Medicare Part D pharmacy updates: dose optimization

Today, health care organizations are being tasked with the job of providing costly new technologies, expanding services and improving quality of care while still trying to hold the line on escalating medical and pharmaceutical costs.

One cost-saving measure that is simple to implement and well accepted by providers and patients alike is called dose optimization. Dose optimization is the practice of identifying patients who take multiple units (tablets or capsules) of a lower strength, once-daily maintenance medication. The physician consolidates or optimizes the dosing regimen to an equivalent daily dosage of the same medication given as a single unit. Dose optimization is particularly successful for those medications available in a number of different strengths with parity or near-parity pricing.

For example, let’s take a look at America’s best-selling brand-name medication, Lipitor. The average wholesale prices of both the 20-mg and 40-mg strengths of Lipitor are $4.77 a tablet. A simple conversion from two 20-mg tablets to one 40-mg tablet could save an estimated $1,717 over 12 months.

An extreme example of dose optimization would be switching a patient taking five 5-mg Revlimid tablets to a single 25-mg tablet daily, which could save the health care system $486,131.52 annually. Even drugs like Azor, which do not have parity pricing, can lead to significant cost savings when considered over an extended period of time. In addition to the cost savings, simplifying the dosage schedule is likely to improve patient compliance and possibly lower out-of-pocket costs.

If the savings are so significant and the switch would appear to be a rather simple exercise, why don’t providers do a better job of optimizing their patient drug regimens? Several factors may contribute to this phenomenon, including a lack of clinician awareness, inappropriate drug titration and drug sampling. Physicians are often unaware a medication is available in multiple dosage strengths and even less aware of the pricing differences among those dosages. In addition, because patients may start at a lower dosage strength, it is common for providers to instruct their patients to utilize some multiple of their current prescription instead of writing a new one. Lastly, samples are often used to test patient tolerability and provide a supply of medication through the titration phase of therapy. Once the patient exhausts the sample supply, many providers simply provide a prescription for the same multiple-units-per-day regimen to continue their therapy.

The table below lists once-daily medications that have multiple dosage strengths with either parity or near-parity pricing. This list is certainly not exhaustive; many more examples likely exist. When in doubt, remember to contact your local retail pharmacist to determine what strengths of a medication are available and if the pricing for these different strengths are the same or similar.

References
Calabrese, D. and S. Baldinger. 2002. Dose-Optimization Intervention Yields Significant Drug Cost Savings. JMCP 8(2): 146–151.
Dose Optimization Program. BlueCross BlueShield Wellmark Web site. http://www.wellmark.com (accessed Sept. 23, 2009).

BCBSTX makes no endorsements, representations, or warranties about any products or services offered by
independent third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or
services offered by them. If you have any questions about the products or services mentioned in this newsletter,
contact the vendor directly.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

Blue Review • Issue 1, 2010 • www.bcbstx.com