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Cost Savings with Generic Lovastatin: WI Medicaid's Prior Authorization, Summaries of Health sciences

Wisconsin medicaid's prior authorization guidelines for brand name hmg-coa reductase inhibitors, focusing on the use of generic lovastatin to reduce costs. Information on the cost comparison between brand name and generic lovastatin, the clinical information on hmg-coa reductase inhibitors, and recommendations for prescribing and monitoring. The document aims to help prescribing physicians and pharmacies understand the guidelines and save costs for the medicaid program.

What you will learn

  • What are the approved indications and equivalent daily doses for various HMG-CoA reductase inhibitors?
  • What are the criteria for prior authorization of brand name HMG-CoA reductase inhibitors in Wisconsin Medicaid?
  • How does the use of generic lovastatin provide cost savings for the Wisconsin Medicaid program?

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Wisconsin DUR ProjectJanuary 2004 1
To:
Prescribing Physicians, Pharmacies
From:
Wisconsin Medicaid, Division of Health Care Financing January 2004
PRIOR AUTHORIZATION GUIDELINES
In order to encourage the use of generic lovastatin, the Wis-
consin Medicaid program began requiring prior authorization
for brand name HMG-CoA reductase inhibitors on April 15,
2003. Prior authorization was made available through the
STAT-PA system. Only recipients new to statin drugs are re-
quired to try lovastatin first. The criteria for determining prior
authorization includes:
Any recipient currently on an effective brand name statin
will be granted PA to continue on that statin drug.
Any recipient who requires >35% reduction in low-density
lipoprotein (LDL) cholesterol will be granted PA to start
on the brand name statin drugs.
Any recipient who has impaired renal function will be
granted PA to start on the brand name statin drugs.
Any recipient who is at high risk for drug interactions will
be granted PA to start on the brand name statin drugs.
For more information, go to the Wisconsin Medicaid phar-
macy handbook website at
http://www.dhfs.state.wi.us/Medicaid2/handbooks/pharmac
y/index.htm.
Wisconsin Medicaid analyzes claim data to review adherence
to prior authorization policies.
Utilization and Program Costs of Statins
for Wisconsin Medicaid
THE COST OF GENERIC VERSUS BRAND-
NAME HMG-COA REDUCTASE INHIBITORS
In June 2002, lovastatin became the first HMG-CoA reduc-
tase inhibitor with an AB rated generic equivalent. All other
statins are currently available only as brand name products.
Brand name lovastatin is also still marketed as Mevacor. Other
brand name products include Altocor (lovastatin ER), Lipitor
(atorvastatin), Zocor (simvastatin), Pravachol (pravastatin),
Crestor (rosuvastatin), Lescol (fluvastatin), and Lescol XL
(fluvastatin XL). Products that contain an HMG-CoA reductase
inhibitor combined with another ingredient (e.g. Advicor) were
not included in this analysis.
The generic form of lovastatin is significantly less expen-
sive to the Medicaid program than brand name products.
Average cost to the Wisconsin Medicaid Program for generic
lovastatin 40 mg is $1.20 per tablet1 and for a brand name
HMG-CoA reductase inhibitors (including the brand name
forms of lovastatin) range from $1.65 to $4.18 per equipotent
dosage2 (table 1).
Trade Name Generic Name Cost Per
Tablet
Mevacor 40 mg Lovastatin $4.18
Zocor 20 mg Simvastatin $4.03
Pravachol 40 mg Pravastatin $3.98
Crestor 10 mg Rosuvastatin $2.31
Lipitor 10mg Atorvastatin $2.28
Lescol 40 mg or Lescol
XL 80 mg Fluvastatin or
Fluvastatin XL $1.79/$2.09
Altocor 40 mg Lovastatin ER $1.65
Lovastatin 40 mg
(Generic) ------------- $1.20
Table I
Cost Per Tablet for Wisconsin Medicaid
pf3
pf4

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Download Cost Savings with Generic Lovastatin: WI Medicaid's Prior Authorization and more Summaries Health sciences in PDF only on Docsity!

To: Prescribing Physicians, Pharmacies From: Wisconsin Medicaid, Division of Health Care Financing January 2004

PRIOR AUTHORIZATION GUIDELINES

In order to encourage the use of generic lovastatin, the Wis- consin Medicaid program began requiring prior authorization for brand name HMG-CoA reductase inhibitors on April 15,

  1. Prior authorization was made available through the STAT-PA system. Only recipients new to statin drugs are re- quired to try lovastatin first. The criteria for determining prior authorization includes:
  • Any recipient currently on an effective brand name statin will be granted PA to continue on that statin drug.
  • Any recipient who requires >35% reduction in low-density lipoprotein (LDL) cholesterol will be granted PA to start on the brand name statin drugs.
  • Any recipient who has impaired renal function will be granted PA to start on the brand name statin drugs.
  • Any recipient who is at high risk for drug interactions will be granted PA to start on the brand name statin drugs.

