Overall drug costs are likely to increase over the next couple of decades because of the size of the aging baby boom generation in relation to the total population.

That statistic is even more sobering when you realize that the proportion of Americans diagnosed with Alzheimer’s disease is projected to nearly triple.

In fact, the Centers for Disease Control and Prevention notes that by 2030, the proportion of the population age 65 and older will double to approximately 71 million — 1 in 5 Americans.

The increasing number of older Americans and their growing diversity will make unprecedented demands on public health, services for the aged, and the nation’s health care system. CVS Caremark recently conducted a retrospective study of Alzheimer’s disease drug utilization to identify prevalence, concomitant therapy, drug expenditures, and utilization patterns by demographic groups. The company analyzed 571.3 million prescription claims.

The plan sponsors included Medicaid, national and local employers, health plans, managed care organizations, insurance companies, unions, and government agencies located throughout the United States.

Anna Theodorou, RPh, MBA, director of industry analytics at CVS Caremark and the lead author, says that members were categorized by generation with these age bands: 83 years and older (GI generation), 63 to 82 years (silent generation), 44 to 62 years (baby boom), and 30 to 43 years (generation X).

The overall annualized total drug cost for patients treated with Alzheimer’s drugs was greater than that of patients not receiving Alzheimer therapies.

The average annual total drug cost for a member categorized in the silent generation without Alzheimer’s disease was $2,381, compared with $5,268 for a silent generation member with the disease.

Theodorou says that “a significant portion of the additional cost was attributed to concomitant drug therapy associated with the condition.”

Annualized drug costs by age of Alzheimer’s patients

Annualized drug costs by age of Alzheimer’s patients

Source: Theodorou AA, Johnson KM, Moore M, et al. Drug utilization patterns in patients with Alzheimer’s disease. 2010. Am J Pharm Benefits. 2(1):77–82

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.