Mediscor Medicines Review 2011 Mediscor Client Workshop 2012

28 August 2012

Presented by:

Madelein Bester

Benefit Management

Mediscor PBM

• Background of the report

• Overall trends

• Expenditure per benefit type

• Provider type

• Originals vs. generics

• Therapeutic groups

Content

• 10th annual publication

• Goal to measure trends in medicine expenditure in the private health care sector

• Schemes contracted for entire period (1 mil lives)

• Excluding capitation schemes and non-medical schemes

Background of the report

Expenditure trends All medicines: 2009 - 2011

Key indicator

% Change year-on-year

2011 vs. 2010 2010 vs. 2009

Total expenditure Gross cost per beneficiary

5.0 % 7.6 %

Item cost Gross cost per item

0.3 % 5.8 %

Utilisation Items per beneficiary

5.3 % 1.7 %

The role of item cost

• Single exit price / ingredient cost

• Dispensing fee

• Number of units dispensed

• “Medicine mix”

SEP of basket of medicines

-1.0%

5.6%

4.6%

1.8%

Max 7.4%

Utilisation trends Existing medicines

Key indicator

% Change year-on-year

2011 vs. 2010 2010 vs. 2009

Prevalence % Utilising beneficiaries

2.7 % 2.2 %

Intensity Items per utilising beneficiary

2.8 % 3.6 %

New chemical entities

• + contribution to change in expenditure (0.9%)

• 3.5% of expenditure & 1.0% of volume

New chemical entities are novel or innovator medicines that were launched to the South African

healthcare market during the previous five years (2007-2011).

Key indicator % Change

Cost per beneficiary (R) 29.7 %

Cost per item (R) 9.7 %

% Prevalence 11.7%

Intensity 5.8 %

NCEs vs. Existing medicines

Key indicator NCEs Existing

medicines

% Expenditure 3.5 % 96.5 %

% Volume 1.0 % 99.0 %

Cost per item (R) R 482 R 132

% Prevalence 5.8 % 81.8 %

Intensity 3.0 20.9

Expenditure per benefit category

38.8%32.3%

9.8%

9.5%3.9% 3.0%

2.7% Acute

PMB

Non-CDL chronic

Oncology

OTC

Other

HIV/AIDS

50.1%28.9%

9.1%

8.2% 1.7% 1.4%0.7% Acute

PMB

OTC

Non-CDL chronic

Other

HIV/AIDS

Oncology

Expenditure

Volume

PMB 2007: 22.6% 2008: 23.5% 2009: 25.5% 2010: 28.6%

PMB 2007: 18.4% 2008: 20.7% 2009: 22.5% 2010: 24.9%

Changes per benefit category

Benefit

2011 2010

% Expenditure

% Volume

% Expenditure

% Volume

Acute 38.8 50.1 43.1 54.4

PMB (CDL chronic) 32.3 28.6 28.6 24.9

Non-CDL chronic 9.8 8.2 10.9 8.8

Oncology 9.5 0.7 8.9 0.6

OTC 3.9 9.1 3.6 8.6

HIV/AIDS 2.7 1.2 2.4 1.3

Benefit category

105162

261

1 855

246

58152

0

10

20

30

40

50

60

70

80

0

500

1 000

1 500

2 000

Acute

Non-C

DL

chro

nic

HIV

/AID

S

Oncolo

gy

Oth

er

OTC

PM

B

Perc

enta

ge

Rand

Cost per item Prevalence

Changes per benefit category

Benefit

2011 2010

Item cost (R)

% Prevalence

Intensity

Item cost (R)

% Prevalence

Intensity

Acute 105 73.5 11.8 107 78.1 12.9

PMB (CDL chronic)

152 21.9 22.8 154 21.2 21.7

Non-CDL chronic

162 10.5 13.5 168 11.9 13.6

Oncology 1 855 0.7 16.2 1 940 0.7 16.5

OTC 58 29.8 5.3 57 31.0 5.1

HIV/AIDS 261 1.2 20.9 247 1.1 21.3

76.4

20.1

3.5

81.3

9.2 9.5

Retail pharmacies Courier pharmacies Dispensing doctors

0

10

20

30

40

50

60

70

80

90

Perc

enta

ge

% Expenditure % Volume

Expenditure per provider type

Expenditure per provider type

Benefit % Expen-

diture % Volume

Item cost (R)

