Wednesday, July 29, 2015

Reasons Behind Non-Adherence in Patients

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

Non-adherence in patients with prescription medications
When presented with a medication or other health care service, one would naturally assume that the patient who received it would follow through. However, recent reports have shown that many patients actually fail to comply with several health care services, particularly prescription medications, and unfortunately, this has led to an increase in health care costs.

Earlier this month, Express Scripts reported that "non-adherence is a major contributor to skyrocketing health care costs as well as higher rates of hospital and ER visits for patients who do not take their medications." But why exactly are patients leaving their medications in the dust? Well, the report further explained that 69% of non-adherence by patients is a result of certain behaviors such as forgetfulness, procrastination and even confusion; when patients have multiple medications to take, it can be easy to get things mixed up. Additionally, aside from the patient's own behavior, the cost of such medications has also proven to be a cause of non-adherence in 16% of cases. Lastly, 15% of non-adherence is due to clinical side effects, according to the data provided by Express Scripts.

So what can be done to combat this issue? First and foremost, if a medication is too expensive or causes severe side effects, the first plan of action should be to switch it for that particular patient. Or, if there is no alternative, health care providers should work with the patient as closely as they can to make their current situation work. If copayments for mail order prescriptions and if mail order discounts are competitively negotiated by an independent third party like PBIRx, home delivery for medications can offer patients reminders so that they don't lose track of when it's time to take or renew a medication.

To learn more about non-adherence in patients, including how it is directly linked to rising health care costs, check out this article from HealthIT Analytics.

At PBIRx, we understand just how big a role non-adherence plays in health care costs. And as a company whose main priority is to reduce costs wherever possible for our clients, we encourage you to contact us if you're struggling to keep up with the rise in prices for prescription medications so that we can audit your pharmacy benefit plan. For more information, please call (888) 797-2479 or visit us at today.

Friday, July 17, 2015

PBIRx Client Testimonials

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

Established in 1993 by President and Founder Pat Sirowich, we at PBIRx have been providing solutions for the management of pharmacy benefit plans and health care costs for many years. Since our inception, it has been our goal to create optimal health care outcomes for those we work with, which in part includes minimizing total health care costs. To date, after gaining many valuable experiences and practicing our trade, we are proud to say that we have accomplished just that and continue to do so with each client who comes to us for help.

If you are in need of assistance with your pharmacy benefit plan OR your pharmacy benefit costs are exceeding your budget, PBIRx encourages you to give us a call. Why? Just take a look at what some of our current clients are saying about us:

"Thank you again for all the help and guidance you've given us over the years to keep our prescription drug costs down. This helps us keep more funds in our program budgets to directly benefit our students. I truly appreciate all your hard work."

"Thank you both again for the presentation and all the work you do on behalf of LEARN and the Cooperative. Because of your help and guidance, more dollars can go directly to benefit students and in this economy that really helps."

"You always provide excellent superior service! It worked because of you and I really appreciate it! You're just always on your game, provide the best client services and I would refer anyone to you!!"

"We would like to thank you for all your hard work on our prescription drug plan. We certainly learned a great deal yesterday and we both felt the process you followed was extremely thorough."

"Thank you for the information and for all the work you've done on our behalf. We are very pleased with our drug plan and especially the cost."

"You're terrific! We couldn't ask for more in a partner for our Rx needs."

Our diverse, dedicated staff of actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers, IT personnel and more are truly grateful for the opportunities we have been given to assist with pharmacy costs and hope that we have the chance to help YOU next! 

For more information about our services, including pharmacy benefit consulting and auditing, please visit us at or give us a call at (888) RxPBIRx (797-2479) today.

Friday, July 10, 2015

PCSK9 Inhibitors

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

What are PCSK9 Inhibitors?
PCSK9 inhibitors are a new class of drugs that can greatly reduce LDL (Low Density Lipoprotein) cholesterol levels.  LDL is the “Bad Cholesterol” associated with increased risk of heart disease, including heart attack and stroke.

What does PCSK9 stand for?
PCSK9 stands for Proprotein Convertase Subtilisin Kexsin 9.

How much do they cost?
We do not yet know the specific cost but do know they will initially range about $6-12K per year.

Are these drugs currently available?
Two different brands of this drug Praluent™ (alirocumab) and Repatha™ (evolocumab) will be approved third quarter 2015.

What does the FDA say?
The FDA has not formally approved these drugs for market. It is highly expected they will formally approve this drug in the coming months. An FDA medical advisory committee has recommended approval of these drugs for certain conditions.

Are the PCSK9’s for everyone with “high cholesterol”?
No.  As of today, the FDA medical advisory committee has unanimously recommended use of these drugs in people with HoFH (Homozygous Familial Hypercholesterolemia). This is a rare genetically induced high cholesterol disorder that affects 1 in 2000 people.

Additionally the committee was split for recommendation for use for people with any other indication for these agents.

Other indications include:
All patients with high LDL cholesterol
Patients that are “statin resistant”
Patients that are “statin intolerant”

Why is the FDA advisory committee not unanimous for these other indications?
All the data is not yet available. Studies to date have proven that these drugs will reduce LDL by up to 60%. While in theory this is a good sign, it has yet to be shown that this will result in lower heart disease rates.  Two studies involving 20,000 patients are currently under way but the results will not be avialable until at least 2017.

Why the caution?
Historically other cholesterol reducing agents have been approved based upon their cholesterol improving abilities, but later studies showed limited outcomes benefits. These agents include niacin, fibrates and Zetia™ (ezetimibe). While they have all found a place in the cholesterol lowering arsenal their actual results are much less then the initial studies had shown.

