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5.31 Percent Trend: One Small Number, One Great Suite of Programs Behind It In this year’s issue of Walgreens Health Initiatives Outlook, Trend Report—2007, you can see how our cost-containment solutions held our clients’ 2006 drug trend to a single digit for the third year in a row: 7.68 percent. For clients who chose to take

advantage of our many clinical pro-grams and plan design options it was even lower: only 5.31 percent. Some strategies that helped our clients achieve these excellent results in both improved member health and plan savings include:• Advantage90®, complementing mail service by allowing members to obtain up to a 90-day supply

of maintenance medications through a select network of retail pharmacies• Clinical prior authorization programs, designed to get your members the most appropriate and cost-effective medications

In This Issue: PBM Receives Top Honors.......................2

Walgreens Wins Adherence Award ..........2

Access to Limited Distribution Meds ........... 3

Healthful Living™ On-Site Learning ........... 3

Flu Deadline ........................ 4

Outcomes............................. 4

Medication Management..5

New Rx Indications ............ 6

Rx Drug Update ................. 6

Mark Your Calendar ...........7

Medication Matters ........... 8

July-August 2007

Volume 11, Number 4

©2007 Walgreens Health Initiatives, Inc., a wholly owned subsidiary of Walgreen Co. All rights reserved.

Rx Matters

Certified By

A newsletter created for Walgreens Health Initiatives clients,

delivering a mix of news and trends in healthcare, and up-to-date

information about our products and services

continued on p. 2

Walgreens Health Initiatives

Outlook shows how Walgreens Health Initiatives trend management solutions helped our clients navigate

the complex 2006 healthcare landscape, and looks ahead for opportunities to maximize cost

savings while optimizing patient care

®

Rated No. 1 in overall member satisfaction by:

• Step care therapy programs, leading members through the appropriate step toward effective first-line agents before covering more expensive, second-line alternatives • Tiered formulary, categorizing preferred medications into three copay levels

Besides illustrating how Walgreens Health Initiatives trend management solutions helped our clients maximize cost saving opportunities while optimizing patient care, Walgreens Health Initiatives Outlook also analyzes national healthcare trends, primary drivers of healthcare costs, and factors influencing future drug trends. Our trend report is also available online at walgreenshealth.com/trendreport.

In addition, for an overview of the specialty pharmacy industry, the premiere issue of the Walgreens Specialty Phar-macy State of the Industry Report, Outlook, is available at www.walgreensspecialtyrx.com/report or from your account executive. This report should prove valuable in helping clients make informed decisions about the direction of their specialty pharmacy component, which, as more specialty medications are approved, will have an increasing impact on pharmacy expenditures. This report gives readers an

overview of the current state of the specialty pharmacy industry, outlines new specialty pharmacy cost- saving management strategies, and describes our specialty program’s patient-focused care process that offers multiple levels of clinical care, based on patients’ needs in specific therapeutic classes.

Walgreens Health Initiatives Gets Top Honors in Independent Survey Wilson Health Information, LLC, an independent healthcare consumer research firm, named Walgreens Health Initiatives the highest rated PBM nationally in overall member satisfaction among the 18 major PBMs evaluated in the 2007 WilsonRx® PBM Member Satisfaction Survey. The 2007 survey, the largest of its kind, is based on responses from 28,855 PBM members. We take pride in this reflection of our ability to balance plan savings and member satisfaction. It’s what we specialize in for 6 million covered lives nationwide, one life at a time. (More information is available at www.wilsonrx.com or by emailing [email protected].)

Walgreens Wins Strategic Patient Adherence Award Walgreen Co., along with the manufacturer Amgen, received the award for Best Branded Adherence Program for the Persistency Program for Sensipar® at the Strategic Patient Adherence Awards. The award was presented at the Sixth Annual Forum on Patient Compliance, Adherence and Per-sistency held April 23 in Philadelphia, Pa. These awards, co-sponsored by CBI Research, Inc. and PharmaVoice, are presented to pharmaceutical organizations that have been deemed exceptional in their medication adherence initiatives. Organizations’ medication adherence programs are evaluated on criteria that include: innovation; quality; patient recruitment, medication adherence, and acceptance; health practitioner acceptance; health outcomes; and marketing return on investment.


