Cost Savings with Generic Lovastatin: WI Medicaid's Prior Authorization, Summaries of Health sciences

Download Cost Savings with Generic Lovastatin: WI Medicaid's Prior Authorization and more Summaries Health sciences in PDF only on Docsity! Wisconsin DUR Project—January 2004 1 To: Prescribing Physicians, Pharmacies From: Wisconsin Medicaid, Division of Health Care Financing January 2004 PRIOR AUTHORIZATION GUIDELINES In order to encourage the use of generic lovastatin, the Wis- consin Medicaid program began requiring prior authorization for brand name HMG-CoA reductase inhibitors on April 15, 2003. Prior authorization was made available through the STAT-PA system. Only recipients new to statin drugs are re- quired to try lovastatin first. The criteria for determining prior authorization includes: • Any recipient currently on an effective brand name statin will be granted PA to continue on that statin drug. • Any recipient who requires >35% reduction in low-density lipoprotein (LDL) cholesterol will be granted PA to start on the brand name statin drugs. • Any recipient who has impaired renal function will be granted PA to start on the brand name statin drugs. • Any recipient who is at high risk for drug interactions will be granted PA to start on the brand name statin drugs. For more information, go to the Wisconsin Medicaid phar- macy handbook website at http://www.dhfs.state.wi.us/Medicaid2/handbooks/pharmac y/index.htm. Wisconsin Medicaid analyzes claim data to review adherence to prior authorization policies. Utilization and Program Costs of Statins for Wisconsin Medicaid THE COST OF GENERIC VERSUS BRAND- NAME HMG-COA REDUCTASE INHIBITORS In June 2002, lovastatin became the first HMG-CoA reduc- tase inhibitor with an AB rated generic equivalent. All other statins are currently available only as brand name products. Brand name lovastatin is also still marketed as Mevacor. Other brand name products include Altocor (lovastatin ER), Lipitor (atorvastatin), Zocor (simvastatin), Pravachol (pravastatin), Crestor (rosuvastatin), Lescol (fluvastatin), and Lescol XL (fluvastatin XL). Products that contain an HMG-CoA reductase inhibitor combined with another ingredient (e.g. Advicor) were not included in this analysis. The generic form of lovastatin is significantly less expen- sive to the Medicaid program than brand name products. Average cost to the Wisconsin Medicaid Program for generic lovastatin 40 mg is $1.20 per tablet1 and for a brand name HMG-CoA reductase inhibitors (including the brand name forms of lovastatin) range from $1.65 to $4.18 per equipotent dosage2 (table 1). Trade Name Generic Name Cost Per Tablet Mevacor 40 mg Lovastatin $4.18 Zocor 20 mg Simvastatin $4.03 Pravachol 40 mg Pravastatin $3.98 Crestor 10 mg Rosuvastatin $2.31 Lipitor 10mg Atorvastatin $2.28 Lescol 40 mg or Lescol XL 80 mg Fluvastatin or Fluvastatin XL $1.79/$2.09 Altocor 40 mg Lovastatin ER $1.65 Lovastatin 40 mg (Generic) ------------- $1.20 Table I Cost Per Tablet for Wisconsin Medicaid 2 Wisconsin DUR Project—January 2004 WISCONSIN MEDICAID COST AND EXPENDITURES FOR HMG-COA REDUCTASE INHIBITORS The annual drug budget for the Wisconsin Medicaid program is currently over $500 million. The budget has increased approxi- mately 16 percent each year over the past 2 years. Wisconsin Medicaid spent more than $12.5 million on HMG-CoA reductase inhibitors in 2001. In 2002, Wisconsin Medicaid spent more than $16 million. This is an increase of 29% from the previous year. The average cost per prescription of an HMG-CoA reductase inhibitor for the last quarter of 2002 as compared to the cur- rent cost per prescription is illustrated in Figure 1. The percent of the overall number of prescriptions for these agents is i llus- trated in Figure 2. Figure 1 Average Cost Per Stat in Prescript ion for the Wisconsin Medicaid Program $38 $53 $95 $106 $30 $77 $59 $104 $114 $82 $ 0 $20 $40 $60 $80 $100 $120 Lovastatin Fluvastatin Pravastatin Simvastatin Atorvastatin Quarter 4 2002 Current Figure 2 Percent Market Share of HMG-CoA Reduces Inhibitors Prescriptions for the Wisconsin Medicaid Program 2.9% 4.4% 10.6% 58.4% 23.8% 3.7% 10.0% 56.4% 22.5% 7.5% 0% 10% 20% 30% 40% 50% 60% 70% Lovastatin Fluvastatin Pravastatin Simvastatin Atorvastatin Quarter 4 2002 Current CLINICAL INFORMATION HMG-CoA reductase inhibitors (also known as ‘statins’) are used to treat dyslipidemias of various etiologies. Table 2 briefly su mma- rizes the approved indications of the available products. When given in approximately equivalent daily doses, HMG-CoA reductase inhibitors can reduce low-density lipoprotein (LDL) cholesterol up to about 40% (table 3). However, if a reduction in LDL greater than 40% is desired, a daily dose of atorvastatin 20mg, lovastatin 80mg, simvastatin 40mg or rosuvastatin 5 mg is more likely to achieve this goal. In addition to the reduction of LDLs, the HMG-CoA reductase inhibitors have mixed influence on other lipoproteins. Even though this article concentrates on the reduction of LDLs, table 4 briefly summarizes which HMG-CoA reductase inhibitors are approved to treat other lipoprotein disorders. Atorvastatin Fluvastatin Lovastatin Pravastatin Simvastatin Rosuvastatin Hypercholesterolemia X X X X X X Mixed Dyslipidemia X X X X X Primary Prevention Of CHD X X X X X Secondary Prevention Of CHD X X X X Dysbetalipoproteinemia X X X Elevated Serum Triglycerides X X X X TABLE 2: SUMMARY OF APPROVED INDICATIONS Rosuvastatin 5 (45%) 10-20 (52-55%) 40 (63%) Atorvastatin 10 (38%) 20 (43%) 40 (50%) 80 (60%) Simvastatin 10 (30%) 20 (38%) 40 (41%) 80 (47%) Lovastatin 10 (21%) 20 (27%) 40 (31%) 80 (42%)--as 40 bid Pravastatin 20 (30%) 40 (34%) Fluvastatin 20 (20%) 40 (24%) 80 (30%) Fluvastatin XL Lovastatin ER TABLE3: EQUIVALENT DAILY DOSE IN MILLIGRAMS (%REDUCTIONS IN LDLS)