Are there other concerns?
Yes.  As with any other newly approved drug there is an unknown side effect adverse event profile. New drugs are studied in controlled populations. After drugs come to market they are exposed to a much greater cross section of the general population. Invariably unknown issues come to light. What is known to date is that the PCSK9 inhibitors have shown a greater degree of “cognitive dysfunction” vs. placebo.  While not statistically significant in the limited studies to date, it is an issue of concern for the FDA advisory committee.

Additionally theses drugs will initially be available only in a subcutaneous injectable form. Similar to Insulin in administration, they will be administered either once or twice monthly depending on the PCSK9 dispensed.  Historically there is some resistance to injections from a portion of the population. An oral version of this drug is currently under study.

Are PCSK9 drugs a “cure”?
No. These agents will lower LDL cholesterol levels but will not treat the underlying causes. This means that these drugs, and any other cholesterol lowering drugs, must be given for the lifetime of the patient.

What is the current treatment for lowering cholesterol?
The drug class of choice is the “Statins”, for which there are many low cost generics available.  This is a class of drugs with proven effectiveness in lowering LDL. While highly effective there is a subset of patients that are resistant to the positive effects of statins and others who suffer from its side effects, primarily muscle pain.

How much do statins cost?
Generic statins cost around $100 per year. Crestor™(rosuvastatin), a brand statin, can cost around $450 per year.

How many Americans have “high cholesterol”?
70 million Americans have high LDL.

Are there other means of lowering cholesterol?
Yes.  Diet, exercise and stress control are all contributing factors and can be controlled, or mitigated, by lifestyle changes.

What does PBIRx recommend?
At this point in time we recommend restricted use of these medications only for those with HoFH, or patients at high CV risk that are statin intolerant or statin resistant. We work within the guidelines of the American College of Cardiology and American Heart Association as to the definition of these conditions.

Our recommendation is to only allow use of these agents with a Prior Authorization from your PBM, after consultation with the patient’s doctor.

Because of the potential costs involved we believe you, the payer, have a right to know that this drug is being prescribed under the most optimum conditions and being used correctly and appropriately. 

As these are a new class of drugs, with multiple competitors, incoming information is evolving rapidly, and criteria and situations may change. As your pharmacy consultants we strive to be aware of this evolving landscape and will keep our clients informed. 

Thursday, July 9, 2015

PBIRx Presenting At 340B Coalition Annual Conference

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

340B conference in Washington, DC

From July 13 to July 15, members of the PBIRx team will be attending and presenting at the 340B Coalition Conference in Washington D.C. This conference is designed for covered entities, consultants, compliance experts and other individuals in the pharmaceutical field who work hand in hand with the 340B program on a regular basis. As a company that specializes in performing 340B compliance audits for our clients, we are extremely excited to have the opportunity to present and learn more about the future of 340B.

PBIRx is honored to be chosen to present "Independent HRSA 340B Compliance Auditing" during the Vendor Perspective Session on Tuesday, July 14th at 3:45 PM.

The agenda for this year's conference includes, but is not limited to:
  • Stories from real life patients about their experience with the 340B program
  • A discussion on the various ways that 340B savings can improve care for patients
  • Tips on how to identify 340B compliance issues as well as how to solve them (this is especially important to our team as 340B compliance audits are one of the services we offer!)
  • Updates from those at the legislative level on any program changes that may be taking effect
  • Information on the rise of specialty drugs and limited distribution networks, including how this impacts covered entities
Here at PBIRx, our 340B compliance audits are completed on-site by a team of pharmacists, analysts and specialists in pharmacy benefits. We are available to provide detailed reports that prepare providing entities for actual HRSA audits, and will offer as much information as possible when it comes to any discrepancies in behavior that could cause one to lose their 340B status. 

Our ongoing services range from targeted claims review to full 340B committee member for covered entities.

For more information about our compliance audits, please visit or give us a call at (888) 797-2479.

Tuesday, July 7, 2015

Orkambi Officially Receives FDA Approval

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

Last month, PBIRx introduced our readers to a new drug known as Orkambi, that was expected to receive FDA approval in early July. Today, we are following up to share the news that the approval has officially gone through!
Orkambi receives FDA approval
As explained by the FDA, this drug was designed to treat cystic fibrosis in individuals that have two copies of a specific mutation. The mutation, known as the F508del mutation, "causes the production of an abnormal protein that disrupts how water and chloride are transported in the body." As of now, this drug will solely be used to treat the disease in patients who are 12 years of age or older, who have two copies of the specific genetic mutation which the drug treats. That represents 28% of cystic fibrosis patients.

Upon hitting the market, Orkambi is expected to cost $259,000 per patient, according to the Wall Street Journal. It's manufacturer, Vertex Pharmaceuticals, anticipates that the drug will be available rather quickly.

Things To Remember:
  • Orkambi is taken orally twice a day. 
  • The drug is a combination of Kalydeco (ivacaftor) and lumacaftor.
  • The effectiveness of Orkambi has not been proven in Cystic Fibrosis patients that do not have two copies the F508del mutation.
  • Side effects of Orkambi include, but are not limited to, shortness of breath, nausea, rash and upper respiratory tract infections.
For more information about Orkambi, please click here.

Here at PBIRx, we realize that the approval of this new drug could affect many pharmacy benefit plans. That's why our team is working closely on analyzing its impact and developing solutions for each of our many clients.

To learn how your pharmacy benefit plan may be affected, please give us a call at 1 (888) Rx-PBIRx (797-2479).