|Volume 6 Issue 43 Published - 14:00 UTC 08:00 EST 12-Feb-2004 Next Update - 14:00 UTC 08:00 EST 13-Feb-2004||Editor: Susan K. Boyer, RN
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Health plans that did not cover over-the-counter (OTC) Claritin and moved other prescription non-sedating antihistamine (NSA) drugs to third tier status realized additional 7% to 16% cost savings
Health plan sponsors that did not cover over-the-counter (OTC) Claritin® (loratadine) and moved other prescription non-sedating antihistamine (NSA) drugs to third tier status under a three-tier drug benefit design realized an additional 7% to 16% in cost savings for all covered anti-allergy drugs compared to sponsors using other strategies, according to a study by Express Scripts.
All forms and strengths of Claritin, which had the largest market share of the prescription NSAs, became available for sale OTC in December 2002. The study used data from 1,779 plan sponsors across Express Scripts' book of business in examining the financial impact on plans sponsors of their choice of prescription NSA benefit design after Claritin went OTC.
"The results of the study indicate that plans should not cover OTC loratadine unless the coverage is provided simply as a benefit to their members without consideration of the lost savings," reported Tom Delate, PhD, director of research for Express Scripts and principal investigator for the study.
In another finding, increases in the rate of spending for Singulair® and Flonase® increased during the period.
"All benefit designs experienced substantial increases in the rate of Singulair spend and use, which coincided with its U.S. Food and Drug Administration (FDA) approval for its use with allergic rhinitis, also known as hay fever," said Delate. "Plans should consider step therapy to manage spending on Singulair." Under step therapy, a patient tries a lower cost but similar drug to see if it works and is well tolerated before using a more expensive alternative.
Editor's note: This is an example of insurance companies helping themselves instead of their patients or clients. Are shareholder and fudiciary interests more important than health? And at what point do mission and fiscal duties collide? We'd be interested in knowing your thoughts. Write to firstname.lastname@example.org. Reasonable and well-thought replies on both sides of the issue will appear in an upcoming issue of Vidyya.