An integrated approach to evaluate different tetracycline derivatives for formulary decisions

2021 ◽  
Author(s):  
Andrei Zidaru ◽  
Kady Phe ◽  
Todd M Lasco ◽  
Vincent H Tam
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Acquisition Cost ◽  
Inhibitory Concentration ◽  
Treatment Options ◽  
Wholesale Price ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Integrated Approach ◽  
Base Case ◽  
Dosing Regimens

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Stenotrophomonas maltophilia has emerged as a critical opportunistic pathogen associated with significant morbidity and mortality. Tetracycline derivatives have been recognized as alternative treatment options, but they have varied pharmacokinetic properties. An integrated approach to different tetracycline derivatives for formulary decisions is reported. Methods The minimum inhibitory concentration (MIC) data from clonally diverse bloodstream S. maltophilia isolates were examined, along with the pharmacokinetic profiles of 4 tetracycline derivatives, to predict achievable pharmacodynamic exposures with standard intravenous dosing regimens. Antimicrobial therapy was assessed using the ratio of daily drug acquisition cost relative to the ratio of the free-drug area under the time-concentration curve (fAUC) to the 90th percentile for minimum inhibitory concentration (MIC) values for isolates (fAUC/MIC90). Results In our analysis, minocycline had the greatest fAUC/MIC90. Doxycycline was the most financially preferred agent, as calculated using 2020 average wholesale price for base-case estimates of drug acquisition cost. Conclusion An integrated evaluation for antimicrobial formulary decision-making addressed local susceptibility data, pharmacokinetics, pharmacodynamics, dosing regimens, and drug acquisition costs. This comprehensive method is more objective than the conventional approach and warrants validation.

Pharmaceutical pricing benchmarks: governmental versus private sector

2020 ◽  
Vol 9 (15) ◽  
pp. 1091-1100
Author(s):  
Fatema Turkistani ◽  
Aseel Bin Sawad
Keyword(s):  
Acquisition Cost ◽  
Wholesale Price ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Cost Savings ◽  
Workers Compensation ◽  
Pharmaceutical Pricing ◽  
Drug Prices ◽  
Upper Limit ◽  
Wholesale Acquisition Cost

Purpose: To explore the best pricing benchmark for workers’ compensation drugs reimbursement at retail pharmacies. Materials & methods: We used California workers’ compensation system (CAWCS) total cost of pharmacy dispensed medications (2017–2019) as a proxy to estimate drug prices using alternative pricing mechanism fee schedules. Results: CAWCS paid 65.6% of the average wholesale price (AWP), 104.1% of Medi-Cal, 122.1% of the wholesale acquisition cost (WAC), 140.1% of the national average drug acquisition cost (NADAC), and 253.5% of the federal upper limit. In addition, we found the AWP-based formulas: CAWCS = AWP - 34.4%, Medi-Cal = AWP - 36.9%, WAC = AWP - 46.3%, NADAC = AWP - 53.2%, and federal upper limit = AWP - 74.1%. We found that AWP: 50% for generics and AWP - 18.2% for brands are the lowest paying formulas. The estimated median cost savings were $8.7 million (by adapting 97% of the WAC) and $9.5 million (by adapting the NADAC) across all states. Conclusion: NADAC was the best pricing benchmark for reimbursement of pharmacy dispensed drugs.

OSTEOPOROSIS DRUGS MARKETED IN THE UNITED STATES: GENERIC COMPETITION, PRICING STRUCTURE, AND DISPERSION AMONG PAYERS

2016 ◽  
Vol 32 (6) ◽  
pp. 385-392
Author(s):  
Bander Balkhi ◽  
Enrique Seoane-Vazquez ◽  
Rosa Rodriguez-Monguio
Keyword(s):  
United States ◽  
Acquisition Cost ◽  
Market Entry ◽  
Generic Drugs ◽  
Wholesale Price ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
The United States ◽  
Generic Competition ◽  
Drug Prices

