServicePharmacy Points of Service
All Ages, FY02All Ages, FY02
MTF
Retail
60% 14%18%
Mail Order
3%2%
1%1%
5.7M Unique Users
DoD Drug Expenditures & ProjectionsDoD Drug Expenditures & ProjectionsFY 95 – FY 03FY 95 – FY 03
$Mil
lio
ns Mail
Retail
MTF
Percent Increase over Previous Fiscal Year
Overall 7% 15% 13% 17% 22% 28% 47% 21%
Mail Order 137% 27% 81% 82% 25%
Retail 7% 27% 16% 21% 33% 50% 88% 27%
MTFs 7% 12% 8% 10% 18% 13% 19% 15%
$617 $662 $741 $797 $878 $1,034 $1,170$1,420
$1,633$245 $283$342
$455
$681
$1,279
$1,627
$347
$435
$193$181
$191
$106
$35$83
0
500
1000
1500
2000
2500
3000
3500
4000
1995 1996 1997 1998 1999 2000 2001 2002 2003 (projected)
TSRx Implementation 1 Apr 2001
* MTF costs do not include dispensing costs.
* Retail costs are contractor paid claims (HCSR Data); do not include admin fees
* Mail order costs are net costs to government
Note: FY03 is Pharmacy Benefit Division cost projections. These projections do not reflect Pharmacy budget or funding per the POM.
DoD Strategic Managers of the DoD Strategic Managers of the P&T ProcessP&T Process
• CEO has primary responsibility for big strategic decisions– TRICARE Management Activity– Surgeons General
• General Managers have profit and loss responsibility for a unit and consequently a leadership role in formulating and implementing business-level strategy for that unit– DoD Pharmacy and Therapeutics Executive Council– Federal Pharmacy Executive Steering Committee
• Subcommittee for contracting
• Source: “Strategic Management Concepts and Cases” by Thompson and Strickland
DoD Strategic Managers of the DoD Strategic Managers of the P&T ProcessP&T Process
• Functional area managers have direct authority over a major piece of the business and must support overall business strategies with strategic actions of their own– MTF Pharmacy and Therapeutic Committees
• Managers of major operating departments who have frontline responsibility for the details of strategic effort in their areas– MTF Department Heads, Department Chiefs or Flight
Commanders
• Source: “Strategic Management Concepts and Cases” by Thompson and Strickland
MTF P&T StrategiesMTF P&T StrategiesMinimizing the money spentMinimizing the money spent
• We sell Marketshare– Formulary Position = Preferred Status– “Have-nots” vs. “haves”
• What will the “haves” pay to keep their marketshare?• What will the “have-nots” pay to get marketshare?
– “Exclusivity” pays the best
• Minimize expenditures– Don’t give away formulary status– Form a consortium with other MTFs– Use your corporate resources– Opportunity (switching) cost can be worth paying– Formulary status, alone, does not save any money
MTF P&T StrategiesMTF P&T StrategiesMaximizing Quality of OutcomesMaximizing Quality of Outcomes
• Maximize quality of outcomes– Choose P&T membership carefully– Staff your P&T Committee with dedicated resources– Find MTF champions and change-agents– Direct the message you want to send your staff
• Partner with industry• Be the guest speaker for the noon lunch
– Demonstrate an ROI to the Command Suite• Measure MTF outcomes• Involve house staff as much as possible
– Consider collaborative practice models– Demand the evidence
Pharmaceutical Pharmaceutical Procurement Challenges Procurement Challenges
• Products not built to specification
• Uncertainty inherent in biological systems
• Cross-functionality of products
• The provider – patient relationship
• The result is you have to make choices and trade-offs to determine what offers the greatest value
What obligations do P&Ts face? What obligations do P&Ts face?
• Independently evaluate the evidence• Independently draw conclusions about the
strengths and weaknesses associated with comparable drugs.
• Make the tough decisions about trade-offs• Formulate an appropriate procurement and
business strategy• Make the deal• Abide by the deal (unless the world changes)• Be a change-agent by following through
PECPECProcurement Strategy AnalysisProcurement Strategy Analysis
• ESTOP analysis– Efficacy / effectiveness– Safety– Tolerability– Other Factors (may be non-clinical)– Price / Cost
• Therapeutic interchangeability of medications– Patient populations– Clinical outcomes– Indications
• Coverage of clinical needs • Provider acceptance
PECPECProcurement Strategy ExecutionProcurement Strategy Execution
• DoD PEC and VA PBM work jointly to develop and execute a rational business strategy, supported by comprehensive clinical analysis, to procure pharmaceutical products.
