In our mid-2018 compliance review, we look at inspection challenges
faced by companies across the world. In the first half of this year,
manufacturing compliance challenges dominated headlines. But we also saw
shortcomings at major pharmaceutical companies like Pfizer, Bayer
and Akorn
generate news.
While China, India and the US continued to be the top three countries
where regulators uncovered compliance issues, this year has also seen the FDA
take action against many South Korean companies. The European authorities found
concerns in India, Taiwan, Italy and Spain. However, there were no
non-compliance reports issued to firms in China until the end of June 2018.
While data-integrity violations and a failure to thoroughly
investigate deviations continued to remain a major concern for inspectors, this
year the real concern emanated from the supply of product to market (which had
the potential to impact product quality or patient safety).
Click here to access
all Mid-Year Non-Compliances in 2018 (Excel version) for FREE!
China: API with a cancerous impurity, vaccine scandal and data-integrity
woes
The most recent regulatory non-compliance issue pertains to the
European Medicines Agency (EMA) raising concern over the active pharmaceutical
ingredient (API) valsartan supplied by China’s Zhejiang Huahai Pharmaceuticals.
The concern was the impurity — nitrosodimethylamine (or NDMA) — detected by the company in their valsartan API. NDMA is
classified as a probable human carcinogen and its presence was unexpected as it was not detected by routine tests carried out by
Zhejiang Huahai.
Zhejiang Huahai sold over US$ 50 million of
the API in 2017 and supplies to most major manufacturers producing valsartan
medicines available in the EU and United States.
While a review is underway, national
authorities across the EU, US and Asia are recalling medicines containing
valsartan supplied by Zhejiang Huahai.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
Vaccine scandal: A major vaccination scandal has sparked off a huge outcry in China as vaccine
maker Changsheng Biotechnology was found to have falsified production data for
its rabies vaccine.
Changchun
Changsheng Bio-tech Co, in Changchun, reported serious irregularities, including fabricating
production records in the manufacture of rabies vaccines for human use, during
an inspection by the State Drug Administration, China FDA said in a statement.
Although there has been no evidence of harm
from the vaccine, the firm has been ordered to halt production and recall
rabies vaccines. And Chinese Premier Li Keqiang has urged severe punishment for the people involved, saying the incident had “crossed a moral line”.
Data-integrity violations: This year, the FDA also posted
the warning letter issued to Henan Lihua Pharmaceutical in China, a company that produces steroid APIs
like hydrocortisone and prednisone.
The warning letter
highlighted data integrity concerns that landed Henan on FDA’s import alert list in March 2018.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
During the inspection, the FDA investigator observed numerous blank batch manufacturing records in an open cabinet in the firm’s manufacturing workshop office.
Among these was multiple blank, product release forms marked with a red quality assurance release stamp stating ‘Permitted to Leave [the] Factory’.
The FDA also posted a warning letter issued to Jilin Shulan Synthetic Pharmaceutical, a manufacturer of caffeine API in China. The letter revealed
flagrant data-integrity violations.
Another warning letter was
issued by the FDA to API manufacturer Lijiang Yinghua Biochemical and Pharmaceutical, following
an October 2017 inspection.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
United States: Drug shortages due to Pfizer’s manufacturing problems
Drug
major Pfizer’s production problems continued to make headlines this year. An article in Fortune put the blame on Pfizer’s much-touted US$ 17 billion acquisition of Hospira in 2015 for turning the United States’ chronic drug shortage into a full-blown crisis.
According to the article, as of May 11 this year, Pfizer — which is the world’s largest maker of sterile injectable drugs — had 370 products that are depleted or in limited supply, 102 of which the company has indicated will not be available until 2019.
“The simple answer to why America currently has so many shortages of generic sterile injectable drugs: America’s leading manufacturer of generic sterile injectable drugs hasn’t been making them,” the article said.
Mylan’s flagship product EpiPen is also likely to face shortages due to problems at Pfizer. Although Mylan owns the rights to the EpiPen, it subcontracts manufacturing of the auto-injector to Meridian Medical Technologies, a division of Pfizer.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
While Mylan is putting pressure on Pfizer
to do more to tackle shortages of this life-saving medicine, Pfizer has
struggled to meet demand for the EpiPen and the FDA had put the medicine on its
official shortages list.