Rx Matters5.31 Percent Trend ... (continued from p. 1)

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Sensipar is indicated for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis and for the treatment of hypercalcemia in patients with parathyroid carcinoma. This award underscores our commitment to offering programs aimed at helping our clients achieve their cost-containment goals while providing superior patient care, which includes promoting medication adherence.

Enhanced Access to Limited Distribution Specialty Medications Our recent acquisition of Medmark Specialty Pharmacy Solutions, reported in our March-April issue, has added another facet of service to our clients: our increased access to limited-distribution medications, such as Synagis® (palivizumab). Synagis is indicated for the prevention of serious lung infections caused by respiratory syncytial virus (RSV) in children at high risk of RSV disease. It is given as a shot each month during RSV season, which starts in the fall and runs through spring. Walgreens Specialty Pharmacy has the honor of being a limited-distribution supplier, not only for this medication, but also a significant number of other limited-distribution medications because of our specialty pharmacy program capabilities: Increlex™, Macugen®, Nexavar®, Orencia®, Raptiva®, Revlimid®, Tykerb®, Tysabri®, Visudyne®, Vivaglobulin®, Xolair®, Zavesca®, and Zorbtive®.

Medications can be categorized as limited-distribution for a number of reasons. These include the need for a higher level of patient interaction (for example, due to the inclusion of a black box warning) or FDA-required reporting of specific information and dispensing under strict guidelines. Pharmaceutical manufacturers select a specialty pharmacy as a limited-distribution supplier based on the pharmacy’s ability to manage medication adherence and side effects, provide patient counseling, distribute educational materials, conduct benefits investigation, provide reimbursement support, and produce detailed outcomes reports and analytics.

Healthful Living™ On-Site Learning Increases Employee Health Awareness The new Walgreens Health Initiatives Healthful Living™ On-site Learning Program provides plan sponsors with a way to promote—right at the workplace—members’ understanding of their

health conditions, the best strategies for manag-ing them, and how to prevent those for which they might be at risk. Through lunchtime inter-active seminars conducted by our pharmacists, participants can enhance their self-management behavior and learn proper monitoring and treat-ment options, which can help achieve long-term medical savings for plan sponsors.

Each seminar presents an overview of the condition, prevention, lifestyle modifications, treatment options, appropriate use of and adherence to medication regimen, monitoring, and potential complications. Plan sponsors also have the option of offering health screenings (where available)


Rx Matters

Participants can enhance their self-management behavior and

learn proper monitoring and treatment options, which can

help achieve long-term medical savings for plan sponsors

Walgreens Wins Strategic ... (continued from p. 2)

continued on p. 4

or device training sessions for their members who have conditions such as asthma, diabetes, and high blood pressure, as well as wellness-related behaviors such as tobacco cessation and weight management. This program empowers members with the information they need to manage their health conditions, with the potential to improve their health and reduce their health-related expenses, as well as yours.

Flu Deadline Nears August 1 is the deadline for signing up for the Walgreens Health Initiatives Flu Program, offered in collaboration with Maxim Health Systems, one of the nation’s leading providers of wellness services. An annual flu shot is the best way to prevent the flu and its sometimes life-threatening complications, which cause more than 200,000 hospitalizations annually. The flu affects an estimated 5 percent to 20 percent of the U.S. population each year, according to the U.S. Centers for Disease Control and Prevention (CDC). We offer a community-pharmacy-based coupon program or a work-site flu shot clinic to help keep your members healthy and productive. Because the CDC recommends vaccinating high-risk people (for example, the elderly) in October, we will schedule work-site clinics after November 1.

Requests received after August 1 will be considered on a per-client basis. In the event of a national vaccine shortage, work-site clinics will be canceled but vaccina-tions of coupon participants will continue in accordance with CDC recommendations. The coupons are valid at all Maxim-affiliated flu shot clinics, which are held at a variety of pharmacies, including Walgreens. In addition to flu shots, pneumonia shots are also available under the work-site program option. Contact your account executive to sign up or get more information.