– DoD PEC currently negotiates best prices for the BCF and TMOP• Uniform Formulary will add responsibility for Retail prices
– Determine optimum contract strategy and develop SOW• Competitive process used to determine clear winners and losers
• Contracted agent(s) must be sufficiently efficacious, safe, and tolerable to meet clinical needs of at least 90% of patients
PEC ActivitiesPEC Activities
Procurement Strategy ExecutionProcurement Strategy Execution
– Determine appropriate use of Incentive Agreements• Non-competitive process used to negotiate price agreements• Leaves drug class open for MTFs to have additional products
– Monitor cost avoidance and contract compliance• MHS centric- Is DoD upholding its end of the deal?
– Monitor contract/agreement performance• Vendor centric- Is the Vendor upholding their end of the deal?
Procurement Program Results Procurement Program Results
• Over 100 current contracts or agreements in place– 160 procurements over 3 years– Saving DoD $500 Million and VA $1 Billion
• DoD Prices– 27% less than Federal Ceiling Price (FCP)– 51% less than Commercial Market Prices (WAC)
• Cost Avoidance (1st three quarters of FY03)– $109 Million for agreements– $250 Million additional due to “market” effect
• Contract Compliance (growth industry)– $61 Million unrealized– MTFs and Services are inconsistent– Assisting MTFs improve compliance is a PEC priority for 2004
MTF P&T CommitteesMTF P&T CommitteesBeing a good corporate citizenBeing a good corporate citizen
• Read the DoD P&T Minutes• Provide input when things first appear in the
minutes, not after the contract is awarded• Take ownership for your MTF compliance• Provide education to providers• Develop transition plans• Provide MTF recommendations for DoD P&T
action items• Each MTF is part of a bigger picture• This is an 80/20 business
Barriers to Being a Good Barriers to Being a Good Corporate CitizenCorporate Citizen
• Commanders and Commanding Officers– P&T Membership– Time and Resources
• Culture– No one likes change– Everybody is an expert in their own little world– No one likes to feel they are being told what to do
• Victims of our own training– Clinicians inherently think they provide the best care– Discouraged to think of healthcare as a business
• Laws of economics cannot be ignored
• Egos
MTF Expenditures FY 2003MTF Expenditures FY 2003
1. Antihistamines - $88M
2. NSAIDs - $86M
3. Lipotropics - $83M
4. SSRIs - $64M
5. PPIs - $61M
6. Bisphosphonates - $45M
7. CCBs - $45M
8. ACEs - $43M
9. Vaccines - $38M
10. Anticonvulsants - $37M
Total:$590M
11. Advair - $31M
12. TZDs - $30M
13. Quinolones - $28M
14. AntiPlatelets - $27M
15. Penicillins - $24M
16. BG Strips - $24M
17. Contraceptives - $23M
18. Opiates - $22M
19. AQ Nasal Steroids - $22M
20. ARBs - $22 M
Total:$253M
$843M represents 52% of MTF total expenditures
MTF Expenditures FY 2003MTF Expenditures FY 2003 (Next Twenty) (Next Twenty)
1. Metformin - $22M
2. Leukotriene Ant. - $21M
3. Glucocorticoids - $20M
4. Macrolides - $19M
5. Antifungals - $19M
6. Antimalarials - $18M
7. Hematinics - $17M
8. Antimigraines - $17M
9. Beta Blockers - $16M
10. Estrogenics - $15M
Total:$184M
11. Antipsychotics - $15M
12. Toxoids - $14M
13. Gram(-) Bacilli - $13M
14. Norepi. & Dopamine - $13M
15. Introc. Pressure - $13M
16. Beta Blockers - $12M
17. Insulins - $11M
18. ADHD Drugs - $10M
19. Antidepressants - $10M
20. Sedative-hypnotics - $10M
Total:$121M
$1,148M represents 70% of MTF total expenditures
What have we done for you lately?What have we done for you lately?
