Omeprazole Promises Savings on PPI Class

By Carl Reed

Proton Pump Inhibitors (PPIs) are used to treat stomach problems such as gastric and duodenal ulcers, gastroesophageal reflux and gastrointestinal hypersecretory conditions. While PPIs are not indicated for common "indigestion", some of the class growth in the marketplace may be attributed to this usage. One of the fastest growing class of drugs, PPIs command as much as 8% to 10% of most health plan pharmacy budgets.

Omeprazole, the generic form of leading PPI Prilosec® (AstraZeneca), should be available later this year. Strategies for realizing the greatest savings from omeprazole include:

• Minimize drug switching in the PPI class until omeprazole is available to maximize the number of opportunities to move patients to the lower-cost generic. Short-term savings gained by switching to a lower-cost PPI now may result in higher long-term costs.
• Review PPI costs and utilization to ensure that your plan's cost-sharing mechanisms cover the added cost of branded agents when the generic becomes available.
• Identify the lowest cost brand-name PPI for placement on second tier with all others being on a third or higher tier as shown in Scenario A in Figure 3: Tier Recommendations for PPIs. Alternatively, place all branded PPIs on a third or higher tier as shown in Scenario B.
• Utilize a generic program where selection of the brand-name agent requires the patient to pay the ingredient cost differential between the brand and the generic.

Ongoing member and physician education about the safety and efficacy of generic drugs also are critical for seizing the savings from omeprazole. Because different state laws may affect the ability to implement some of the above strategies or to achieve savings, it is important to know the requirements of the state(s) in which the majority of your business is conducted.

Reed is Director of Pharmacy for Preferred Care, a New York HMO with more than 200,000 lives. He also is a member of the New York State Medicaid Pharmacy & Therapeutics Committee.