In September last year, the FDA had
issued a warning letter to Meridian
Medical Technologies over serious component and product failures that had
been associated with patient deaths.
Pfizer’s
troubles are far from over as an FDA inspection of an ex-Hospira sterile
manufacturing facility in India resulted in the issuance of a 32 page Form 483. The
same facility was issued a warning letter by the FDA in 2013.
Germany: FDA highlights contamination, data-integrity concerns at Bayer facility
In a shocking warning letter issued
by the FDA to Bayer Pharma’s finished pharmaceuticals manufacturing facility
located in Leverkusen, Germany, investigators found compliance shortcomings
ranging from concerns over data-integrity to serious product contamination
problems.
While reviewing a drug product manufacturing
operation, FDA investigators found residue on equipment which seemed most
likely from a drug product that had been previously processed in the same room.
When Bayer tested the samples of the tablets being produced to “assess the potential of cross-contamination”, the testing confirmed contamination of the previously processed product inside the tablets which resulted in a recall of several lots of drug products.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
Before the FDA inspection, Bayer had started its own data-remediation program to discontinue the practice of using “test” injections during testing. However, when the FDA investigators performed their own inspection, they found unreported data from in-process tablet weight checks. Bayer’s staff had programmed their in-process weight checker not to report values that varied more than a specified amount from the tablet target weight.
The inspection was held between January 12 and
20, 2017, and responses submitted to the FDA in May and August 2017
failed to address the concerns of the agency.
Fresenius aborted US$ 4.3
billion takeover of Akorn: ‘Blatant fraud’ or buyer’s remorse?
This year also saw German healthcare group
Fresenius abandon its US$ 4.3 billion takeover of US generic drugmaker Akorn over
data-integrity concerns.
Illinois-based Akorn filed a lawsuit in the
Delaware Chancery Court asking that Fresenius be required to “fulfill its obligations” under the buyout agreement.
In a court filing made public, Fresenius alleged that its investigation uncovered “blatant fraud at the very top level of Akorn’s executive team, stunning evidence of blatant and pervasive data integrity violations.”
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
Akorn’s lawsuit acknowledged it investigated the possible submission of falsified data and
fired an executive who was involved.
Fresenius claims the executive involved in the fraud wasn’t fired. Instead, he was suspended and given a consulting position with a US$ 250,000 salary. The executive, whose name is redacted from the court filings, stands to receive a payout if the merger is consummated.
The most significant instance
of a data integrity issue involves an ANDA for the drug product azithromycin that was pending with the FDA, which Akorn had submitted
on December 21, 2012.
The court will decide if the data-integrity concerns are truly legitimate or being blown out of proportion by Fresenius, who may be suffering from buyer’s remorse and wants to exit the deal.
The court agreed to put Akorn’s case on fast track and the trial is currently underway.
South Korea: Teva’s potential blockbuster gets delayed due to problems at Celltrion
As Korea emerges as a force
to reckon with in the emerging world of biosimilars, the USFDA's issuance of a warning letter to Celltrion (a major manufacturer of biosimilars that has also partnered
with Pfizer for commercialization in the United States) came as a major
setback.
In an inspection conducted by
the FDA from May 22 to June 2, 2017, the investigators raised concerns over
multiple poor aseptic practices during the set-up and filling operations.
The warning letter highlights
an example where during the aseptic filling of vials, an operator used
restricted access barrier system (RABS) to remove a jammed stopper by reaching
over exposed sterile stoppers
in the stopper bowl. The RABS disrupted the unidirectional airflow over the
stopper bowl, creating a risk for microbial contamination.
After the operator removed
the jammed stopper, the filling line was restarted, but the affected stoppers
were not cleared.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
At Celltrion, the FDA
raised concern over 140 complaints received between October 2015 to May 2017,
which were identified to have occurred because of vial stoppers.
The deficiencies at Celltrion impacted Teva as the Korean company is the main API supplier for Teva’s migraine drug fremanezumab.
Teva confirmed that the USFDA had extended the goal date of the
Biologics License Application (BLA) for fremanezumab. The Prescription Drug
User Fee Act (PDUFA) action date for fremanezumab is currently set
for September 16, 2018.
