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Official websites use. Share sensitive information only on official, secure websites. Address correspondence to Julie M. Donohue, Ph. Michael A. Fischer, M. Haiden A. Huskamp, Ph. Joel S. Weissman, Ph. To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses DDD and estimated a range of potential savings from generic and therapeutic substitution. The majority Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. Keywords: Prescription drugs, costs, consumer, education, evidence-based medicine. Prescription drug expenditures have grown as a share of total health expenditures from 8. Third-party payers have responded to increased drug spending by implementing tiered formularies that have increased consumer cost-sharing for many drugs Gibson, Ozminkowski, and Geotzel When faced with high out-of-pocket costs for prescription drugs, many patients, particularly the elderly and disabled, skip or take smaller doses of their medications, or stop filling prescriptions Safran et al. Nonadherence to medication therapy has been shown to lead to negative health outcomes, and greater use of emergency department and inpatient hospital services Adams, Soumerai, and Ross-Degnan ; Artz, Hadsall, and Schondelmeyer ; Safran et al. For example, one study reported that one-third of the most expensive medications used by Medicare beneficiaries who exceeded their pharmacy benefits in managed care plans had generic equivalents or a lower cost therapeutic alternative Tseng et al. However, consumers and physicians often lack accurate information on the prices and quality of prescription drugs required to make more cost-effective choices Reichert, Simon, and Halm In , Consumers Union, a not-for-profit organization and publisher of Consumer Reports , launched the Consumer Reports Best Buy Drugs CRBBD program, a national effort to make information on the value of prescription drugs more transparent for consumers Voelker In this paper, we estimate the dollars that would be saved, from a societal perspective, if the CRBBD made up a greater share of sales in four classes of drugs to prevent and treat cardiovascular disease. While several studies have estimated potential savings associated with greater generic substitution Fischer and Avorn b ; Haas et al. Understanding the potential economic impact of greater use of lower cost drugs can inform health policy and educational interventions such as CRBBD. Since , DERP has conducted evidence-based reviews of 32 drug classes for several state Medicaid programs and other agencies. DERP selects drug classes for review that 1 account for a large share of pharmacy budgets; 2 consist of multiple drugs; 3 feature a substantial amount of off-label use; and 4 have new additions of costly drugs. DERP reviewers consider clinical evidence only and do not take cost or cost-effectiveness studies into account. Briefly, the CRBBD program chooses drugs that are equal to or better than their competitors in terms of clinical effectiveness, safety, and side effects, yet generally have retail prices that are equal to or lower than those of other drugs in the class. In some cases, the best buy drug s are not less expensive. This might be the case if effective, relatively low-cost drugs have undesirable side effects or risks. Food and Drug Administration FDA , the comparative monthly prices of individual drugs, and peer review. Cardiovascular disease remains one of the leading causes of death in the United States Thom et al. While pharmacologic treatment of cardiovascular disease and risk factors such as hypertension and hyperlipidemia can significantly reduce morbidity and mortality, evidence suggests that these medicines are underused relative to what treatment guidelines would recommend Ellis et al. First, they are commonly used to treat or reduce the risk of a range of chronic cardiovascular conditions. Second, drugs in these classes are intended for long-term use and can result in high annual and lifetime out-of-pocket costs for patients. Third, there is substantial variation in the retail prices of these drugs, so medication choices have significant economic implications for patients depending on the drug chosen and their level of insurance coverage. Fourth, these classes are suitable for this analysis because patients typically take only one from the class. Thus, polypharmacy within a class is not an issue that could complicate our analysis. Aggregate data on pharmaceutical sales were obtained from Wolters Kluwer Health, which collects sales data from a large nationally representative network of pharmacies and pharmacy benefit managers. We collected data from January 1 to December 31, for every prescription drug in each of the four therapeutic categories. The dataset contains information on each drug's brand and generic name, form e. Dollar sales were based on the dispensed prescriptions containing the retail price charged to the consumer the price faced by cash payers or copay plus plan payment for insured individuals and vary by payer type Medicaid, private or cash payer. These sales data do not account for rebates manufacturers provide to payers. DDDs are the assumed average maintenance dose per day for a drug used for its main indication in adults. They provide a fixed unit of measurement independent of price and formulation enabling us to perform comparisons between drugs in the same class with different dosing requirements. For our analysis, we made four assumptions about switching behavior: 1 individuals taking the brand name versions of the best buy drugs would switch to their generic equivalents generic substitution ; 2 individuals taking a combination drug e. Therefore, the hypothetical cost of the drugs under the assumption of therapeutic substitution is the product of the DDD units for other drugs and the weighted average best buy drug price. We calculated potential savings associated with patients switching from other drugs in the class to best buy drugs as follows Fischer and Avorn b :. In order to decompose savings from generic versus therapeutic substitution, we estimated rates of generic use for each multisource drug i. Most but not all of the best buy drugs in the four classes have FDA-approved