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AIHW: arthritis and osteoporosis drugs

Early use of DMARDs is now common practice in managing rheumatoid arthritis with methotrexate the most frequently recommended medication, according to a report from the Australian Institute of Health and Welfare (AIHW).

The report summarises data on the use of medications for osteoarthritis, rheumatoid arthritis and osteoporosis using information from the 2004–05 National Health Survey and the Bettering the Evaluation and Care of Health (BEACH) general practitioner surveys from 1998–99 to 2007–08.

“In the last decade, the variety of medicines available for managing arthritis and osteoporosis has expanded considerably,” said Dr Kuldeep Bhatia from the AIHW’s National Centre for Monitoring Arthritis and Musculoskeletal Conditions.

Complementary medicines were commonly used for arthritis and osteoporosis, especially by women.

“While GPs do recommend complementary medicines, the rates are much lower than for pharmaceutical medications,” Dr Bahtia added.

People with osteoarthritis and rheumatoid arthritis most commonly used NSAIDs, and GPs commonly recommended paracetamol for these conditions as well.

For RA, GPs most commonly recommended methotrexate, and for osteoporosis they prescribed bisphosphonates.

Methotrexate was estimated to cost consumers $1.1 million and the Australian Government $2.5 million in 2007, with more than 100,000 subsidised prescriptions dispensed.

More than 1.6 million subsidised prescriptions for meloxicam were dispensed in 2007, costing consumers $7.4 million and the Australian Government $36.9 million.

The report also found that the recall of rofecoxib in 2004 and lumiracoxib in 2007 led to less GP recommendation of other COX-2 inhibitors such as celecoxib, from 32 per 100 encounters in 2000–01 to 8 per 100 in 2007–08.

In 2007, alendronate, alendronate with cholecalciferol, and risedronate with calcium carbonate for the treatment of osteoporosis cost the Australian Government more than $129 million and consumers $19 million.

Drug interactions can lead to Implanon failure: TGA

Women using the Implanon etonogestrel implant are being warned to use “barrier protection” by the Therapeutic Goods Administration (TGA) following evidence of contraceptive failures when used with other medications.

In an announcement this week, the TGA said it had received 32 reports of contraceptive failure leading to unintended pregnancy due to a suspected interaction between Implanon and hepatic-enzyme inducing medicines.

The drug regulator listed a number of products that may lead to a decrease in the efficacy of the contraceptive implant, which included popular complementary medicine, St John’s wort.

“Interactions between hormonal contraceptives and other medicines leading to a decreased contraceptive effect are well recognised.

“For example, carbamazepine can reduce the effect of oral and implantable hormonal contraceptives by inducing cytochrome P450 enzymes, with increases clearance of sex hormones,” the TGA said.

The administration stressed health care professionals should tell women using Implanon to use condoms or the intrauterine device depending on the length of co-administration of a medication that may decrease the effects of the implant.

“Women taking hepatic-enzyme inducing drugs should use a barrier method in addition to Implanon during the time of concomitant drug administration and for 28 days after discontinuation.

“In women on long-term treatment with hepatic-enzyme inducing drugs, [health professionals should recommend] removing Implanon and recommend a non-hormonal method instead,” the TGA said.

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Pharmacy News

New Data on Pharmacy Industry Market Share

With little fanfare, NACDS just released its new estimates of 2009 pharmacy revenues and prescriptions. See Industry Facts-at-a-Glance.

Check out the charts below for my summary of prescription revenues and number of prescriptions for the five major drug dispensing formats. The data nicely illustrate key trends that are transforming the pharmacy industry:
The shift to high-cost specialty pharmaceuticals

The dampening effect of generic drugs on retail revenues

The slowdown in mail prescription growth

The slow-motion decline of independent pharmacies
Don’t just take my word for it. Please post your thoughts and predictions about these newly-released data in the comments below.

NCPA’s New CEO and the Pharmacy Industry’s Future

On Sunday, the National Community Pharmacists Association (NCPA) announced the appointment of Kathleen Jaeger as Executive Vice President and CEO. Ms. Jaeger was most recently President and CEO of the Generic Pharmaceutical Association (GPhA).

I’m impressed by this selection. NCPA has chosen an experienced association director and Washington insider. I expect her to upgrade NCPA into a more professional organization, assuming that the old guard doesn’t block her from making the necessary changes.

Ms. Jaeger’s appointment illustrates how the balance of power is shifting in U.S. drug channels.

GPhA became a powerful lobbying organization during Ms. Jaeger’s tenure—a period which also corresponded to an increase in the retail generic dispensing rate (GDR) from about 40% in 2002 to more than 70% today. Retail GDR will exceed 80% within two years, so generics represent the future of the pharmaceutical industry.

But generic drugs turn pharmaceutical channel economics upside down. The costs of distributing and dispensing a traditional (non-specialty) generic drug far exceed the actual cost of the medicine, which is the opposite of brand-name drugs. As a result, the economic interests of companies within the U.S drug channel—pharmacies, wholesalers, and PBMs—are diverging from brand-name drug manufacturers.

Intriguingly, GPhA often aligned with the Pharmaceutical Care Management Association (PCMA), which represents the pharmacy benefit management (PBM) industry. Members of both associations gain with increases in the generic dispensing rate. Members of NCPA also gain from a higher GDR because the average generic prescription is more profitable for a pharmacy than the average brand-name prescription. (Yes, this really is true despite the howls of protest that you often read in comments on Drug Channels.)

In contrast to the PCMA-GPhA relationship, NCPA and PCMA are usually at odds on most issues due to the underlying economic relationship between PBMs and pharmacies. Ms. Jaeger’s background implies that she understands the true economics of the PBM business today, such as the fact that the majority of a PBM’s profits come from dispensing generic drugs from their own mail-order pharmacies while retail network spreads are a comparatively small source of profits. Can we presume that NCPA’s messaging will start to more accurately reflect the real economics of today’s drug channels? Perhaps no more odd reactions to Walmart announcements?

This appointment also fuels NCPA’s expanding political ambitions. As I note in The Politics of Pharmacy, the NCPA’s Political Action Committee (PAC) has become one of the largest association PAC in the country. Whether it’s good or bad…well, that’s a different question.

I counsel my pharmaceutical manufacturer clients to break down functional silos and improve cross-departmental collaboration as channels consolidate and converge. Effective channel management starts with an economic understanding of how the revenue from an individual prescription gets divided between the manufacturer, the wholesaler, the pharmacy, and the PBM. The growing political savvy of trade associations makes this effort more important than ever.

NACDS honors pharmacy industry leaders

The National Association of Chain Drug Stores (NACDS) recognized Charles Vance Burnett, JD, BS Pharm, and Stanley F. Barshay, with its highest honors at the 2010 annual meeting in Palm Beach, Fla.

Burnett, senior vice president, pharmacy, Costco, received the Sheldon W. Fantle Lifetime Achievement Award. Barshay, former chairman of Schering-Plough Consumer Health Care Products, was honored with the Robert B. Begley Award.

Established in 1989, the Lifetime Achievement Award was renamed in 1996 in honor of the late Sheldon “Bud” Fantle of People’s Drug Stores. The Begley Award, established in 1980, is named in memory of former NACDS Chairman of the Board Robert B. Begley and honors great personal warmth, generous spirit, and long-time service to the industry.