The Celltrion warning letter
was followed by an announcement by the US-based Evolus that a USFDA pre-approval inspection of Daewoong Pharmaceutical’s plant in South Korea, where a botox biosimilar is being produced, resulted in 10 observations.
Back in 2013, Daewoong had inked a
contract with Evolus to export DWP-450 (a botulinum neurotoxin candidate),
which was expected to be released in the US market around 2017-18.
While Daewoong said it expects “no significant further actions”, Evolus’ SEC filing highlights that “any failure to adequately resolve the FDA’s observations at the Daewoong facility would likely cause FDA approval of DWP-450 to be delayed or denied”.
In May, the FDA declined to approve Evolus’ Botox rival citing deficiencies related to the chemistry and manufacturing of its potential treatment for frown lines.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
India: Data-integrity
violations, invalidation of OOS results continue
Alkem has ‘no quality control unit’: After eight days of inspecting Alkem Laboratories’ finished formulation facility in India in March 2018, the FDA investigators concluded — “there is no quality control unit”.
Alkem’s head of quality control (QC) and quality assurance (QA) confirmed out-of-specification (OOS) results for the assay for a batch of tablets. However, the company did not recall the product, which was distributed in the US market.
Less than three weeks before the inspection, the “firm’s QC department deleted two-thousand one hundred one (2,101) files” on its computer network.
Alembic invalidated OOS results: In the seven days that the FDA investigator — Jessica L Pressley — spent at
Alembic Pharmaceuticals’ oral solid dosage manufacturing facility in Tajpura, Gujarat, she uncovered that the firm invalidated 131 of the 140 OOS results (an invalidation rate of 94 percent) for products marketed in the US.
The firm attributed the invalidation to
analyst errors. In 2017, the invalidation rate was 91 percent.
The Form 483 shares a concern that the “OOS results that were invalidated by the firm’s QC unit were without rationale and supporting documentation.”
Alchymars falsified lab data: A September 2017 inspection by the USFDA at Alchymars ICM SM Private Limited in India uncovered that the firm “was falsifying laboratory data”. During the inspection, the FDA investigator found that an analyst reported far fewer colony-forming units (CFU) in a water sample than those observed on the plate by the investigator.
The FDA raised serious concerns as Alchymars uses the water to manufacture
APIs intended for use in sterile injectable dosage form drug products.
Alchymars is part of a group of companies and the factory is controlled by Trifarma in Italy, a
company which was cited
by the FDA for data-integrity violations in 2014.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
Our view
This year, concerns over pharmaceutical
manufacturing spread beyond China, India and the United States as data
integrity issues also emerged in Japan and Australia.
In Taiwan, the failure to establish an
adequate system for monitoring environmental conditions in aseptic processing
areas was a problem uncovered by both the FDA and EU inspectors.
A firm in France released an over-the-counter
(OTC) drug product without testing if the active ingredients conformed to
specifications.
PharmaCompass’ review of the observations indicates that as inspectors start adopting a more standardized approach towards inspections, the problems they uncover across countries are along similar lines.
At PharmaCompass, we believe that a
review of our Mid-Year Non-Compliances in
2018 will provide you with the
insights necessary to prepare and insulate your business from the concerns
raised during regulatory inspections.
Click here to access all Mid-Year Non-Compliances
in 2018 (Excel version) for FREE!
Impressions: 9249
This week, Phispers brings you an update on M&As in the drug and medical equipment industry, along with verdicts of lawsuits against GSK and Mylan. There is also news on Samsung Bioepis’ biosimilar —Renflexis; a directive from the Medical Council of India for doctors to prescribe generics; and news that Marathon may soon wind up. Read on.
M&A
update: Fresenius buys Akorn; Becton Dickinson to acquire C R Bard
Fresenius Kabi-Akorn: Fresenius Kabi is buying US-based manufacturer and marketer of prescription and over-the-counter drugs — Akorn — for around US $ 4.3 billion, or US $ 34.00 a share. Kabi will also assume approximately US $ 450 million of Akorn’s debt.
The
transaction, which is likely to close by early 2018, has the support of Akorn's
largest shareholder, who controls approximately 25 percent of its shares.