% Preva-lence

Intensity

Retail pharmacy 76.4 81.3 128 76.2 18.4

Courier pharmacy 20.1 9.2 299 5.4 29.4

General practitioners

3.2 9.4 47 20.0 8.1

Specialists 0.3 0.1 368 0.5 2.9

Expenditure per provider type

0

10

20

30

40

50

60

70

80

90

100

Retail

pharmacies

Courier

pharmacies

General

practitioners

Medical

specialists

Perc

enta

ge

Acute

OTC

PMB

Non-CDL chronic

HIV/AIDS

Oncology

Other

Originals vs. generics

0

50

100

150

200

250

Original with patent valid Original with patent expired

Generic equivalents

Rand

Average Rand per item

R 222

R 89

R 135

R 2.50 R 1.00 R 1.50

Generic utilisation

28.4%

19.2%

52.4%

Original with valid patent

Original with patent expired

Generic equivalents

2010: 50.0 %

Top 10 therapeutic groups 2011

Rank 2011

Therapeutic group

% of total

expen- diture

% of total item

volume

Average cost per ben (R)

Average cost per UB (R)

Average cost per item (R)

UB as % of total

ben

Average # items per UB

1 Anti-hypertensives 11.6 12.2 272 1 506 129 18.0 11.7

2 Cytostatics 6.7 0.3 156 24 888 3 051 0.6 8.2

3 Anti-diabetic agents 5.3 3.6 125 2 303 198 5.4 11.6

4 Anti-depressants 4.5 3.6 106 929 171 11.4 5.4

5 Hypolipidaemic agents

4.5 5.0 105 969 122 10.9 7.9

6 Gastric acid reducers 4.2 3.1 98 551 184 17.8 3.0

7 Anti-viral agents 3.2 1.5 76 1 705 286 4.4 6.0

8 Bronchodilators 2.8 2.1 67 613 187 10.9 3.3

9 Beta-lactam antibiotics

2.8 3.7 66 177 103 37.0 1.7

10 Non-steroidal anti-inflammatory drugs

2.6 3.6 61 230 98 26.7 2.4

Top 10 products 2011

Rank 2011

Rank 2010

Brand name Therapeutic group

% Total

expen-diture

% Total item

volume

Avg. cost

per UB (R)

Avg. cost per item (R)

% UB

Avg. # items per UB

1 6 Lantus SoloSTAR 100IU/ml

Insulin 0.9 0.2 4 204 673 0.5 6.2

2 1 Nexiam 40mg Tab

Proton pump inhibitor

0.9 0.3 875 414 2.4 2.1

3 2 Prexum Plus Tab*

ACE inhibitor and diuretic combination

0.8 0.7 1 166 171 1.7 6.8

4 3 Gleevec 400mg Tab

Cytostatic 0.8 <0.1 266 862 29 350 <0.1 9.1

5 9 Herceptin IV Soln

Cytostatic 0.8 <0.1 182 348 30 660 <0.1 5.9

6 4 Celebrex 200mg Cap

Selective COX2 inhibitor

0.8 0.5 485 235 4.0 2.1

7 5 NovoMix 30 Flexpen 3ml

Insulin 0.8 0.2 5 139 708 0.4 7.3

8 7 Crestor 10mg Tab

Statin 0.8 0.5 1 549 227 1.2 6.8

9 12 MabThera 500mg Vial

Cytostatic 0.6 <0.1 64 281 17 726 <0.1 3.6

10 11 Prexum 4mg Tab*

ACE inhibitor 0.6 0.6 828 136 1.6 6.1

* Generic equivalent

Anti-diabetic agents

Therapeutic group Rank % Total expen-diture

% Total item

volume

Avg. cost per UB (R)

Avg. cost per item (R)

UB as % of total

ben

Avg. # items per UB

Insulins 1 72.2 22.2 6 207 645 1.4 9.6

Oral anti-diabetic agents 2 27.0 77.3 688 69 4.9 9.9

Other anti-diabetic agents 3 0.8 0.5 1 129 324 0.1 3.5

• 3rd class in 2011, 4th in 2010, 6th in 2009 • Two insulins on top 10 products - Lantus SoloSTARTM (#1) - NovoMix 30 Flexpen (#7)

Incretin-based therapies:

Exenatide (GLP1 analogue) - 2010

Vildagliptin (DPP-4 inhibitor) - 2011

Cytostatics

• 2nd in 2010, 2nd in 2009, 3rd in 2008 & 5th in 2007 • 6.7% of expenditure (up from 6.2% in 2009) • 0.3% of volume (same as 2009) • Three agents in top 10 products and • Five agents in top 50 products