Outcomes In this new feature, we will share key findings from our Health Outcomes team. This team plays a vital role by assessing the effectiveness of our programs and services, using appropriate scientific research methodologies.

Study Reveals Value of Laboratory Data in Healthcare Management A recent Walgreens Health Initiatives outcomes study, based on deidentified data to protect patients’ privacy, investigated the value of laboratory data as a supplement to medical claims, pharmacy claims, and self-reported information for identifying people at risk for common chronic conditions. This study shows that selected laboratory tests can help identify at-risk participants who may need to be targeted for medical intervention. These participants are likely to be at greater risk than those


Rx MattersHealthful Living™ On-Site ... (continued from p. 3)

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who are aware of their conditions and have been under some form of medical care. Early interven-tion with these people has potential cost-saving implications. In addition, by identifying abnor-malities in the lab results of people with certain medical conditions or taking certain medication therapies, appropriate treatment interventions can be recommended to correct them, potentially preventing harmful effects. Study methodology and results are outlined below: • Data: Two sources: the Walgreens Health Initiatives Healthful Living™ Risk Assessment Program, offered to eligible employees of a Walgreens Health Initiatives client, and Walgreens Health Initiatives claims data for the employees participating in the Risk Assessment Program. The Risk Assessment Program included a health risk assessment (HRA) questionnaire and selected laboratory tests. The Walgreens Health Initiatives claims data included pharmacy and medical claims. • Methods: A retrospective claims analysis was conducted to identify participants with certain medical conditions inferred from pharmacy claims, medical claims, or laboratory data but who did not self-report a diagnosis of the inferred condition. • Results: The results show that, combined with the HRA, pharmacy, and medical data, the laboratory data helped to identify 84 participants (24.6 percent) at risk for diabetes, 95 participants (27.8 percent) at risk for dyslipidemia (abnormal cholesterol or triglyceride levels), 24 participants (7.0 percent) at risk for hypertension, and eight participants (2.3 percent) at risk for kidney disease. These participants had abnormal laboratory values, but did not self-report the condition on the HRA or have pharmacy or medical claims for the condition.

Our Risk Assessment Program can help identify the health needs of your members and recommend appropriate follow-up solutions to minimize employee absenteeism and long-term healthcare costs.

Medication Management Below is the latest enhancement to the Walgreens Health Initiatives Medication Management Pro-grams—clinical prior authorization (CPA) and step care therapy—which provide patient-centric programs that promote clinically appropriate, cost-effective drug utilization:

New Step Care Therapy Program Promotes Effective, Low-Cost Insomnia Medication Walgreens Health Initiatives has developed the Nonbenzodiazepine Insomnia Agent Step Care Therapy Program, designed to promote the safe and appropriate use of zolpidem, the generic form of Ambien®. This program is designed to help ensure the appropriate dosing of the targeted nonbenzodiazepine insomnia medications Ambien, Ambien CR™, Lunesta®, Rozerem®, and Sonata®, and also offers a quantity limitation to help prevent over-utilization. The program promotes the treatment of insomnia with effective, low-cost generic agents, while approving brand-name agents for patients who have tried and failed zolpidem or for whom zolpidem is not an appropriate therapeutic option. If you have any questions or would like to implement these programs, please contact your account executive.


Rx MattersOutcomes ... (continued from p. 4)

New Rx Indications The following medications have been approved by the Food and Drug Administration for new or expanded indications: Drug Name Original Indication New Indication

Singulair® (montelukast) tablets Prevention of chronic asthma and relief of symptoms of allergic rhinitis

Prevention of exercise-induced bronchoconstriction

Invega™ (paliperidone) extended-release tablets

Acute treatment of schizophrenia Long-term maintenance treatment of schizophrenia

Rx Drug Update The Food and Drug Administration (FDA) recently approved the following new medications: Drug Name Company/