Akorn
is a specialty generic pharmaceutical company engaged in the development,
manufacture and marketing of multi-source and branded pharmaceuticals.
Sawai
to buy Upsher Smith: A leading generics manufacturer in Japan — Sawai Pharmaceutical — and US-based generics manufacturer — Upsher-Smith Laboratories — announced an agreement whereby Sawai will buy the generic pharmaceuticals business of Upsher-Smith, from its parent — Acova for $ 1.05 billion.
Upsher-Smith is a privately held drug company, based in Minnesota. It’s owned by the Evenstad family through their company, Acova. It has a diversified product portfolio of over 30 pharmaceutical products.
Becton Dickinson to acquire C R Bard: Becton Dickinson and Co, a medical equipment
supplier, will acquire C R Bard Inc in a US $24 billion cash-and-stock deal. This way, Becton Dickson will add
Bard's devices to its portfolio in the high-growth sectors of oncology and
surgery.
This
is the latest in a string of deals in the medical technology sector. Two years
ago, Becton Dickinson had acquired CareFusion Corp for US $ 12 billion.
This
acquisition will strengthen Becton Dickinson’s position in the markets for
catheters, pumps and other items.
FDA approves Samsung Bioepis’ biosimilar; Merck to sell it in US
This
week, the US Food and Drug Administration (FDA) approved Samsung Bioepis' Renflexis (infliximab-abda) — a biosimilar referencing Remicade (infliximab), across all eligible indications.
In the US, Renflexis is indicated for reducing signs and symptoms in patients with adult and pediatric Crohn’s disease, adult ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, and for the treatment of adult plaque psoriasis.
The
FDA approval comes as a blow to Johnson & Johnson’s top earning drug
Remicade, which may finally begin to experience greater competition at lower
prices.
Samsung
Bioepis is a big player in the field of biosimilars. It has arrived
in the US market close to a year after the EMA approved it for Europe.
While
Merck KGaA, the German Merck that
specializes in chemical, pharmaceutical and life sciences sectors, sold its biosimilars business to Fresenius Kabi
this week, in the US, Merck will be marketing Samsung Bioepis’ Renflexis.
In
Germany, Merck KGaA is selling off its entire development pipeline and an
experienced team of more than 70 employees located in Aubonne and Vevey (Switzerland)
to Fresenius Kabi for Euro 670 million. The product pipeline has a focus on
oncology and autoimmune diseases.
Confused
about the two Mercks? Read: Merck vs Merck: A ‘Mercky’ Tale
Doctors
in India to prescribe generics; to face action if found violating norms
Last
week, Phispers carried news that India’s Prime Minister Narendra Modi indicated his government may bring in a legal framework under which doctors
will have to prescribe generic medicines. And soon, the Medical Council of India
asked all registered medical practitioners to ensure they prescribe drugs with
generic names only.
The
MCI has asked the medical community to follow its 2016 notification in which it amended the clause 1.5 of the
Indian Medical Council (Professional Conduct, Etiquette and Ethics)
Regulations, 2002 mandating the doctors to prescribe medicines by generic names
in place of brand names.
Therefore, if a patient is complaining of fever, the doctor must prescribe ‘paracetamol’ (the generic name drug), and not Crocin or Dolo (which are brand name drugs).
This move will prevent doctors from prescribing brand-name drugs that are costlier. India’s medical regulator has also warned doctors of action against those found violating these regulations.
This
news comes at a time when price control on stents in India has led to companies
withdrawing their innovative products from the market. A stent is a tiny
expandable tube shaped mesh to open up narrowed or weakened coronary arteries.
It is performed in a cath lab, using a less-invasive procedure known as
angioplasty.
Last
week, Abbott announced it is withdrawing two of its latest
coronary stents from India as they were not commercially viable. This includes
a bio-absorbable stent that was introduced by the company four years back.
In
February this year, the National Pharmaceutical Pricing Authority had effected
up to 80 percent price cuts on stents under the Drug Price Control Order
(DPCO). The price of a bare metal stent was fixed at around US $113 (Rs 7,260)
and drug eluting stent (DES) and biodegradable stents at around US $462 (Rs 29,600).
