Moving esomeprazole (Nexium) to the third tier of the Tricare formulary and subsequently raising its copayment from $9 to $22 for a 30-day supply resulted in a 25-percent reduction in the number of prescriptions filled in the month after the change, according to research published in the January/February issue of the Journal of Managed Care Pharmacy.
Over the 24-month study period, the total numbers of proton-pump inhibitor fills and of PPI users increased by 8.5 percent and 9 percent, respectively, but the number of esomeprazole users decreased 4.6 percent.
Researchers observed a statistically significant growth in esomeprazole fills during the six months before the switch and a significant reduction in the month immediately after the formulary change.
Of the 117,801 esomeprazole users, 73.3 percent continued using esomeprazole, 15 percent switched to other prescription PPIs, 0.6 percent used only non-PPI prescription therapy, and 11.1 percent discontinued all prescription acid-reducing therapy.
Although the formulary change apparently resulted in a reduction in esomeprazole use, the magnitude of the change was relatively modest. The authors suggest that the unprecedented spending by the drug’s manufacturer on direct-to-consumer advertising may explain, in part, the consumer’s willingness to spend more on esomeprazole when several less costly therapeutic equivalents were widely available. The authors also suggest that even the $22 copayment was still substantially less than what most health plans charge for third-tier medications, and many Tricare beneficiaries may not be price-sensitive until an out-of-pocket threshold cost is reached. More dramatic formulary changes such as step therapy may be required to promote greater use of first- and second-tier medications.
Source: Linton A, Bacon T, Peterson M. Proton-pump inhibitor utilization with the change to nonpreferred formulary status for esomeprazole in the TRICARE pharmacy. J Man Care Pharm 2009;15(1):42–54