• Contracts
– Luteinizing Hormone Releasing Hormone (LHRH) Agonist
– HMG-CoA Reductase Inhibitors (Statins)
– 5HT1 Agonist (Triptans)
– Oral Fluoroquinolones
• Incentive Agreements
– Aqueous Nasal Steroids
– Proton Pump Inhibitors (PPIs)
– Thiazolidinediones (TZDs)
– Bisphosphonates
– 2nd Generation Antihistamines (NSAs)
Key FactorsKey Factors
• Degree of therapeutic interchangeability– What is preferred for a new patient, if any– How often do you need a back-up (failure rate)
• Amount of competition– How many products are in the class
• Distribution of utilization– What is the reason for the distribution
• External Factors– Supply, political, Personal
• Avoid Formulary Creep– Adding a new drug in the class should be assessed in
relationship to the entire class of drugs
30 D
ay E
q R
x F
ills
MonopolyMonopolyPDE5-Inhibitor Usage PDE5-Inhibitor Usage 30 Day Eq Rx Fills30 Day Eq Rx Fills
(All POS) July 01 to Oct 03 (All POS) July 01 to Oct 03
0,000
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000Ju
ly 2
001
Aug
us
t 2
00
1
Sep
tem
ber
20
01
Octo
be
r 2
00
1
Nov
em
be
r 2
00
1
Dec
em
be
r 2
00
1
Ja
nu
ary
20
02
Fe
bru
ary
20
02
Marc
h 2
002
Apri
l 200
2
May
20
02
Ju
ne
200
2
Ju
ly 2
002
Aug
us
t 2
00
2
Sep
tem
ber
20
02
Octo
be
r 2
00
2
Nov
em
be
r 2
00
2
Dec
em
be
r 2
00
2
Ja
nu
ary
20
03
Fe
bru
ary
20
03
Marc
h 2
003
Apri
l 200
3
May
20
03
Ju
ne
200
3
Ju
ly 2
003
Aug
us
t 2
00
3
Sep
tem
ber
20
03
Octo
be
r 2
00
3
Sildenafil
Vardenafil
Source: PDTS
• Vardenafil (Levitra®; Bayer/GlaxoSmithKline)
• Summer 2003 (available now)
• Tadalafil (Cialis®; Icos/Lilly)• Anticipated launch sometime in mid-2004
• Potential opportunity to reduce prices through formulary management or procurement strategies
New PDE5-InhibitorsNew PDE5-Inhibitors
OligopolyOligopolyMTF LHRH Rxs for MalesMTF LHRH Rxs for Males
ContractPre-Contract
0
50
100
150
200
250
300
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Sep
-03
Goserelin 1 & 3 mo
Leuprolide 1& 3 mo
Leuprolide 4 mo
Luteinizing Hormone Releasing Luteinizing Hormone Releasing Hormone (LHRH) Agonist Hormone (LHRH) Agonist
• Goserelin Acetate Implant (AstraZeneca)
• Contract Effective on 17 Feb 03
• Terms: Sole LHRH agonist on the BCF and VANF for the treatment of prostate cancer
MTF LHRH Cost/month of MTF LHRH Cost/month of treatmenttreatment
$0.00
$20.00
$40.00
$60.00
$80.00
$100.00
$120.00
$140.00
$160.00
Oct
-01
No
v-01
Dec
-01
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
1 & 3 MO KIT
4 MO KIT
Contract price: $90/mo
MTF Statin Utilization by TabsMTF Statin Utilization by Tabs
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000O
ct-0
1
No
v-01
Dec
-01
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Sep
-03
SIMVASTATIN
ATORVASTATIN
PRAVASTATIN
LOVASTATIN
FLUVASTATIN LOVASTATIN/NIACIN
MTF Statin Cost/doseMTF Statin Cost/dose
$0.00
$0.20
$0.40
$0.60
$0.80
$1.00
$1.20
$1.40
Jun
-99
Au
g-9
9
Oct
-99
Dec
-99
Feb
-00
Ap
r-00
Jun
-00
Au
g-0
0
Oct
-00
Dec
-00
Feb
-01
Ap
r-01
Jun
-01
Au
g-0
1
Oct
-01
Dec
-01
Feb
-02
Ap
r-02
Jun
-02
Au
g-0
2
Oct
-02
Dec
-02
Feb
-03
Ap
r-03
Jun
-03
Au
g-0
3
1st statin contract
2nd statin contract
$0.99
$0.64
$0.57
High Potency Statin IIHigh Potency Statin II
• Simvastatin (Merck and Co)
• Contract Effective on 1 May 03
• Terms: – Sole High-potency Statin on the BCF and VANF
for the treatment of hyperlipidemia– May have lovastatin and pravastatin or
fluvastatin (deferred to MTFs)
MTF TZD Utilization by 30-day MTF TZD Utilization by 30-day equivalent Rxsequivalent Rxs
0
5,000
10,000
15,000
20,000
25,000
30,000
Jul-
01
Au
g-0
1
Sep
-01
Oct
-01
No
v-01
Dec
-01
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Sep
-03
ROSIGLITAZONE
PIOGLITAZONE
Thiazolidinediones (TZDs)Thiazolidinediones (TZDs)
• Rosiglitazone Incentive Agreement (GlaxoSmithKline)
• Agreement Effective on 1 July 2003
• Terms: – Sole TZD on the BCF– Class remains open, MTFs can add additional
agents through their local P&T process
MTF TZD Cost/tabMTF TZD Cost/tab
$1.00
$1.20
$1.40
$1.60
$1.80
$2.00
$2.20
Oct
-01
No
v-01
Dec
-01
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Ophthalmic Prostaglandins Ophthalmic Prostaglandins MTF Rx Fills MTF Rx Fills
Source: PDTS
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000O
ct-
02
No
v-0
2
De
c-0
2
Ja
n-0
3
Fe
b-0
3
Ma
r-0
3
Ap
r-0
3
Ma
y-0
3
Ju
n-0
3
Ju
l-0
3
Au
g-0
3
Se
p-0
3
Oc
t-0
3
BIMATOPROST.