Top 10 Cytostatics

Product Active ingredient

Over-all

rank 2011

% Total expen-diture

% Total item

volume

Avg. cost per UB (R)

Avg. cost per item (R)

UB as % of total ben

Avg. # items per UB

GleevecTM 400mg Tab

Imatinib mesylate

4 12.5 1.3 266 862 29 350 <0.1 9.1

HerceptinTM IV Soln

Trastuzumab 5 12.5 1.2 182 348 30 660 <0.1 5.9

MabTheraTM 500mg Vial

Rituximab 9 9.2 1.6 64 281 17 726 <0.1 3.6

TaxotereTM 80mg Inj

Docetaxel 29 4.7 1.1 51 614 13 110 <0.1 3.9

VelcadeTM 3.5mg Inj

Bortezomib 41 4.1 0.3 178 977 37 433 <0.1 4.8

OxaliwinTM RTU Vial 100mg/20ml

Oxaliplatin 51 3.8 1.3 41 589 8 591 <0.1 4.8

VidazaTM 100mg/4ml Inj

Azacitidine 67 3.3 0.3 163 781 38 537 <0.1 4.3

AvastinTM 400mg/16ml Inf

Bevacizumab 73 3.2 0.5 110 243 20 606 <0.1 5.4

MabTheraTM 100mg Vial

Rituximab 80 3.1 1.3 27 609 7 027 <0.1 3.9

XelodaTM 500 Tab Capecitabine 81 3.1 2.4 16 573 3 992 <0.1 4.2

Gastric acid reducers

• NexiamTM 40mg moved down to 2nd place after 2 years at #1

• Four agents in top 50 products (all are Proton Pump Inhibitors) Therapeutic group

% Total expen-diture

% Total item volume

Proton pump inhibitors (PPIs) 85.5 70.5

Antacids and combinations 8.4 19.6

Cytoprotective agents 4.6 3.7

H2 receptor antagonists 1.4 6.2

Gastric acid reducers

Therapeutic group Year Avg. cost

per UB (R)

Avg. cost per item

(R)

UB as % of total

ben

Avg. # items per

UB

Proton pump inhibitors 2011 682 223 12.3 3.1

2010 705 226 13.1 3.1

Antacids and combinations 2011 121 79 6.8 1.5

2010 137 83 7.7 1.7

Cytoprotective agents 2011 319 227 1.4 1.4

2010 333 232 1.7 1.4

H2 receptor antagonists 2011 69 43 2.0 1.6

2010 67 42 2.4 1.6

Hypolipidaemics

• Moved down from #2 in 2006 to #3 in 2009 and #5 in 2010 and 2011

• Despite increase in prevalence in group! - Prevalence : 8.5% in 2006 to 10.9% in 2011 - Item cost : R169 in 2006 to R122 in 2011 • Lipitor 10mg #1 in 2006 down to #166 in 2011

• Introduction of generics

Therapeutic group % Total expen-diture

% Total item

volume

Avg. cost per UB (R)

Avg. cost per item (R)

UB as % of total

ben

Avg. # items per UB

HMG-CoA reductase inhibitors (statins)

90.1 95.6 895 115 10.6 7.8

Fibrates 5.7 3.0 1 688 232 0.4 7.3

Other 4.2 1.3 1 500 381 0.3 3.9

Hypolipidaemics Statins - % volume

Active ingredient 2011 2010 2009 2008 2007

Atorvastatin 31.0 31.7 33.5 34.6 34.8

Simvastatin 44.9 45.2 45.6 47.1 49.6

Rosuvastatin 20.1 18.9 16.1 12.4 8.5

Other 3.9 4.1 4.8 5.9 7.1

17.3% of expenditure

41.2% of expenditure

34.1% of expenditure

• Six statin active ingredients • First generic launched:

- Atorvastatin (LipitorTM) – 2007 Currently – 6 generic equivalent available Avg item cost: R158 (2010) to R127 (2011) - Simvastatin (ZocorTM) – 2002 Currently – 17 generic equivalent available Avg item cost: R48 (2010) to R44 (2011)

• Rosuvastatin – no generic available Avg item cost: R239 (2010) to R236 (2011)

Highlights from the report

• Increase in use of high cost specialty medicines

• Cost of cytostatics continues to increase

• Generic utilisation is still increasing – more savings can still be achieved

• CDL cost becoming bigger portion of the pie

Thank you For more information

please contact Madelein Bester +27 12 674-8006