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AIS's Health Business Daily
Featured Story April 18, 2008 Despite Excessive Alcohol-Related Health Costs and Lost Productivity, Available Prescription Drug Therapies Remain UnderutilizedReprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies. By Neal Lerner, Managing Editor, (nlearner@aispub.com) Excessive alcohol use costs U.S. employers billions of dollars annually in health care costs and lost productivity, according to a new study by The George Washington University (GWU) Medical Center. And while employers are starting to push health plans to address the issue, the use of prescription drug therapies to treat alcohol problems remains an underutilized option, experts tell DBN. That may be in part due to the stigma of the condition and questions about efficacy, which new drugs in the pipeline are trying to overcome. On average, 9% of U.S. workers drink in ways that contribute to absenteeism and higher health care costs, says the GWU report released March 25. In addition, 18% of workers between the ages of 18 and 25 have alcohol-related problems, compared with 7% of workers aged 26 and older, the study finds. According to the World Health Organization, alcohol abuse is one of the leading causes of disability in the U.S. and Canada, says Eric Goplerud, Ph.D., director of GWU Medical Center's program, Ensuring Solutions to Alcohol Problems (ESAP). While there is a growing realization of the problem, the medications available to treat alcohol dependency remain "tremendously underutilized," he tells DBN. "Our data indicate that there are better than 20 million adolescents and adults who have serious alcohol problems," Goplerud says. "About less than 2 million receive any treatment in the course of the year. And it's in the 100,000-or-less [range] who receive medications. There is a big gap." On the positive side, more than 80% of people with alcohol-use disorders are employed or in families of people who work, he adds. "So there is an enormous opportunity from the pharmaceutical side to develop this market in which you have health plans and employment-based health insurance that could cover the costs of the pharmaceuticals." Many of the large pharmaceutical companies are now exploring the market and have compounds under development, Goplerud says. Products already on the market include Antabuse (disulfiram), which has been used to treat alcohol dependence since the late 1940s. Other medicines used to treat alcohol dependence, according to WebMD, include:
The global market for alcohol dependence drugs was estimated at just $86 million in 2006, according to a February report from market analyst firm Datamonitor. By contrast, depression drugs had global sales of $11.8 billion in 2006, Datamonitor said. The alcohol dependence Rx market is projected to grow to roughly $304 million by 2016, the report adds, saying that growth will be driven by continued uptake of Vivitrol and the launch of two pipeline opioid antagonists. New treatments expected in 2011 include Biotie Therapies Corp.'s nalmefene and Elbion's Natrel, which is another naltrexone injectable product, according to Datamonitor. Goplerud says employers are starting to push their health plans to provide alcohol screening and treatment programs. But coverage of drugs has been spotty, he adds, in part because the treatment for substance-abuse disorders under health insurance has not been well covered. Historically, alcohol abuse has been seen as something to be treated through willpower, he says. Issue Is Not Yet on Plans' Radar Screens Some health plans and PBMs say issues regarding the use of these products haven't yet hit their radar screens. They also note that drug utilization may be low due to questions of efficacy. Keystone Mercy and AmeriHealth Mercy Health Plans, for example, cover Antabuse and Revia, says Mesfin Tegenu, president of PerformRx, the PBM division of the AmeriHealth Mercy companies. While some PerformRx clients cover the drugs without the need for a prior authorization, other plans have instituted a PA requirement, including Keystone and AmeriHealth, Tegenu tells DBN. The PA requires a diagnosis of alcoholism or alcohol abuse, and that the prescribing physician is a psychiatrist and not simply a family practitioner. "While it can be argued that these drugs should be available to family-practice physicians, our research suggests that unless the drug therapy is combined with a rather intensive behavioral-modification approach, the chance of long-term success is greatly diminished," he says. "At this time, we feel it is important that these individuals are being seen [and] treated by behavioral-health specialists." Medco Health Solutions, Inc. also raises the question on efficacy. The PBM includes drugs to treat alcohol abuse on its formularies, and most health plans cover the drugs, says Keith Bradbury, executive director of drug information at Medco. "However, the available drugs are not really highly effective at helping people to stop," he says. "They do provide some benefit in terms of helping patients reduce alcohol consumption." Because of lower than expected drug utilization, Tegenu says the issue is not "popping up to the top of our radar screen as it would be if the utilization of the available drugs was much higher." PerformRx is, however, "paying attention to the use of the very high cost injectable products in this category, primarily to make sure that they are being used in the appropriate patients [and] individuals," he adds. Billing Codes Approved for Alcohol Treatment Still, Goplerud says utilization of these therapies could increase following the introduction Jan. 1 of two new CPT billing codes for screening and brief intervention on alcohol problems in the primary care setting. "A majority of commercial-sector health plans are saying that they're going to pay on those billing codes," he says. "When primary care physicians realize that they can screen and manage alcohol problems and drug problems in an ambulatory setting, that will help to establish a much more firm foundation for medication-assisted treatment." Goplerud sees adoption of medication treatments for alcohol following the same path as those for depression. "The biggest growth over the last 15 years in the treatment of depression has been in primary care," he says. "With the introduction of screening and brief intervention as a general medical practice and the introduction of these relatively new medications, we really are at the tipping point of alcohol moving into the medical mainstream." Hyong Un, M.D., medical director for Aetna Behavioral Health, also sees the similarities in the evolution of treatment for depression. "Five years ago, people really started to get on the bandwagon related to finding people who were depressed and offering treatment, and making sure they get to the right place," he recalls. "We're just at the beginning of that process with alcohol. I've noticed more interest in talking about this issue. I think it was a very hard issue to even talk about. The treatment options were fairly limited, [and] there were disagreements about whether this was really a medical disorder." As such, alcohol-use disorder has been under-recognized and underdiagnosed, he tells DBN. The new drugs coming to market show promise, but are still not widely used, Un explains. Aetna, for example, receives only about 200 requests a year for Vivitrol, he says. "Those drugs by and large are underutilized, mainly because they are relatively new, and the awareness about these approaches is still low," he says. "Our treatment community needs to be aware of those options, as well as the members, that there is a range of treatment that we can provide." For its part, Aetna is trying to create awareness of the importance of screening and providing brief interventions around the treatment of alcohol use, Un says, pointing out that this approach is often effective, especially if problem drinkers haven't gotten to the level of alcohol abuse. Putting resources into alcohol treatments will result in a significant return on investment, says Goplerud. While PBMs may have to pay more for the drugs, an integrated health plan budget can expect substantial reductions in other health care expenses, especially emergency departments and hospital use, he says. Studies show, for
example, that roughly 20% of gastroesophageal reflux disease (GERD)
is associated with drinking. Likewise, a high percentage of patients
with Type II diabetes who were not managing their insulin well were
found to have drinking problems. And alcohol is a major factor in many
vehicular accidents. |
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