After
the controversy around DMD drug, Marathon may wind up next month
After
creating much hype and controversy around its effort to market a cheap overseas steroid — deflazacort — to the Duchenne muscular dystrophy (DMD) community in the US at a list price of US $ 89,000, Marathon Pharmaceuticals is now quietly planning
to shut down its operations.
On
February 9 this year, Marathon had received FDA approval for Emflaza (deflazacort), tablets and oral
suspension, to treat patients aged 5 years and older with DMD, a rare genetic
disorder that causes progressive muscle deterioration and weakness.
Since the drug has been approved outside the US for decades, patients in the US imported the drug from Canada and the UK, where it’s available at a price between US $1,000 or US $2,000 a year.
An
article published in Endpoints News cites the divestiture of deflazacort to PTC as the main reason why Marathon may not exist past May 1, 2017. When the author of the article contacted Marathon, he received the statement: “With the wind down of our Emflaza business following the close of the PTC transaction on April 20, we will continue to manage the legacy matters of Marathon Pharmaceuticals.”
This
news comes at a time when PTC, the company that purchased the rights for the
drug from Marathon, suffered a setback as the Washington State Drug Utilization Review Board
decided to recommend another medicine for the treatment of the disorder.
The
board endorsed a policy by the Washington State Health Care Authority, which
administers the state Medicaid program, that prednisone is the “lower cost, equally effective alternative” to Emflaza, the drug that PTC bought for around US $140 million last month from Marathon.
Sanofi highlights Mylan’s unfair trade practices in lawsuit
Earlier
this week, Sanofi SA sued Mylan NV, accusing it of
engaging in illegal conduct to suppress competition to its EpiPen allergy treatment. Mylan’s EpiPen has been at the centre of a public debate on the pricing of drugs.
The lawsuit was filed in Trenton, New Jersey. According to Sanofi, Mylan caused it a loss of hundreds of millions of dollars in sales by erecting barriers that denied American consumers access to and use of a rival product — Sanofi’s Auvi-Q.
Auvi-Q
had been introduced by the French drugmaker in 2013 to treat anaphylaxis in
patients who are at risk of or have a history of the potentially fatal allergic
reaction. The company ceased marketing of the product in 2015 following a recall.
In
a statement, Sanofi sought damages for Mylan's conduct in the market for epinephrine auto-injectors.
With
the lawsuit filed by Sanofi, Mylan appears to be getting a taste of its own
medicine, Back in 2015, in a bold and unusual move, Mylan had sued West Virginia to keep its EpiPens on the state’s “preferred drug list”. The move failed. However, it revealed yet another way in which Mylan can use aggressive marketing and legal tactics to boost profits from EpiPens.
Since
Mylan acquired rights to EpiPen in 2007, the company raised its price by more
than 400 percent.
While Sanofi is fighting Mylan in the US, in its home country it has to address regulator’s concerns over Valproate, its treatment against epilepsy and bipolar disorders.
According
to the French drug regulator, up to 4,100 children in France suffered major malformations in the womb after their
mothers took Valproate between 1967 and 2016. Valproate, which is manufactured
in France by Sanofi under the brand Depakine for epilepsy and Depakote and Depamide for bipolar disorders,
is also believed to cause slow neurological development.
GSK
to pay US $3m in suicide case; Teva introduces
competition to Advair
GlaxoSmithKline must fork out US $3
million to a woman who sued the British drug maker because her husband committed suicide after taking a generic equivalent of GSK’s antidepressant — Paxil, a federal court in the
US ruled.
Back in 2010, Stewart Dolin (a partner at law firm Reed Smith LLP) jumped in front of an ongoing commuter train after taking the generic version of Paxil. The verdict in favor of his wife — Wendy Dolin — was confirmed by GSK. However, the company said it should not be made liable since GSK did not manufacture or market the medicine.
The lawsuit had been filed by Wendy Dolin in 2012 against GSK and Mylan — which manufactured the generic version of Paxil. However, a federal judge dismissed Mylan from the lawsuit in 2014.
There
was more bad news for GSK, as Israeli drugmaker Teva Pharmaceutical Industries
launched the first direct competition to GSK’s best-selling Advair (an inhaler with APIs — fluticasone propionate and salmeterol).
