Disincentives to Adopting New Drug Delivery Systems

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Scientists from the University of Syracuse chemistry department recently created a new drug delivery system which uses gold nanoparticles with attached DNA designed to bind to Doxorubin, an anticancer drug. The system allows for a large number of drug molecules to potentially be released within or in the close proximity of cancer cells. The new technique should allow for a more targeted approach, minimizing side effects and “collateral damage,” which often occurs with the present method of delivering most anticancer drugs via chemotherapy. Obviously, this is very exciting news.

In the February issue of Life Science Leader magazine, Shane Cooke, EVP and head of Elan Drug Technologies, wrote an article entitled, “Leveraging Drug Delivery Expertise to Drive New Product Opportunities.” In his article he stated, “Drug delivery systems can play a significant role in portfolio enhancement for the pharmaceutical industry.” New drug delivery systems will favor those that improve therapeutic outcomes, reduce costs, and improve compliance. Thus, the more targeted approach developed in Syracuse seems to fit the bill. Just one problem — the U.S. managed care and insurance industry.

It has been my experience that these organizations are very good at impeding progress under the guise of cost containment.For example, I was once involved in the launch of a prescription product which used a spheroidal oral drug absorption system. This allowed for a powerful pain medication to be delivered once-daily. Pain medications can be highly addictive. One way to reduce the likelihood of addiction is to decrease the frequency of administration. The drug I was launching had the benefits of better pain management, possibly reducing the likelihood of addiction, and improving quality of life — three very desirable outcomes. If a patient was going to require long-term pain management (months versus days) then this product would make a great deal of sense. However, insurance companies were reluctant to add it to their formularies, advocating the use of less-expensive generic medications.

In cases where it was added, it usually involved a higher co-pay for the patient. Another disincentive for its adoption was the way in which many physicians were compensated by insurance companies. One clinician explained to me how his pharmacy risk pool worked. In effect, his practice had a targeted annual budget for total prescription drug expenses. If the practice exceeded the targeted figure, the health plan retained the risk pool funds. Conversely, if the pharmacy costs came in under the target, the extra money was then returned to the practice as an end-of-year “bonus.” The pharmacy risk pool functioned as a financial disincentive for new drug utilization. As a result, products such as hydrocodone, an orally active narcotic pain reliever, which can be taken up to 12 times a day, continued to be prescribed, even in long-term pain management cases.

Taking pain medications more frequently results in what is commonly referred to as “clock-watching” whereby the patient focuses on the pain with an increased concern about the availability of pain medications. Patients begin to anticipate when the pain will begin its onset and thus, take the medication a little earlier each time. This results in the patient considering pain mediation as the primary approach to pain relief rather than just one component of a comprehensive approach. Perhaps the cost savings of not using this new technology up front were later gobbled up in the form of treating patients for prescription drug addiction.

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