Prescription Pain Relievers Overprescribed, Overpriced, Express Scripts Survey Finds
Pain relievers known as Cox-2 inhibitors, such as Vioxx and Celebrex, are "over-prescribed, overpriced, and an unnecessary expense for health plans," according to a study released yesterday by the pharmacy benefits manager Express Scripts Inc., the Washington Post reports (Redfearn, Washington Post, 6/4). Cox-2 treatments are designed to prevent inflammation and pain and have been shown to reduce the risk of ulcers, a possible side effect of generic anti-inflammatory treatments such as ibuprofen and naproxen. However, an Express Scripts review of the prescriptions it filled in 2000 found that 74% of patients taking Vioxx or Celebrex were not at risk for ulcer complications (Petersen, New York Times, 6/4). The survey also found that 29% of patients taking Cox-2 inhibitors were using the drugs for lower back pain, which is not a condition the medications have been approved to treat. In addition, the study found that about half of the patients who regularly use Cox-2 treatments also took aspirin in doses high enough to block the "stomach-soothing effects" of Cox-2 drugs.
Based on these findings, Express Scripts concluded that Cox-2 inhibitors are being prescribed to patients who should be treated with cheaper generic medications, some of which are available over the counter for a fraction of the cost of the name-brand treatments (Washington Post, 6/4). A 30-day supply of Celebrex or Vioxx costs about $80 a month, compared to $15 for ibuprofen (Agovino, AP/Newsday, 6/4). The Post reports that Express Scripts is using the survey to encourage managed care companies to persuade doctors to prescribe Cox-2 inhibitors only if over-the-counter treatments are ineffective or produce side effects. For each patient who hat uses the "less expensive" anti-inflammatories instead of a Cox-2 inhibitor, insurers will save $40 to $50, Express Scripts said (Washington Post, 6/4). Emily Cox, Express Scripts' outcome research manager, said that Cox-2 inhibitors are "definitely a major driver of pharmaceutical costs." For their part, Vioxx maker Merck & Co. and Celebrex manufacturer Pharmacia Inc. said it is better to prescribe Cox-2 drugs because nearly 100,000 people taking generic anti-inflammatories each year experience side effects severe enough to require hospitalization.
In related news, a recent editorial in the BMJ has renewed criticism about an earlier clinical trial conducted by Pharmacia that found that Celebrex was safer than ibuprofen (AP/Newsday, 6/4). The editorial said the study, which appeared in the Journal of the American Medical Association in 2000, contained "serious irregularities" because it only included results from the first six months of a year-long trial. Dr. Peter Juni, a senior researcher at the University of Berne, wrote in the editorial that when all the data are analyzed, the "safety advantage" of Celebrex found in Pharmacia's study "appears to disappear" (Petersen, New York Times, 6/1). The editorial notes that the results from the full-year trial found that Celebrex caused a similar number of side effects as compared to generic anti-inflammatory treatments (Washington Post, 6/4). Pharmacia has said that the last six months of the study were not included because of a high drop-out rate of study participants, which would have altered the results. Juni, however, said that such a claim was "inadequate" and that because Pharmacia's study has been "widely distributed," the company should be required to notify doctors that the findings were "invalid." The Times reports that Pharmacia is "struggling" with the FDA over whether Celebrex's label and advertising should be changed to promote the claim that the drug causes fewer ulcers (New York Times, 6/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.