TRAVOPROST
LATANOPROST
Rx
Fil
ls
MTF Expenditures for MTF Expenditures for Ophthalmic ProstaglandinsOphthalmic Prostaglandins
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Sep
-03
BIMATOPROST
LATANOPROST
TRAVOPROST
BPA Initiated
Reduction in cost attributable to BPA: $280,296
Source: Prime Vendor Data
Open CompetitionOpen CompetitionMTF Triptan Utilization by RxsMTF Triptan Utilization by Rxs
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
Oc
t-0
2
No
v-0
2
De
c-0
2
Ja
n-0
3
Fe
b-0
3
Ma
r-0
3
Ap
r-0
3
Ma
y-0
3
Ju
n-0
3
Ju
l-0
3
Au
g-0
3
Se
p-0
3
SUMATRIPTAN
RIZATRIPTAN
ZOLMITRIPTANNARATRIPTAN
ELETRIPTAN FROVATRIPTAN
ALMOTRIPTAN
ContractPre-Contract
5HT1 Agonist (Triptans)5HT1 Agonist (Triptans)
• Zolmitriptan (AstraZeneca)
• Contract Effective on 11 July 03
• Terms: – Certain placement on the BCF and one of up to
two triptans available on MTF Formularies– MTFs are currently free to select a second
agent using their local P&T process
MTF Triptan Cost/tabMTF Triptan Cost/tab
$3.00
$4.00
$5.00
$6.00
$7.00
$8.00
$9.00
Oct
-98
Dec
-98
Feb
-99
Ap
r-99
Jun
-99
Au
g-9
9
Oct
-99
Dec
-99
Feb
-00
Ap
r-00
Jun
-00
Au
g-0
0
Oct
-00
Dec
-00
Feb
-01
Ap
r-01
Jun
-01
Au
g-0
1
Oct
-01
Dec
-01
Feb
-02
Ap
r-02
Jun
-02
Au
g-0
2
Oct
-02
Dec
-02
Feb
-03
Ap
r-03
Jun
-03
Au
g-0
3
Contract price for zolmitriptan - $3.20/tab
MTF Nasal AQ Steroid MTF Nasal AQ Steroid Utilization by RxsUtilization by Rxs
0
20,000
40,000
60,000
80,000
100,000
120,000
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Sep
-03
FLUTICASONE
MOMETASONE
TRIAMCINOLONE
BUDESONIDE
BECLOMETHASONE
FLUNISOLIDE
Aqueous Nasal CorticosteroidsAqueous Nasal Corticosteroids
• Fluticasone Incentive Agreement (GlaxoSmithKline)
• Agreement Effective on 1 January 2003
• Terms: – Sole AQ Nasal Steroid on BCF– Class remains open, MTFs can add additional
agents through their local P&T process
What happens when the world What happens when the world changes?changes?
