Fewer prescriptions,
lower costs after
Claritin’s over-the-counter switch
After the allergy drug Claritin became available without a prescription in
2002, insurance plans and consumers spent less on the prescription form of
its main ingredient, loratadine, and all similar allergy drugs, according
to a new report published in this month’s The American Journal
of Managed Care.
Contrary to what Patrick Sullivan, PhD, of the University of Colorado School
of Pharmacy, and colleagues expected, patients did not turn to other prescription
drugs for allergies and asthma or to antibiotics in greater numbers after
loratadine lost its prescription-only status.
“Instead, there were fewer prescriptions and lower costs for all drugs
across the board,” Sullivan said.
The decrease in costs occurred across all types of plans, regardless of whether
loratadine was covered as a “preferred” drug, the researchers
say.
Insurance plans may have saved money after Claritin’s switch to OTC
status in part because physicians wrote fewer prescriptions for antihistamines,
the researchers found.
“Consumers appear to have benefited as well,” Sullivan said, noting
that the price of what had been the world’s most-prescribed antihistamine
is now lower than the average copayment for prescription antihistamines before
the switch.
This class of drugs also includes cetirizine (Zyrtec) and fexofenadine (Allegra).
The drugs treat seasonal allergies and chronic nasal congestion without some
of the side effects, such as drowsiness, of early antihistamines.
When loratadine became an over-the-counter product in December 2002, some
insurance plans moved the drug into their third tier of coverage, a group
of brand name drugs that have an effective and less costly generic equivalent.
Third-tier drugs generally have the highest prescription costs and copayments
within an insurance plan.
Other plans made no change to loratadine’s status, while other sponsors,
including many Medicaid managed care plans, offered loratadine under its
original prescription status only to patients who had been prescribed the
drug prior to its OTC switch.
A year after any plan changes, patients with third-tier coverage for second-generation
antihistamines paid $11.40 more a prescription. Those under restricted plans
paid $1.70 less a prescription, while there was no change in price under
plans that kept the same coverage.
When Sullivan and colleagues calculated co-payment costs based on how many
prescriptions each person filled a month, however, average co-payment costs
fell 23 percent in third-tier plans and 46 percent to 64 percent in the no-change
and restricted plans.
The difference may be a result of patients obtaining fewer prescriptions
for the drugs. The average number of prescriptions filled for each person
a month fell at least 46 percent during the study, the researchers found.
Sullivan says it is possible that allergy patients “were able to obtain
adequate treatment with over-the-counter loratadine and had less need to
contact the health plan for the treatment of their primary condition.”
The researchers say it is unclear whether patients who used fewer prescription
second-generation antihistamines treated themselves properly with OTC loratadine,
or whether they turned in greater numbers to older OTC drugs such as Benadryl.
“This effect would be detrimental to society and should be examined in
future research,” Sullivan and colleagues say.
The study was supported by a grant from Schering-Plough, the makers of Claritin.
Submitted by Becky Ham, science writer, Health Behavior News Service.
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