Background: Despite the cost of pharmaceuticals, studies assessing prices of osteoporosis drugs are lacking. This study examined trends in prices of osteoporosis drugs in the United States in the period 1988–2014, assessed pricing structure of osteoporosis drugs, and evaluated price trends before and after generic drugs market entry.Methods: Data were derived from the U.S. Food and Drug Administration, the RedBook, the Centers for Medicare & Medicaid Services, and the Federal Supply Schedule (FSS). Descriptive statistics and segmented linear regression analyses were performed.Results: In the period 1988–2014, osteoporosis drug prices increased faster than the inflation. The average wholesale price (AWP) of generic products at market entry represented 90 percent of the AWP for the corresponding brand. Prices of brand products continued to increase after generic entry. Drug prices showed a significant variation when compared with the brand AWP. The brand wholesale acquisition cost (WAC) was typically set at 83.3 percent of the AWP. Community pharmacies acquired osteoporosis brand drugs at a median of 80.5 percent of the brand AWP. Significant reductions in brand AWP were observed for Medicare Part B (78.5 percent of the brand AWP), generic National Average Drug Acquisition Cost (33.7 percent), and FSS (22.5 percent).Conclusions: There are significant differences in the manufacturer prices, pharmacy acquisition costs and reimbursement rates of osteoporosis drugs. Pharmaceutical companies listed prices are higher than the pharmacy actual estimated acquisitions costs, and the prices used for reimbursement to providers. Generic drugs entry significantly drives down prices; still, prices of branded drugs facing generic competition continued to increase after generic market entry.

Parnaparin: confronto con le altre eparine a basso peso molecolare

2005 ◽  
Vol 6 (3) ◽  
pp. 227-241
Author(s):  
Lorenzo Pradelli
Keyword(s):  
Drug Class ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Health Resources ◽  
Low Molecular Weight ◽  
Home Based ◽  
Dosing Regimens ◽  
Home Based Therapy ◽  
Deep Vein

Sodium parnaparin is a low molecular weight heparin (LMWH). The introduction of this drug class has represented a medical advancement in the prevention and therapy of thromboembolic pathologies, as they maintain the same efficacy of unfractionated heparin, but with simplified dosing regimens and reduced side effects. Parnaparin has demonstrated its thromboprophylactic efficacy on both high- and moderate risk surgical patients, besides resulting effective in treating established deep vein thromboses and thrombosis-associated phlebopathies. Alongside these clinical advantages, parnaparin and other LMWHs allow outpatient or home-based therapy of a large number of subjects that should otherwise be treated in hospital, with important savings of health resources and enhanced quality of life for the patients. In Italy, parnaparin drug acquisition cost is among the lowest in its class for many applications, permitting marginal savings in health costs at the same efficacy level. In summary, the use of parnaparin in thrombotic pathologies has very good efficacy and safety profiles, and has positive clinical and economical outcomes for patients, health system and society as a whole.

scholarly journals Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-Based Chemotherapy at a Safety Net Hospital

2019 ◽  
Vol 15 (8) ◽  
pp. e644-e651 ◽  
Author(s):  
Neil Keshvani ◽  
Mary Hon ◽  
Arjun Gupta ◽  
Timothy J. Brown ◽  
Lonnie Roy ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Acquisition Cost ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Cost Savings ◽  
Safety Net ◽  
Patient Survey ◽  
Outpatient Setting ◽  
Chemotherapy Administration ◽  
Safety Net Hospital

PURPOSE: EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) -based chemotherapy is traditionally administered inpatient because of its complex 96-hour protocol and number of involved medications. These routine admissions are costly, disruptive, and isolating to patients. Here, we describe our experience transitioning from inpatient to outpatient ambulatory EPOCH-based chemotherapy in a safety-net hospital, associated cost savings, and patient perceptions. METHODS AND MATERIALS: Guidelines for chemotherapy administration and educational materials were developed by a multidisciplinary team of physicians, nurses, and pharmacists. Data were collected via chart review and costs via the finance department. Patient satisfaction with chemotherapy at home compared with hospitalization was measured on a Likert-type scale via direct-to-patient survey. RESULTS: From January 30, 2017, through January 30, 2018, 87 cycles of EPOCH-based chemotherapy were administered to 23 patients. Sixty-one ambulatory cycles (70%) were administered to 18 patients. Of 26 cycles administered in the hospital, 18 (69%) were the first cycle of treatment. Rates of inappropriate prophylactic antimicrobial prescription and laboratory testing were lower in the outpatient setting. Eight of nine patients surveyed preferred home chemotherapy to inpatient chemotherapy. Per-cycle drug costs were 57.6% lower in outpatients as a result of differences in the acquisition cost in the outpatient setting. In total, the transition to ambulatory EPOCH-based chemotherapy yielded 1-year savings of $502,030 and an estimated 336 days of avoided hospital confinement. CONCLUSION: Multiday ambulatory EPOCH-based regimens were successfully and safely administered in our safety-net hospital. Outpatient therapy was associated with significant savings through avoided hospitalizations and reductions in drug acquisition cost and improved patient satisfaction.