For more information, go to the Wisconsin Medicaid phar- macy handbook website at http://www.dhfs.state.wi.us/Medicaid2/handbooks/pharmac y/index.htm.

Wisconsin Medicaid analyzes claim data to review adherence to prior authorization policies.

Utilization and Program Costs of Statins

for Wisconsin Medicaid

THE COST OF GENERIC VERSUS BRAND- NAME HMG -COA REDUCTASE INHIBITORS

In June 2002, lovastatin became the first HMG-CoA reduc- tase inhibitor with an AB rated generic equivalent. All other statins are currently available only as brand name products. Brand name lovastatin is also still marketed as Mevacor. Other brand name products include Altocor (lovastatin ER), Lipitor

(atorvastatin), Zocor (simvastatin), Pravachol (pravastatin), Crestor (rosuvastatin), Lescol (fluvastatin), and Lescol XL (fluvastatin XL). Products that contain an HMG-CoA reductase inhibitor combined with another ingredient (e.g. Advicor) were not included in this analysis. The generic form of lovastatin is significantly less expen- sive to the Medicaid program than brand name products. Average cost to the Wisconsin Medicaid Program for generic lovastatin 40 mg is $1.20 per tablet^1 and for a brand name HMG-CoA reductase inhibitors (including the brand name forms of lovastatin) range from $1.65 to $4.18 per equipotent dosage^2 (table 1).

Trade Name Generic Name Cost Per Tablet

Mevacor 40 mg Lovastatin $4.

Zocor 20 mg Simvastatin $4. Pravachol 40 mg Pravastatin $3.

Crestor 10 mg Rosuvastatin $2.

Lipitor 10mg Atorvastatin $2. Lescol 40 mg or Lescol XL 80 mg

Fluvastatin or Fluvastatin XL

Altocor 40 mg Lovastatin ER $1. Lovastatin 40 mg (Generic)

Table I Cost Per Tablet for Wisconsin Medicaid

WISCONSIN MEDICAID COST AND EXPENDITURES FOR HMG-COA REDUCTASE INHIBITORS

The annual drug budget for the Wisconsin Medicaid program is currently over $500 million. The budget has increased approxi- mately 16 percent each year over the past 2 years. Wisconsin Medicaid spent more than $12.5 million on HMG-CoA reductase inhibitors in 2001. In 2002, Wisconsin Medicaid spent more than $16 million. This is an increase of 29% from the previous year. The average cost per prescription of an HMG-CoA reductase inhibitor for the last quarter of 2002 as compared to the cur- rent cost per prescription is illustrated in Figure 1. The percent of the overall number of prescriptions for these agents is illus- trated in Figure 2. Figure 1 A v e r a g e C o s t P e r S t a t i n P r e s c r i p t i o n f o r t h e Wisconsin Medicaid Program

$

$

$ $

$

$ $

$104 $ $

$ 0

$

$

$

$

$

$

Lovastatin Fluvastatin Pravastatin Simvastatin Atorvastatin

Quarter 4 2002 Current

Figure 2 P e r c e n t M a r k e t S h a r e o f H M G - C o A R e d u c e s Inhibitors Prescriptions for the Wisconsin Medicaid Program

2.9% (^) 4.4%

10.6%

58.4%

23.8%

3.7% 10.0%

56.4%

22.5% 7.5%

0%

10%

20%

30%

40%

50%

60%

70%

Lovastatin Fluvastatin Pravastatin Simvastatin Atorvastatin Quarter 4 2002 Current

CLINICAL INFORMATION

HMG-CoA reductase inhibitors (also known as ‘statins’) are used to treat dyslipidemias of various etiologies. Table 2 briefly su mma- rizes the approved indications of the available products.

When given in approximately equivalent daily doses, HMG-CoA reductase inhibitors can reduce low-density lipoprotein (LDL) cholesterol up to about 40% (table 3). However, if a reduction in LDL greater than 40% is desired, a daily dose of atorvastatin 20mg, lovastatin 80mg, simvastatin 40mg or rosuvastatin 5 mg is more likely to achieve this goal.

In addition to the reduction of LDLs, the HMG-CoA reductase inhibitors have mixed influence on other lipoproteins. Even though this article concentrates on the reduction of LDLs, table 4 briefly summarizes which HMG-CoA reductase inhibitors are approved to treat other lipoprotein disorders.