• Examples– Products begin to go generic– Dramatic price changes– New competition– New information
• Every P&T decision has consequences– How will the competition react– How will you react
• Considerations– Use the evidence– Consider any external factors– Cut you losses– Renegotiate
MTF PPI Utilization by tabs/capsMTF PPI Utilization by tabs/caps
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000J
an
-02
Fe
b-0
2
Ma
r-0
2
Ap
r-0
2
Ma
y-0
2
Ju
n-0
2
Ju
l-0
2
Au
g-0
2
Se
p-0
2
Oc
t-0
2
No
v-0
2
De
c-0
2
Ja
n-0
3
Fe
b-0
3
Ma
r-0
3
Ap
r-0
3
Ma
y-0
3
Ju
n-0
3
Ju
l-0
3
Au
g-0
3
Se
p-0
3
RABEPRAZOLE
LANSOPRAZOLE
OMEPRAZOLE
PANTOPRAZOLE
ESOMEPRAZOLE
Proton Pump InhibitorsProton Pump Inhibitors
• Rabeprazole Incentive Agreement (Janssen)
• Lansoprazole Incentive Agreement (TAP)
• Agreements Effective on 1 April 2003
• Terms: – Both agents on the BCF– Class remains open, MTFs can add additional agents
through their local P&T process
MTF PPI Cost/doseMTF PPI Cost/dose
$0.00
$0.20
$0.40
$0.60
$0.80
$1.00
$1.20
Oct
-01
No
v-01
Dec
-01
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Non-Sedating Antihistamine Non-Sedating Antihistamine IssuesIssues
• Chronology– Loratadine goes OTC at almost half the price– DoD P&T Committee publishes guidance, via the
PEC, recommending use of Loratadine at MTFs– Fexofenadine remains on BCF to allow transition and
meet needs of non-MTF points of service– Price of Fexofenadine rises 30%– Competitors are more than 2.3 times the expense of
Loratadine– MTFs not using Loratadine to any significant degree
MTF 30 Day Eq MTF 30 Day Eq 22ndnd Gen Antihistamines Gen Antihistamines
Jul 01 – Dec 03 Jul 01 – Dec 03
0,000
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Ju
ly 2
00
1
Au
gu
st 2
00
1
Sep
tem
be
r 200
1
Octo
ber 2
00
1
No
ve
mb
er 2
001
Dec
em
be
r 200
1
Ja
nu
ary 2
00
2
Fe
bru
ary
20
02
Ma
rch
20
02
Ap
ril 200
2
Ma
y 2
002
Ju
ne
20
02
Ju
ly 2
00
2
Au
gu
st 2
00
2
Sep
tem
be
r 200
2
Octo
ber 2
00
2
No
ve
mb
er 2
002
Dec
em
be
r 200
2
Ja
nu
ary 2
00
3
Fe
bru
ary
20
03
Ma
rch
20
03
Ap
ril 200
3
Ma
y 2
003
Ju
ne
20
03
Ju
ly 2
00
3
Au
gu
st 2
00
3
Sep
tem
be
r 200
3
Octo
ber 2
00
3
No
ve
mb
er 2
003
Dec
em
be
r 200
3
CETIRIZINE
DESLORATADINE
FEXOFENADINE HCL
LORATADINE
30 D
ay E
qu
iv R
xs
Fluoroquinolone MTF Rx FillsFluoroquinolone MTF Rx Fills
0
5,000
10,000
15,000
20,000
25,000
30,000
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
Sep
-03
Oct
-03
No
v-03
GATIFLOXACIN
LEVOFLOXACIN
MOXIFLOXACIN
Rx
Fil
ls
Post-Contract Actions and Post-Contract Actions and ReactionsReactions
• Response of competitors is very difficult to predict, but no obligation to maintain pre-contract pricing exists– Gatifloxacin contract price is $1.35, available 1 Jan 04
• contract effective date is 15 Jan 04
– Levofloxacin has been removed from the BCF and Gatifloxacin has been placed on the BCF
– BPA price for Levofloxacin expires 31 Jan 04– Levofloxacin expected to be the Federal Supply Schedule price
• $5.26 per 250mg and 500mg tablet