Teva had won the US regulatory nod to make an inhaler that’s similar to Advair in January this year.
However, Teva also launched a generic version of its own inhaler, AirDuo RespiClick.
AirDuo is not a true
generic of Advair, but contains the same two APIs. However, it delivers a lower
dose of salmeterol.
Impressions: 3226
In less than three weeks, Donald Trump will assume office as the
President of the United States. He has mentioned that he wants Medicare (a
national social insurance program) to directly negotiate the price it pays for prescription drugs.
Medicare provides health insurance to Americans aged 65 or more, who
have worked and paid into the system through the payroll tax. It also provides
health insurance to younger people with some disabilities or end-stage renal
disease and amyotrophic lateral sclerosis.
In 2015, Medicare provided health insurance to over 55 million Americans — including 46 million people aged 65 or more, and nine million younger people.
As we flag off the New Year, PharmaCompass
provides insights into drug prices and prescription patterns in the US in order
to help professionals make informed decisions. We believe that the cost of
medicines in the US, which have been a subject of much public outcry and
discussions in the recent years, will continue to be scrutinized during 2017.
Medicare data for 2014
Medicare Part D, also known as the Medicare prescription drug benefit — the program which subsidizes the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries — published a data set (for calendar year 2014) which contains information from over one million healthcare providers
who collectively prescribed approximately US $121 billion worth of prescription
drugs paid for under this program.
For each prescriber and drug, the dataset
includes the total number of prescriptions that were dispensed (including
original prescriptions and any refills), and the total drug cost.
The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees. It’s based on the amounts paid by the Part D plan, the Medicare beneficiary, other government subsidies, and any other third-party payers (such as employers and liability insurers).
The total drug cost does not reflect any manufacturer rebates paid to Part D plan sponsors through direct and indirect remuneration or point-of sale rebates. In order to protect the beneficiary’s privacy, the Centers for Medicare & Medicaid Services (CMS) did not
include information in cases where 10 or fewer prescriptions were dispensed.
Top
Ten Drugs by Cost, 2014 [Most expensive for Medicare]
Drug Name
Total Claim Count
Beneficiary Count
Prescriber Count
Total Drug Cost
Sofosbuvir
109,543
33,028
7,323
$3,106,589,192
Esomeprazole Magnesium
7,537,736
1,405,570
286,927
$2,660,052,054
Rosuvastatin Calcium
9,072,799
1,752,423
266,499
$2,543,475,142
Aripiprazole
2,963,457
405,048
130,933
$2,526,731,476
Fluticasone/Salmeterol
6,093,354
1,420,515
281,775
$2,276,060,161
Tiotropium Bromide
5,852,258
1,211,919
253,277
$2,158,219,163
Lantus
Solostar
(Insulin Glargine)
4,441,782
972,882
224,710
$2,016,728,436
Sitagliptin Phosphate
4,495,964
789,828
190,741
$1,775,094,282
Lantus
(Insulin Glargine)
4,284,173
787,077
223,502
$1,725,391,907
Lenalidomide
178,373
27,142
9,337
$1,671,610,362
View the Medicare Part D National Prescriber Summary Report, Calendar Year 2014 (Excel version available) for FREE!
Top
Ten Drugs by Average Cost per Claim, 2014 [Most expensive drugs]
Drug Name
Total Claim Count
Beneficiary Count
Prescriber Count
Total Drug Cost
Average Cost Per Claim
Adagen
13
$1,224,835
$94,218
Elaprase
100
$6,560,225
$65,602
Cinryze
1,820
194
196
$96,155,785
$52,833
Carbaglu
60
$2,901,115
$48,352
Naglazyme
129
$6,189,045
$47,977
Berinert
538
73
68
$25,685,311
$47,742
Firazyr
1,568
269
232
$70,948,143
$45,248
H.P. Acthar
9,611
2,932
1,621
$391,189,653
$40,702
Procysbi
314
41
47
$12,542,911
$39,946
Folotyn
15
$598,210
$39,881
Top
Ten Drugs by Claims, 2014 [Most Commonly Used by Patients]
Generic Name
Total Claim Count
Beneficiary Count
Prescriber Count
Total Drug Cost
Lisinopril
38,278,860
7,454,940
464,747
$281,614,340
Levothyroxine Sodium
37,711,869
6,245,507
416,518
$631,855,415
Amlodipine Besylate
36,344,166
6,750,062
451,350
$303,779,661
Simvastatin
34,092,548
6,768,159
387,651
$346,677,118
Hydrocodone-Acetaminophen
33,446,696
8,005,790
677,865
$676,296,988
Omeprazole
33,032,770
6,707,964
475,122
$529,050,385
Atorvastatin Calcium
32,603,055
6,740,061
419,327
$747,635,818
Furosemide
27,133,430
5,176,582
456,047
$135,710,772
Metformin HCl
23,475,787
4,509,978
364,273
$203,948,989
Gabapentin
22,143,641
4,298,609
486,754
$492,557,255
View the Medicare Part D National Prescriber Summary Report, Calendar Year 2014 (Excel version available) for FREE!