generic equivalents. CRBBD identified bisprolol and metoprolol succinate as the BBDs for mild or moderate heart failure and carvedilol for severe heart failure. Figure 1 displays the share of DDDs compared with the dollar share of the market held by the best buy drugs and other drugs in each class in Table 2 shows the average prices per DDD for the drugs in the four classes. The best buy drugs are, on average, 15—65 percent less costly per DDD than their therapeutic alternatives, depending on the class. We found significant variation in the prices of generic equivalents relative to their brand name counterparts. For instance, brand name pravastatin was only 2. The estimated savings are presented in Table 3. Table 3 also presents savings resulting from 25 and 50 percent of substitutions possible. Nearly half The amount of potential savings varies by class from 4. The percentage of sales saved by switching to best buy drugs was highest in the CCB class, where best buy drugs only had a Generic penetration varied widely in the classes we studied. The proportion of savings from therapeutic as opposed to generic substitution ranged from 3. We set out to estimate the potential savings associated with the drug recommendations in a novel consumer-oriented program of prescription drug education. Our analysis points to significant potential savings for patients and the health care system. Public and private payers have instituted a range of policies in recent years to reduce spending on prescription drugs including increased cost-sharing e. Savings resulting from these policies are substantial, but our findings point to potential for further reductions in drug spending. Indeed, studies have shown that many elderly who are under- or uninsured for prescription drugs are prescribed therapeutic agents for which less expensive alternatives are available Tseng et al. The choice of more costly medicines may relate to clinical factors, but may also be due to the fact that older medicines with generic equivalents are not as heavily promoted by the pharmaceutical industry as newer medicines Hurwitz and Caves ; Iizuka We found that the majority of savings in these four classes would be achieved through therapeutic as opposed to generic substitution. The rate of generic use in some of our classes is substantially higher than what recently published estimates indicate Haas et al. Payers have become much more aggressive in recent years at requiring patients to fill prescriptions for generic equivalents for multisource drugs O'Malley et al. Nearly two-thirds of prescriptions filled in the U. However, our findings also suggest substantial variability in use of generic equivalents across classes and products. Early experience with the Medicare drug benefit suggests that financial incentives to use generic drugs may outweigh concerns among some elderly and their physicians about the safety and efficacy of generics Banahan and Kolassa ; Hellerstein ; Genther and Kreling ; Gaither et al. We found evidence of variation in the relative prices of generic drugs compared with their brand name counterparts. Studies have shown that generic drugs are priced 10—70 percent lower than brand name drugs Frank and Salkever ; Suh et al. It is important to monitor the price differences between generic and brand name drugs in the midst of dramatic changes in pharmaceutical markets. On the one hand, generic manufacturers have more aggressively challenged the patents of brand name drugs, increasing generic entry and price competition Frank There are limitations to our analysis, which may limit generalizability. First, medication switches may not be appropriate in some cases due to medication side effect profiles or potential drug interactions. We were interested, however, in gaining an understanding of the maximum economic impact of the program and providing a range of possible savings estimates. Second, our findings are not necessarily generalizeable to other medication classes. We made simplifying assumptions in our analysis, which may be difficult to apply to other classes i. Thus, while savings could be achieved in other classes through therapeutic substitution, the magnitude of savings will vary by class. Third, we estimated savings in a dynamic market, in which prices and market shares can change dramatically from year to year. Notably two of the statins simvastatin and pravastatin became available as generics mid-way through our study period. Savings for and beyond will be substantially higher due to the availability of multiple generic alternatives in the class Consumer Reports Best Buy Drugs Fourth, we cannot take into account any rebates or discounts negotiated by third-party payers. Given that the nature and magnitude of these rebates are not publicly reported, it is unclear how our savings estimates would be affected if rebates and discounts were incorporated. Fifth, because we used aggregate data on total sales in these four pharmacologic classes, we cannot estimate how much of the savings would accrue to patients as opposed to payers. Modest savings that accrue to third-party payers may lower overall health insurance premiums, but are not likely to lead to significant behavior changes among patients. Significant savings that result in lower out-of-pocket spending among consumers could reduce economic barriers to medication adherence. One important question is how the transition costs associated with medication switches might compare with the savings achieved through increased use of the best buy drugs. For instance, when British Columbia instituted a reference pricing system for ACEIs in , visits to physicians increased slightly among those who switched to lower cost medications. It is important to note, however, that these were one-time costs as opposed to savings associated with chronic use of medication over a period of several years. Nevertheless, it is important for efforts like those of the CRBBD program to take these transition costs into consideration. While the findings we report are theoretical, they are of practical importance given that we assessed the potential impact of an existing program targeting consumers. Some payers have provided price and quality information on hospitals and