• The expected levofloxacin price increase has great potential to harm MTF budgets unless 83% of levofloxacin utilization moves to Gatifloxacin by 15 April 04, based on FY03 usage
NSAID Expenditures By POSNSAID Expenditures By POSJul 01 – Sep 03 Jul 01 – Sep 03
$M
illi
on
s
$0
$1
$2
$3
$4
$5
$6
$7
$8
$9
Mail Order
Retail
MTF
July
200
1
Au
gu
st 2
001
Sep
tem
ber
200
1
Oct
ob
er 2
001
No
vem
ber
200
1
Dec
emb
er 2
001
Jan
uar
y 20
02
Feb
ruar
y 20
02
Mar
ch 2
002
Ap
ril 2
002
May
200
2
Jun
e 20
02
July
200
2
Au
gu
st 2
002
Sep
tem
ber
200
2
Oct
ob
er 2
002
No
vem
ber
200
2
Dec
emb
er 2
002
Jan
uar
y 20
03
Feb
ruar
y 20
03
Mar
ch 2
003
Ap
ril 2
003
May
200
3
Jun
e 20
03
Au
gu
st 2
003
July
200
3
Sep
tem
ber
200
3
Source: PDTS
MTF 30 Day Eq NSAID RxsMTF 30 Day Eq NSAID RxsJul 01 – Dec 03Jul 01 – Dec 03
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
July 2001
Au
gu
st 2001
Sep
temb
er 2001
Octo
ber 2001
No
vemb
er 2001
Decem
ber 2001
Janu
ary 2002
Feb
ruary 2002
March
2002
Ap
ril 2002
May 2002
Jun
e 2002
July 2002
Au
gu
st 2002
Sep
temb
er 2002
Octo
ber 2002
No
vemb
er 2002
Decem
ber 2002
Janu
ary 2003
Feb
ruary 2003
March
2003
Ap
ril 2003
May 2003
Jun
e 2003
Au
gu
st 2003
July 2003
Sep
temb
er 2003
Octo
ber 2003
No
vemb
er 2003
Decem
ber 2003
CELECOXIB
IBUPROFEN
INDOMETHACIN
MELOXICAM
NAPROXEN
PIROXICAM
ROFECOXIB VALDECOXIB
30 D
ay E
qu
iv R
xs
MTF 30 Day Eq Rxs: COX-2 Selective MTF 30 Day Eq Rxs: COX-2 Selective NSAIDs, Meloxicam, EtodolacNSAIDs, Meloxicam, Etodolac
Jul 01 – Sep 03 Jul 01 – Sep 03
CELECOXIB
MELOXICAM
VALDECOXIB
30 D
ay E
q R
x F
ills
0
10,000
20,000
30,000
40,000
50,000
60,000
July
200
1
Au
gu
st 2
001
Sep
tem
ber
200
1
Oct
ob
er 2
001
No
vem
ber
200
1
Dec
emb
er 2
001
Jan
uar
y 20
02
Feb
ruar
y 20
02
Mar
ch 2
002
Ap
ril 2
002
May
200
2
Jun
e 20
02
July
200
2
Au
gu
st 2
002
Sep
tem
ber
200
2
Oct
ob
er 2
002
No
vem
ber
200
2
Dec
emb
er 2
002
Jan
uar
y 20
03
Feb
ruar
y 20
03
Mar
ch 2
003
Ap
ril 2
003
May
200
3
Jun
e 20
03
Au
gu
st 2
003
July
200
3
Sep
tem
ber
200
3
ETODOLAC
ROFECOXIB
Aug 02Meloxicam
added to BCF
Source: PDTS
MTF Expenditures for MTF Expenditures for Cholinesterase InhibitorsCholinesterase Inhibitors
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000O
ct-
02
No
v-0
2
De
c-0
2
Ja
n-0
3
Fe
b-0
3
Ma
r-0
3
Ap
r-0
3
Ma
y-0
3
Ju
n-0
3
Ju
l-0
3
Au
g-0
3
Se
p-0
3
ARICEPT
EXELON
REMINYL
Source: Prime Vendor Data
MTF Prescription FillsMTF Prescription FillsCholinesterase InhibitorsCholinesterase Inhibitors
Source: PDTS
0
500
1,000
1,500
2,000
2,500
3,000
Oc
t-0
2
No
v-0
2
De
c-0
2
Ja
n-0
3
Fe
b-0
3
Ma
r-0
3
Ap
r-0
3
Ma
y-0
3
Ju
n-0
3
Ju
l-0
3
Au
g-0
3
Se
p-0
3
Oc
t-0
3
ARICEPT
EXELON
REMINYL
Rx
Fil
ls
162 (6%)
2,386 (84%)
295 (10%)
MTF SSRI Utilization by Caps/tabMTF SSRI Utilization by Caps/tab
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2,000,000
Oct
-01
No
v-01
Dec
-01
Jan
-02
Feb
-02
Mar
-02
Ap
r-02
May
-02
Jun
-02
Jul-
02
Au
g-0
2
Sep
-02
Oct
-02
No
v-02
Dec
-02
Jan
-03
Feb
-03
Mar
-03
Ap
r-03
May
-03
Jun
-03
Jul-
03
Au
g-0
3
FLUOXETINE SERTRALINE
PAROXETINE
CITALOPRAM
ESCITALOPRAM