Top
Ten Drugs by Prescribers, 2014 [Most Popular with Doctors]
Generic Name
Total Claim Count
Beneficiary Count
Prescriber Count
Total Drug Cost
Hydrocodone/Acetaminophen
33,446,696
8,005,790
677,865
$676,296,988
Ciprofloxacin HCl
7,253,018
4,926,835
568,201
$46,728,353
Amoxicillin
6,298,980
4,384,899
557,614
$31,193,739
Cephalexin
5,040,219
3,529,303
557,048
$36,987,401
Azithromycin
7,339,954
5,274,010
544,625
$70,699,119
Prednisone
11,032,986
4,505,821
536,108
$86,537,932
Tramadol HCl
14,250,227
4,272,724
515,816
$125,343,514
Sulfamethoxazole /Trimethoprim
4,833,758
3,090,944
500,790
$29,231,511
Gabapentin
22,143,641
4,298,609
486,754
$492,557,255
Amoxicillin/Potassium Clav
3,551,452
2,710,244
478,361
$61,713,432
The findings from CMS
data
The CY 2014 data represented a 17 percent
increase compared to the 2013 data set and a substantial part of the total estimated prescription drug spending (as estimated by the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, or ASPE) in the United States — at about US $ 457 billion in 2015, which was 16.7 percent of the overall personal healthcare services.
Of that US $ 457 billion, US $ 328 billion (71.9 percent) was for retail
drugs and US $ 128 billion (28.1 percent) was for non-retail drugs.
The drug pricing process in the US is complex and
reflects the influence of numerous factors, including manufacturer list prices,
confidential negotiated discounts and rebates, insurance plan benefit designs,
and patient choices.
An IMS study found that across 12 therapy classes widely used in Medicare Part D,
medicine costs to plans and patients in Medicare Part D are 35 percent below
list prices.
View the Medicare Part D National Prescriber Summary Report, Calendar Year 2014 (Excel version available) for FREE!
While the CMS does not
currently have an established formulary, Part D drug coverage excludes drugs
not approved by the US Food and Drug Administration, those prescribed for off-label
use, drugs not available by prescription for
purchase in the US, and drugs for which payments would be available under Parts
A or B of Medicare.
Part D coverage
excludes drugs or classes of drugs excluded from Medicaid coverage,
such as:
Drugs used for anorexia, weight loss, or weight gain
Drugs used to promote fertility
Drugs used for erectile dysfunction
Drugs used for cosmetic purposes (hair growth, etc.)
Drugs used for the symptomatic relief of cough and colds
Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
Drugs where the manufacturer requires (as a condition of sale) any associated tests or monitoring services to be purchased exclusively from that manufacturer or its designee
Our view
The Medicare program is designed such that the
federal government is not permitted to negotiate prices of drugs with the drug
companies, as federal agencies do under other programs.
For instance, the Department of Veterans Affairs — which is allowed to negotiate drug prices and establish a formulary — has been estimated to pay (on an average) between 40 to 58 percent less for drugs, as opposed to Medicare Part D.
If Trump administration kick starts direct
negotiations on Medicare drug prices with drug companies, 2017 will surely turn
out to be a year for the pharmaceutical industry to remember.
View the Medicare Part D National Prescriber Summary Report, Calendar Year 2014 (Excel version available) for FREE!
Impressions: 7965