Atorvastatin Fluvastatin Lovastatin Pravastatin Simvastatin Rosuvastatin Hypercholesterolemia X X X X X X Mixed Dyslipidemia X X X X X Primary Prevention Of CHD X X X X X Secondary Prevention Of CHD X X X X Dysbetalipoproteinemia X X X Elevated Serum Triglycerides X X X X

TABLE 2: SUMMARY OF APPROVED INDICATIONS

Rosuvastatin 5 (45%) 10-20 (52-55%) 40 (63%) Atorvastatin 10 (38%) 20 (43%) 40 (50%) 80 (60%) Simvastatin 10 (30%) 20 (38%) 40 (41%) 80 (47%) Lovastatin 10 (21%) 20 (27%) 40 (31%) 80 (42%)--as 40 bid Pravastatin 20 (30%) 40 (34%) Fluvastatin 20 (20%) 40 (24%) 80 (30%) Fluvastatin XL Lovastatin ER

TABLE3: EQUIVALENT DAILY DOSE IN MILLIGRAMS (%REDUCTIONS IN LDLS)

Baseline LDL in mg/dL

Goal LDL of <100 mg/ dL 100 1.00% Goal LDL of <130 mg/ dL

110 10.00% 120 17.50% 0.00% (^130) 23.85% 0.77% 140 29.29% 7.86% Goal LDL of <160 mg/ dL

150 34.00% 14.00%

160 38.13%^ 19.38%^ 0.63% (^170) 41.76% 24.12% 6.47% 180 45.00% 28.33% (^) 11.67% 190 47.89% 32.11% 16.32% 200 50.50% 35.50% 20.50% 210 52.86% (^) 38.57% 24.29% 220 55.00% 41.36% 27.73% (^230) 56.96% 43.91% 30.87% 240 58.75% (^) 46.25% 33.75% 250 60.40% 48.40% 36.40% 260 61.92% 50.38% 38.85% 270 63.33% 52.22% 41.11% (^280) 64.64% 53.93% 43.21% 290 65.86% (^) 55.52% 45.17% 300 67.00% 57.00% (^) 47.00% 310 68.06% 58.39% 48.71% 320 69.06% 59.69% 50.31% 330 70.00% 60.91% 51.82% 340 70.88% 62.06% 53.24% 350 71.71% 63.14% 54.57% 360 72.50% (^) 64.17% 55.83% 370 73.24% 65.14% 57.03% 380 73.95% 66.05% 58.16%

HMG-COA REDUCTASE INHIBITORS

GROUPED BY EQUIVALENT DAILY DOSE,

APPROXIMATE (%) REDUCTION IN LDLs AND COST PER MONTH OF THERAPY

Fluvastatin 10mg QD (20%) $48.97/month Lovastatin 10mg QD (21%) $12.83/month

Lovastatin 20mg QD (27%) $20.63/month Fluvastatin 40mg QD (24%) $48.97/month Fluvastatin 40mg BID (30%) $97.94/month Fluvastatin XL 80mg (30%) $62.73/month Pravastatin 20mg QD (30% $81.32/month Simvastatin 10mg QD (30%) $69.39/month

Lovastatin 40mg QD (31%) $36.23/month Pravastatin 40mg or 80mg QD (34-37%) $119.34/month Simvastatin 20mg QD (38%) $121.05/month Atorvastatin 10mg QD (38%) $66.88/month

Simvastatin 40mg QD (41%) $121.05/month Lovastatin 40mg BID (42%) $72.90/month Atorvastatin 20mg QD (43%) $98.60/month Rosuvastatin 5mg QD (45%) $69.30/month

Simvastatin 80mg QD (47%) $121.05/month Atorvastatin 40mg QD (50%) $96.19/month Rosuvastatin 10mg or 20mg QD (52-55%) $69.30/month

Atorvastatin 80mg QD (60%) $96.19/month Rosuvastatin 40mg QD (63%) $69.30/month

LDL LEVELS NEEDED TO ACHIEVE LDL

LEVELS OF < 100MG/DL, <130MG/DL OR <160MG/DL

REFERENCES

  1. Wisconsin Medicaid MAC table. Updated 1/04.
  2. Wisconsin Medicaid Pricing data; 2003.
  3. Drug Class Review Hydroxymethylglutaryl-coenzyme A Reductase Inhibitors (statins). Washington, DC: Pharmacy Benefits Management Strategic Healthcare Group and the Medical Advisory Panel, Veterans Health Administration, Department of Veterans Affairs: December 2002. PBM-MAP publication: http://www.vapbm.org/reviews/HMGStatins04-09-03.pdf.
  4. Project National Cholesterol Education Program. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): National Institute of Health; 2002. Report No.: NIH 02-5215.
  5. HMG-CoA reductase inhibitors; February 2003. From: Drug Fact and Comparisons®^ Updated Monthly (August 2003).
  6. *CRESTOR®^ (rosuvastatin calcium) Prescribing Information. Wilmington, Del: AstraZeneca Pharmaceuticals LP. 8/03.

=LDL reduction not likely with HMG-CoA reductase inhibitor mono- therapy