Rx Costs Rise Significantly After Age 65

Once a person reaches age 65 years, his or her prescription drug costs typically increase dramatically, according to results of a meta-analysis published in the March issue of the British Journal of Clinical Pharmacology. Researchers from the faculty of pharmacy at the University of Barcelona, Spain, led by Eduardo L. Marino, PharmD, PhD, examined the computerized pharmacy dispensing records of 5.47 million patients in Catalonia from January 1, 2002, to December 31, 2002. The team established 20 age-sex categories and analyzed the participants' use of 15 therapeutic classes of prescription drugs.

The researchers reported that age (P < .001) produced a more statistically significant effect than sex (P < .05). They found that compared with average prescription drug costs for persons younger than 65 years, such costs for persons between 65 and 74 years, between 75 and 84 years, and 85 years and older were 6.6, 7.8, and 7.5 times higher, respectively.

The team also found that just under 75% of study participants had received prescriptions for at least 1 medication and that women were 23% (relative risk [RR] 1.23; 95% confidence interval [CI], 1.11 to 1.37; P < .001) more likely than men to receive a prescription. More drugs were likely to be prescribed for women than for men (80.9% vs 67.8%), and women were more than twice as likely as men (11.7% vs 5.1%) to use antidepressants. The difference in antidepressant use between men and women (4.5% vs 10.9%) was most notable among those aged 35 to 44 years.

The researchers also determined that overall prevalence of drug use was 74.5%. The overall prescribing rates were highest for children aged 4 years and younger (84.7% of boys, 81.1% of girls) and among most adults older than 54 years (100%). The only participant categories for which prescribing rates did not reach 100% were men aged 55 to 64 years (85.4%) and men aged 85 years and older (90.8%).

The most commonly used therapeutic classes were analgesics (30.5%), NSAIDs (28.4%), antiulcer medications (14.4%), anxiolytics (13.8%), and expectorants and mucolytics (12.8%).

The surge in prescription drug costs for persons aged 65 years can be attributed to several factors. "Our population is progressively aging, we are better at detecting problems than [we were] 15 years ago, and more expensive drugs are being developed," Marino said.

Interventions May Improve Post-MI Adherence to β-Blockers

Researchers led by David H. Smith, RPh, PhD, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, found that a low-cost, easily replicable direct-to-patient intervention may improve adherence to β-blocker therapy among persons who have had a myocardial infarction (MI). Study results were published in the March issue of Archives of Internal Medicine.

Smith and colleagues conducted a cluster randomized controlled trial in 4 geographically dispersed HMOs (in Boston, Minneapolis, Atlanta, and Portland, Oregon) from June 2004 to March 2005. The team studied 836 post-MI patients (67% men; average age, 65 years; average time from MI to randomization, approximately 136 days) who were given a β-blocker after discharge. The participants received 2 mailings-the first at randomization and the second 2 months later. The communications contained nearly identical information, stressing the importance of lifetime use of β-blockers following MI and of remembering to refill their prescription, reminding patients that adverse effects of the drugs can be managed. The mailings also briefly mentioned other therapies, including statins, angiotensin-converting enzyme (ACE) inhibitors, and aspirin.

After adjusting for age, sex, total number of medications dispensed, days between MI and intervention, and intervention site, the team found that patients who received the mailings had a mean absolute increase of 4.3% in days of β-blocker coverage per month (1.3 days per month; P = .04) compared with those who did not receive the mailings. Mailing recipients were also 17% (RR, 1.17; 95% CI, 1.02 to 1.29) more likely than nonrecipients to have at least 80% of days covered. For every 16 patients receiving the intervention, 1 additional patient would become adherent (80% or more days covered per month).

The researchers also found that the use of ACE inhibitors, angiotensin receptor blockers, and statins did not decrease in the intervention group. The estimated cost of the intervention was between $5 and $10 per patient, depending on the size of the HMO.

CVS Caremark Settles Probe Into Dispensing of Ranitidine Capsules

CVS Caremark reached a settlement agreement on March 18 with the US Department of Justice and nearly 2 dozen state attorneys general to resolve an investigation into the company's practice of dispensing ranitidine in capsule rather than tablet form to Medicaid recipients. The company will pay $36.7 million and another $800,000 in investigative costs and other fees to the federal government, 23 states, and the District of Columbia. Of the $36.7 million, $4.3 million will be paid to Bernard Lisitza, the pharmacist who filed the initial lawsuit in the US District Court of Northern Illinois in 2003. As part of the settlement, CVS Caremark also agreed to sign a corporate integrity agreement for the Office of the Inspector General.

After launching an investigation in 2001, the government alleged that CVS pharmacies dispensed the more costly capsules of ranitidine in order to increase Medicaid reimbursement. Medicaid had set maximum reimbursement prices for the tablet form of ranitidine but not for the less frequently used capsule form. Lisitza filed the complaint under the False Claims Act, which allows persons to file claims alleging fraud against the government and to recover a share of the payments. According to the suit, the illegal pill-switching enabled CVS to charge state Medicaid programs more than 4 times as much for each capsule prescription. The government's investigation showed that the alleged pill-switching occurred between April 1, 1999, and December 31, 2006.

In a statement on the CVS Caremark Web site, the company denied the allegations: "For many years, the company purchased and stocked the capsule form of ranitidine across its chain of retail stores for dispensing to all patients, not just Medicaid recipients, due to the fact that the acquisition costs of capsules was lower than the cost of tablets."

"A prescription for a tablet is not a scrip for the capsule, just as a price for the tablet is not the price for the capsule," explained Michael I. Behn, a Chicago lawyer who represented Lisitza, according to the March 18 issue of US News & World Report published online.

Lilly Terminates AIR Insulin Program

Lilly has halted development of its AIR inhaled insulin program, which it was conducting in partnership with Alkermes. The program was in phase 3 clinical development. A statement on the Lilly Web site explained that the decision was based on "increasing uncertainties in the regulatory environment and a thorough evaluation of the evolving commercial and clinical potential of the product compared to existing medical therapies," and not safety concerns. The statement also included a comment by John C. Lechleiter, PhD, Lilly president and chief operating officer: "We are now beginning the process of halting our ongoing clinical studies and transitioning the AIR insulin patients in these studies to appropriate therapies."

Lilly's decision is the third setback for inhaled insulin products in the past 5 months. On October 18, 2007, Pfizer announced that it would stop selling Exubera, the first marketed inhaled insulin therapy, because of disappointing sales. On January 14, Novo Nordisk discontinued the development of its AERx insulin system reportedly because of concerns about its medical and commercial potential. MannKind Corporation is continuing to develop its Technosphere Insulin system.