Reduce Medicine Cost by Dividing Tablet

Reduce Medicine Cost by Dividing Tablet

“Many Americans promised themselves they would improve their health in the New Year – eat better and get more exercise,” said American Heart Association President Augustus O. Grant, M.D., Ph.D. “Now it is Congress’s turn to make the same pledge to all Americans. Heart disease, stroke and other cardiovascular diseases claim far too many lives – nearly one million per year – and almost a quarter of all Americans are afflicted with at least one type of cardiovascular disease.”

Iowa, this weekend, the candidate for the Democratic presidential nomination revealed a plan he says could save citizens $283 billion in prescription drug costs over a 10-year period, The Des Moines Register said.It's wrong that American citizens should have to pay more for prescription drugs because drug companies are spending billions of dollars lobbying for it," Obama said .

The Illinois politician's report compares prices of such drugs with their actual costs and is said to show significant price increases when sold through Medicare.

In 1959, Senator Estes Kefauver began holding congressional hearings into concerns about pharmaceutical industry practices, such as the perceived high cost and uncertain efficacy of many drugs promoted by manufacturers.The Hatch-Waxman Act was intended as a compromise between the "pioneer" and generic drug manufacturers which would reduce the overall cost of bringing generics to market and thus, it was hoped, reduce the long-term price of the drug, while preserving the overall profitability of developing new drugs.

Drug expenditures are now the fastest-growing component of health care costs, increasing at the rate of about 15 percent per year. They account for about 8 percent of health care spending, and at their current rate of increase, they will soon surpass spending for physicians' services and, for many health maintenance organizations (HMOs), the costs of hospitalization. The increase is due both to a greater use of drugs and to higher prices for individual drugs. Patients feel drug costs keenly, because they pay much of them out of pocket. Many private insurers tightly limit drug coverage, and Medicare does not cover outpatient drugs at all.

Whereas the U.S. government is spending an enormous amount of money to wage this war-a figure that has exploded in the last two decades. In 1981, the federal drug control budget stood at $1.5 billion. By 1991, it was $11 billion. Today, it is $17 billion. And the lion's share of that cost goes not to drug prevention and treatment but to imprisonment.

Still, drug interactions remain a problem. Expected toxic effects from marketed drugs, even when used appropriately, is estimated to rank among the top 10 causes of death in the US and is estimated to cost more than $30 billion annually.In most cases, the cost of experimental drugs is not reimbursed by insurance companies.

Getting a prescription filled is usually easy. But because of the high cost of prescription medicines, most insurance companies and employers are trying to control drug costs. Some of the things they are doing make getting a prescription more complicated for you and your doctor, and some of the terms they use can be confusing.

A dramatic rise in the utilization of prescription drugs, especially newly introduced ones, is the biggest reason for double-digit increases in the overall cost of prescription drugs for American workers - not inflation in the price of established drugs, a new University of Michigan study confirms.

Patients may be resuscitated from a cardiac arrest but condemned to live many weeks in a severely compromised state, requiring costly intensive care. Serious cost-benefit concerns arise when compromised patients die after prolonged hospital stays, not to mention the pain and suffering experienced by the patient and family members.The cost-effectiveness of interventions such as CPR and resuscitation, however, must be evaluated. Investigators should measure costs rather than charges because costs better represent the societal burden of an intervention such as CPR.

Managed care insurance plans designed to contain health care costs are actually seeing the biggest jumps in prescription drug costs, as much as 35 percent in two years, due to their members' rush on prescriptions for existing and new drugs. In the same period, traditional insurance plans saw a 17 percent rise in spending - almost all from the use of new drugs.

The real costs of research on drugs by pharmaceutical companies are much less than the oft-quoted $800 million or so per new drug brought to market. Most of their research is on me-too drugs — unoriginal, tax-deductible (and thus paid for in lost taxes by the public), and mostly unnecessary, except for corporate profits and executive bonuses.

Patients who trust their doctors are more likely to stick to their prescription medicines, even if they face high out-of-pocket costs, a new study finds. But patients who have lower levels of trust in their physicians, or who have depression-like symptoms, are much more likely to skip doses or refills when costs become a problem for them.

In many cases, a lack of resources has forced countries to continue the use of drugs whose effectiveness is known to be limited due to drug resistance. Although the potential value of drug combinations, particularly artemisinin-based combination therapies (ACTs), is widely acknowledged and accepted, high costs are still a major barrier to their effective use.The new ACT preparations are currently only available from major suppliers. It is clear that antimalarial treatment costs in the
future are going to be much higher than today. Until recently, it cost well below US$ 1 to treat a case of malaria, but with more complex drug regimes, including ACTs, the cost will rise to several dollars per treatment .