Parnaparin: review of the literature

2008 ◽  
Vol 9 (1) ◽  
pp. 27-40
Author(s):  
Lorenzo Pradelli
Keyword(s):  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Health Resources ◽  
Antithrombotic Activity ◽  
Home Based ◽  
Dosing Regimens ◽  
Inflammatory Processes ◽  
Home Based Therapy ◽  
Deep Vein

Sodium parnaparin is a low molecular weight heparin (LMWH). The introduction of this drug class has represented a medical advancement in the prevention and therapy of thromboembolic pathologies, as they maintain the same efficacy of unfractionated heparin, but with simplified dosing regimens and reduced side effects. Parnaparin has demonstrated its thromboprophylactic efficacy on both high- and moderate risk surgical patients, besides resulting effective in treating established deep vein thromboses and thrombosis-associated phlebopathies. Besides and independently from its antithrombotic activity, parnaparin possesses modulating effects on cells involved in inflammatory processes, which may explain its reported utility in phlebopathies other than DVT; among LMWHs available in Italy, parnaparin is the only approved for these indications. Alongside these clinical advantages, parnaparin and other LMWHs allow outpatient or home-based therapy of a large number of subjects that should otherwise be treated in hospital, with important savings of health resources and enhanced quality of life for the patients. In Italy, parnaparin drug acquisition cost is among the lowest in its class, permitting marginal savings in health costs at the same efficacy level. In summary, the use of parnaparin in thrombotic pathologies has very good efficacy and safety profiles, and has positive clinical and economical outcomes for patients, health system and society as a whole.

Cost-efficiency analysis of conversion from reference pegfilgrastim to its biosimilar (pegfilgrastim-jmdb) and expanded access to food and transportation support for Medicare/Medicaid patients within the CMS Oncology Care Model.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18837-e18837
Author(s):  
Karen MacDonald ◽  
Neda AlRawashdh ◽  
Ali McBride ◽  
Ivo Abraham
Keyword(s):  
Acquisition Cost ◽  
Cost Efficiency ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Medication Administration ◽  
Incidence Rates ◽  
Tumor Type ◽  
Care Model ◽  
Conversion Rates ◽  
Oncology Care

e18837 Background: The CMS Oncology Care Model (OCM) aims to improve quality of care and health outcomes in cancer centers at the same or lower cost. We performed cost-efficiency analyses of converting selected cancer patients (pts) from reference pegfilgrastim (PFG) to its biosimilar (PFG-jmdb); and simulated re-allocating savings to provide nutrition and transportation support to CMS beneficiaries within OCM. Methods: Incidence rates for breast, ovarian, lung, colorectal cancers and non-Hodgkin lymphoma were extracted from SEER, further stratified by age <65 (commercial insurance) or >65 (Medicare) adjusted for Medicare/Medicaid mix. Chemotherapy (CTX) rates were matched to tumor type; of these 19.4% were assumed to require PFG prophylaxis (PPX). Two models compared respectively prefilled syringe (PFS) and on-body injector (OBI) reference PFG to PFS PFG-jmdb. Cost inputs included Average Sales Price (ASP) 3Q20 for Medicare and National Average Drug Acquisition Cost (NADAC, estimated by wholesale acquisition cost (WAC)-3.9%) for Medicaid pts plus medication administration. Cost savings across various biosimilar conversion rates for CTX cycles 1-6 were translated into $100 units of healthy food or medical transportation. Results: In 2020, biosimilar conversion for the estimated 31,210 Medicare and 1,722 Medicaid pts in the 5 tumor types needing PFG PPX yielded savings of up to ̃$19M (Medicare) and ̃$20M (Medicaid). These savings could have provided a monthly $100 food or transportation check to at least 24,716 Medicare or 33,630 Medicaid pts for 6 months. Conclusions: Savings from biosimilar conversion can be re-allocated on a budget neutral basis to food and transportation support to pts with such needs. This achieves the dual OCM aim of reducing drug budgets while enhancing patient-centric support services.[Table: see text]

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