physicians to consumers in conjunction with consumer-directed health care initiatives, yet little is known about their effects Ginsburg In some respects, reporting on the comparative effectiveness of prescription drugs from randomized controlled trials is technically more straightforward than reporting on the quality of care delivered by physicians and hospitals to which patients are not randomly assigned. Programs such as CRBBD may inform broader efforts that encourage consumers to make value-based purchases in health care. The challenge will be to disseminate the CRBBD information in a way that actually leads to behavior change among consumers and their physicians. Knowing that Internet usage remains low among low-income individuals with high out-of-pocket drug costs who could benefit most from CRBBD-type information Pew Charitable Trust ; Baker, Wagner, and Bundorf , CRBBD works with a number of intermediaries to disseminate the educational material. One such mailing to just over 1 million users of brand name statins about the availability of low-cost generics was followed by 49, members switching to simvastatin or pravastatin G. Shearer, personal communication. Prescribing practices are difficult to change. Simple one-time educational interventions aimed at changing physician's behavior are seldom effective Grimshaw et al. While strategies such as academic detailing have been shown to alter prescribing in some classes Spinewine et al. Very few programs that aim to improve prescribing patterns through consumer education have been evaluated Fillit et al. However, studies of the impact of direct-to-consumer advertising of drugs indicate that physicians are highly responsive to patient requests for medications Kravitz et al. Providing consumers with information on prescription drugs in conjunction with financial incentives to use lower cost drugs could increase consumer demand for drugs of high value. Our analysis can provide insights for the return on investment for programs to increase the use of evidence-based medicines. Disseminating this type of information to consumers and assisting them to act on it will be critical if these savings are to be realized. The authors wish to thank Steve Findlay and Gail Shearer of Consumers Union for helpful comments on earlier drafts of this manuscript. We also wish to thank Keith Newsom-Stewart at Consumers Union for valuable assistance with data collection. The following supplementary material for this article is available online: Appendix SA1: Author Matrix. Please note: Blackwell Publishing is not responsible for the content or functionality of any supplementary materials supplied by the authors. Any queries other than missing material should be directed to the corresponding author for the article. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Health Serv Res. Open in a new tab. Note : Products that are shaded did not have a generic equivalent as of December Source of price data: Wolters Kluwer Health. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

Reducing the Threat of Counterfeit and Unapproved Drugs in Clinical Settings

Buying MDMA pills Engelberg

Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzed reviews to verify trustworthiness. He takes you inside the mysterious world of patents to provide a basic understanding of how drug makers have gamed the laws governing brand and generic competition, misused patents to prolong monopolies, and delayed generic competition on old drugs instead of focusing on discovering new ones. In this book, Engelberg provides readers with an understanding of how the growing use of low-cost generic drugs led to the highest prices in the world for new drugs, and how middlemen in the drug distribution chain have exploited a lack of price transparency in order to earn excessive profits. Breaking the Medicine Monopolies is a must-read for anyone who wants to understand how ill-considered policy decisions and an inept patent system led to unaffordable prices for new drugs, and what can be done to correct the problem. Report an issue with this product or seller. Previous slide of product details. Print length. Post Hill Press. Publication date. January 28, See all details. Next slide of product details. Customers who bought this item also bought. Page 1 of 1 Start over Page 1 of 1. Previous set of slides. Table for Two: Fictions. Amor Towles. Next set of slides. About the Author Alfred Engelberg is widely regarded as the legal father of the modern generic drug industry for his work on the Hatch-Waxman Act, which created the framework for the explosive growth in generic drug use. Engelberg was a pioneer in challenging improperly granted drug patents that block generic competition on important medicines. He is the author of numerous articles on regulation of brand and generic competition, high prices on new drugs, the role of patent monopolies on drug price competition and innovation, drug shortages, and more. Al has degrees in Chemical Engineering Drexel, and law New York University, and has worked as a patent examiner, a patent agent for Exxon, a Justice Department trial lawyer, and a partner in an intellectual property law practice. Brief content visible, double tap to read full content. Full content visible, double tap to read brief content. Help others learn more about this product by uploading a video! Customer reviews. How customer reviews and ratings work Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them. Learn more how customers reviews work on Amazon. Images in this review. No customer reviews. Your recently viewed items and featured recommendations. Back to top. Get to Know Us. Make Money with Us. Amazon Payment Products. Let Us Help You. Amazon Music Stream millions of songs. Amazon Ads Reach customers wherever they spend their time. Sell on Amazon Start a Selling Account. Veeqo Shipping Software Inventory Management. AmazonGlobal Ship Orders Internationally. Shopbop Designer Fashion Brands. Deals and Shenanigans. Ring Smart Home Security Systems. Blink Smart Security for Every Home. Amazon Subscription Boxes Top subscription boxes — right to your door. PillPack Pharmacy Simplified. Amazon Renewed Like-new products you can trust.

Buying MDMA pills Engelberg