Researchers said that a worker who suffers from insomnia costs his or her employer more than $3,000 a year in health costs compared with employees who don't have problems sleeping.The insomniac also pays twice as much out of pocket as a co-worker who falls asleep when the head hits the pillow.The personal and social costs that result from untreated mental disorders are considerable:

A practice patients often use to cut down on drug costs, called "pill splitting," can also save money for insurance companies and employers, a study of the University of Michigan's own health benefit plan shows.

In pill splitting, patients cut larger-dose tablets in half to double the amount of smaller-dose pills they receive in a single prescription -- for example, dividing 40-milligram tablets to create twice as many 20-milligram doses for the same price. And since drug companies and pharmacies don't usually double the price of medications as the dose doubles, that can mean lower overall per-pill drug costs and fewer drug store co-pays for consumers.

"Splitting is not really new," added study lead researcher Hae Mi Choe, who is an assistant clinical professor of pharmacy at the university. "What was different about this study was that we found out what it would be like if you return some of those savings to the patient."

Her team's study involved more than 100 university health plan members who take cholesterol-reducing drugs such as statins. Statins tend to be good candidates for splitting, the researchers noted, because they linger in the body for a long time, and any impact splitting might have on their action wouldn't greatly alter their effects.

The authors cautioned, however, that not all pills can be safely split. For example, those that pass through the body rather quickly, or have special time-release coatings, are not good candidates for splitting.

After the six-month randomized trial, 89 percent said they'd be willing to continue splitting their cholesterol medications in exchange for a 50 percent reduction in their prescription co-pays, the study found.

A survey returned by 109 health plan members found that 59 percent would be willing to split medications for as little as $5 to $10 in savings per prescription. However, for 12 percent of the survey respondents, no amount of monetary reward would encourage them to split pills.

In 2006, the university's health benefit plan (which covers 80,000 employees) offered the pill-splitting program for three statin drugs that reduce cholesterol. The program saved 500 employees who chose that option a total of $25,000 in co-pay reductions. In turn, the university saved $195,000 in drug costs, Choe added.

The study, published in the American Journal of Managed Care's June issue, also showed that pill splitting did not negatively affect participants' adherence to either their medication regimens or health status. Other types of medications are expected to be added to the program, Choe said.

In the corporate world, "early adapters" are looking at adding an incentive for pill-splitting in their 2009 health plans, said Eric Michael of Mercer Human Resource Consulting, in Minneapolis, a pharmacist and expert on corporate health plans. The University of Michigan's "study will go a long way toward promoting financial incentives, because it's from a credible, independent source," Michael said.

Splitting co-pays might not be quite enough of a financial incentive to get large numbers of patients to take the extra trouble to split pills, according to Greg Scandlen, president of the nonprofit Consumers for Health Care Choices, based in Maryland. If insurance carriers or employers "shared savings 50-50 with the patient, that would be a real incentive," he added.

And with an increased use of health savings accounts -- from which consumers pay 100 percent of drug costs -- "you'd have a substantial incentive," added Scandlen, whose group supports private health insurance.

Already, some managed care plans require pill splitting without financial incentive for appropriate medications, Michael explained.

Many other prescription drugs already are scored at their surface and are ready to be split apart by hand, Michael added. For example, he noted that Buspar, an anti-anxiety medication, is scored to break in either half or in thirds. Newer medications, he said, are less likely to come pre-scored, he said. According to Choe, participants in the University of Michigan study used pill-splitter devices to avoid problems with pills crumbling or being too hard to cut

Michael said he favors having pharmacists, not patients, split the pills, and some states -- but not all -- already authorize pharmacists to do this for customers. For one thing, certain patient groups, such as the elderly, might not be appropriate for pill splitting because of problems with dexterity, he said.

In addition, "A patient might forget to split and [therefore] might take twice the dose," Michael reasoned. "That might not be life-threatening, depending upon the medication, but it could be if they took it for a sustained amount of time."

Choe agreed that those kinds of concerns should be considered when deciding what pills to include in a splitting program. "If doubling the dose will lead to detrimental consequences, I wouldn't recommend splitting," she said.

A bill introduced would expand a program that lowers drug prices for hospitals and clinics that serve the poor."This program is vital, needed and important," said Rep. Bobby Rush, D-Ill., sponsor of the 340B Drug Expansion Act of 2007.

The 340B program, established in 1992, allows about 12,000 hospitals and clinics that serve a high proportion of indigent patients to pay as much as 50 percent less for outpatient drugs by requiring drug companies participating in the Medicaid program to provide steep discounts.


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