AvailabilityIndication(s) Dose

Form(s)Regimen AWP as of

June 2007

Altabax™ GlaxoSmithKline

Summer 2007

Treatment of impetigo

1% ointment Applied twice daily for five days

Unavailable

AzaSite™ (azithromycin) ophthalmic solution

Inspire

Summer 2007

Treatment of bacterial conjunctivitis

1% ophthalmic solution

One drop twice daily for two days, then one drop daily for five days

Unavailable

Veramyst™ (fluticasone) nasal spray

GlaxoSmithKline

Summer 2007

Treatment of nasal allergy symptoms

Nasal spray Two sprays in each nostril once daily

Unavailable

Neupro® (rotigotine) transdermal system

Schwarz Pharma

Summer 2007

Treatment of early-stage Parkinson’s disease

2 mg per 24-hour, 4 mg per 24-hour, and 6 mg per 24-hour patches

One patch once daily

Unavailable

Seroquel® XR (quetiapine) extended-release tablets

AstraZeneca

Summer 2007

Treatment of schizophrenia

50 mg, 200 mg, 300 mg, 400 mg tablets

One tablet once daily

Unavailable

Lybrel™ (levonorgestrel/ ethinyl estradiol) tablets

Wyeth

Summer 2007

Prevention of pregnancy

90 mcg per 20 mcg tablets

One tablet once daily

Unavailable


Rx Matters

Mark Your Calendar Stop by the Walgreens Health Initiatives booth at the following shows to learn more about our innovative solutions to pharmacy benefit management:

World Congress 2nd Annual Executive Forum on Rx Benefit Management

(Our clinical services VP is a featured speaker)

Florida Health Care Coalition Second Annual South Florida Conference

July 23-24, 2007 Hilton San Francisco Financial District

San Francisco, Calif. www.worldcongress.com

August 15, 2007 The Signature Grand

Ft. Lauderdale, Fla. www.flhcc.com

The Savvy Self-Funding Healthcare Conference & Expo

20th Anniversary Benefits Management Forum & Expo (BMFE)

August 20-22, 2007 Westin Crown Center Hotel

Kansas City, Mo. www.savvyemployerconference.com

September 16-18, 2007 Wyndham Anatole Hotel

Dallas, Texas www.sourcemediaconferences.com/BMFE07

National ObservancesSome upcoming health-related observances are listed below to help you plan health fairs and other activities. For more information, log on to the sponsoring organization’s web site. For a complete listing of this year’s national observances, visit the National Health Information Center’s web site at www.healthfinder.gov/library/nho. Observance Date Sponsor, Web Site

UV Safety Month July American Academy of Ophthalmologywww.aao.org

National Immunization Awareness Month August Centers for Disease Control and Prevention www.cdc.gov

Childhood Cancer Month September Candlelighters Childhood Cancer Foundationwww.candlelighters.org

Fruit and Vegetable Month September Centers for Disease Control and Prevention/Produce for Better Health Foundationwww.5ADay.gov

Healthy Aging® Month September Educational Television Network, Inc. www.healthyaging.net

National Alcohol and Drug Addiction Recovery Month

September Substance Abuse and Mental Health Services Administrationwww.recoverymonth.gov

National Cholesterol Education Month September National Heart, Lung, and Blood Institute Health Information Centerhin.nhlbi.nih.gov

Ovarian Cancer Awareness Month September National Ovarian Cancer Coalitionwww.ovarian.org

Prostate Cancer Awareness Month September National Prostate Cancer Coalitionwww.fightprostatecancer.org


Rx Matters

Medication Matters The following article, written for your members, can help raise awareness of how properly used skin patches can promote medication adherence in treating various health conditions.

Skin Patches Provide an Alternative Way to Administer MedicationsA skin patch is a medicated adhesive pad that is placed on the skin to deliver a time-released dose of medication through the skin and into the bloodstream. Also referred to as a transdermal patch or transdermal delivery system, skin patches are used to deliver a wide variety of pharmaceuticals. Among the most common is the nicotine patch, which contains nicotine and is used to help someone quit smoking. Other medications admin-istered through skin patches include scopolamine (for motion sickness), estrogen (for menopause and to prevent osteoporosis after menopause), nitroglycerin (for angina), lidocaine (to relieve the pain of shingles), and birth control medications, referred to as contraceptive patches.

Adhesive skin patches use a special membrane to control the rate at which the liquid medication contained in the reservoir within the patch can pass through the skin and into the bloodstream. Some medications must be combined with substances, such as alcohol, which increase their ability to penetrate the skin.

Taking PrecautionsBefore using patches, it is important that individuals tell their doctor or pharmacist if they are allergic to adhesive tape or any medications. They should also inform them of any prescription and over-the-counter medications and vitamins they are taking, as well as any medical conditions they may have.

The patches may cause side effects, which are listed on the packaging information or have been communicated by your doctor. It is important to read the label and contact the doctor if you experience any serious side effects.

Applying PatchesFor all skin patches, users should follow the directions on the prescription label carefully and ask their doctor or pharmacist to explain any part they do not understand. The doctor or pharmacist should tell them or indicate on a diagram where to apply the patch and what areas to avoid. It is recommended that a patch be placed on an area of skin that is not hairy, oily, irritated, broken, scarred, or calloused, and not located in a place where the patch is likely to be rubbed off by tight clothing.

Before applying the patch, users should remove the protective backing. They should try not to touch the exposed surface, because the medication may come off onto the fingers. The sticky side of the skin patch should be pressed firmly against the skin, making sure that there is good skin contact at the edges of the patch. Users should remove the old skin patch each time they apply a new one. Also, they should apply each patch to a new area unless a doctor told them to reuse the same area. This helps in avoiding skin irritation. It is important to wash the area thoroughly with soap and warm water and


Rx Matters

continued on p. �

dry it before applying the patch. They also should find out if the particular patch can be worn while showering or bathing. It is important to know how long to wear the patch, and when to take it off and apply a new one. Properly used, skin patches may be an easier way for you to take your medication. For example, if you have trouble swallowing pills or find yourself forgetting to take your medication, you might want to ask your doctor if it is available as a skin patch.

References Medication Matters• How to use… Pharmacy Division of the General Leonard Wood Army Community Hospital, Ft. Leonard Wood, MO. http://glwach.amedd.army.mil/pharmacy/Howto.htm. Accessed August 2006. • MayoClinic. www.mayoclinic.com/health/birth-control/BI99999/PAGE=BI00016. Accessed August 2006.• Medline Plus. www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601084.html. Accessed August 2006.

Rx Drug Update and New Rx Indications • American Society of Health-Systems Pharmacists®. www.ashp.com/shortage. Accessed June 2007. • Drugs.com™. www.drugs.com. Accessed June 2007. • Facts and Comparisons on-line 4.0. http://online.factsandcomparisons.com. Accessed June 2007. • Food and Drug Administration. www.fda.gov/default.htm. Accessed June 2007. • Pharmaceutical News Harvest™. www.internetdrugnews.com. Accessed June 2007. • Pharmacy OneSource®. www.pharmacyonesource.com. Accessed June 2007.• P&T Community. www.ptcommunity.com. Accessed June 2007.

Top Honors in Independent Survey• ©2007 Wilson Health Information, LLC. New Hope, Pa. 2007 WilsonRx® Pharmacy Survey. www.wilsonrx.com. Accessed June 2007.

Rx MattersMedication Matters ... (continued from p. 8)

©2007 Walgreens Health Initiatives, Inc., a wholly owned subsidiary of Walgreen Co. All rights reserved. PBM6470-0607 Page �

For general information about Walgreens Health Initiatives products and services, call 800-926-6779,

e-mail [email protected] , or visit mywhi.com.

Editorial Board

Editor Christiane Tiskus Contributing Writer Rhonda Deutsch Consultant Patrick Smith, Pharm.D., B.C.P.S.

Designer Rabel ShamuelBrand names are the property of their respective owners.This publication does not constitute professional advice. Although it is intended to be accurate, neither Walgreen Co., its subsidiaries and affiliates, nor any other party assumes liability for loss or damage due to reliance on this material. If you have a medical question, consult your medical professional.

Articles in Walgreens Health Initiatives Rx Matters may be reprinted only by clients of Walgreens Health Initiatives or respective agents of clients. Please attach the following statement: Reprinted with permission. ©2007 Walgreens Health Initiatives, Inc., a wholly owned subsidiary of Walgreen Co. All rights reserved.

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