Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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Early Shortages, Delayed Marketing, High Prices, Other Health Priorities, Among Reasons Why Seniors Skip Shingles Vaccine

Early Shortages, Delayed Marketing, High Prices, Other Health Priorities, Among Reasons Why Seniors Skip Shingles Vaccine | Pharmaguy's Insights Into Drug Industry News |

Seniors have been particularly slow to take advantage of the shingles vaccine. The Food and Drug Administration approved it a decade ago, and the C.D.C. recommends it for those over 60, including those who’ve already had shingles.


Coverage has climbed steadily, but in 2014 had still reached only 31 percent of those over 65. As with nearly all of these vaccines, older whites were more likely to have been vaccinated than blacks, Hispanics or Asians.


Seniors and their caregivers should request vaccinations; the C.D.C. publishes guidelines and a quiz that explain which ones are recommended. Zostavax, the current shingles vaccine, reduces the risk of the disease in adults over 60 by half, and the incidence of postherpetic neuralgia by two-thirds.


(Quick primer: Shingles results from the same virus that causes chickenpox, which nearly all older Americans have had. The virus typically remains dormant for decades, but the odds of its reactivation rise steeply after 50 as the immune system weakens. The lifetime risk of shingles is one in three, rising to one in two for those over 85.)


The vaccine’s underuse can be blamed, in part, on supply shortages in its early years until about 2012. The manufacturer, Merck, and the C.D.C. didn’t increase media campaigns until vaccine supplies were sufficient; such campaigns had just started when Ms. Abate became ill. It’s not surprising that she was only vaguely aware of Zostavax.


Cost remains a barrier to getting Zostavax and some other adult vaccines.


In a study published this past summer, researchers reported that nearly 40 percent of the time, patients over 50 who requested a prescription for Zostavax at a pharmacy chain chose not to receive the vaccine; out-of-pocket costs were most frequently the reason.


The Affordable Care Act requires private insurers to cover Zostavax without co-pays for people older than 60, and many cover it for policyholders over 50. But Medicare beneficiaries find that, unlike the flu and pneumococcal vaccines, which are covered under Part B and often administered in physicians’ offices, Zostavax and Tdap are covered under Part D.


Physicians can’t easily bill for Part D reimbursement, so they often send patients to pharmacies, which can. But because Part D involves a welter of different plans and formularies, some requiring patients to pay for the vaccine and then seek reimbursement, the cost and co-pays can discourage use. Zostavax, at about $200 a dose, is the most expensive adult vaccine.


This landscape could change drastically in a year or so. In October, the pharmaceutical giant GlaxoSmithKline submitted a new shingles vaccine for F.D.A. approval.


International studies indicate that the newcomer, Shingrix, is far more effective than the current vaccine, reducing the incidence of shingles by 90 percent. Moreover, the effectiveness doesn’t appear to decrease among older age groups, as Zostavax’s does.


Shingrix has its own drawbacks. For one, it requires a second injected dose several months after the first; some people won’t follow up. The manufacturer has yet to set a price, and unless Congress changes the law, any new vaccine will face the same Part D billing complications.


But if the F.D.A. approves it, and the C.D.C. recommends its use (which triggers insurance coverage), Shingrix may also prevent a lot of shingles cases — but only if older adults are actually vaccinated.


They don’t have a great track record.

Pharma Guy's insight:

Meanwhile, Merck is now ramping up its promotion of Zostavax in anticipation of the entrance of GSK’s Shingrix to the market (read “Merck Uses Humor & Fear to Promote Zostavax Shingles Vaccine”; Shingrix appears to be much more effective and GSK expects it to be a "major market disrupter" for Merck's Zostavax.

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To Improve Medication Adherence Among Senior Citizens, Lower the Price of Drugs

To Improve Medication Adherence Among Senior Citizens, Lower the Price of Drugs | Pharmaguy's Insights Into Drug Industry News |

It is reported that 10,000 Americans turn 65 each day. Your parents may have reached elderly status, or even yourself. Have you taken a look at the pharmaceutical therapies that your parents or you are using? How much medication do you take daily? How many doctors do you see? How many of those doctors have prescribed medications for you? Do your doctors keep records of the medications that you take, including those prescribed by other doctors? Do you also take over-the-counter drugs? Have you ever pondered about how your pharmaceutical cocktail might affect you and your overall well being? Or that different doctors that you see are prescribing medications for the same problem? Have problems of alcohol and drug misuse arisen that you may or may not recognize? Or is what you are experiencing the normal process of aging?

The Georgetown (University) Health Policy Institute advises, "A study of people aged 65 and older in eight states reports a substantial proportion of people, in particular, those with low incomes, take less medicine than prescribed" Why? Because the medications are too costly. Often they skip doses to make the medication last longer. And just to have the medicines they need, they have spent less on other necessities, like food and heat.

"Older adults' health often at risk from too many medications, including opioids," reads a headline at Author Celia Vimont reports, "The growing population of older adults who are taking many medications prescribed by different doctors, combined with the growing opioid epidemic, is contributing to the increasing problem of drug use among the elderly."

Some senior care facts are provided by the Agency on Aging, Centers for Disease Control and the National Council on Aging:

More than 43.1 million adults (1 in 7) are aged 65 and older. By 2040, it is estimated that there will be 79.7 million.

Almost 92 percent of older adults have at least one chronic condition; 77 percent have at least two.

Approximately 36 percent of older Americans have some sort of disability (hearing, vision, etc.)

Prescription drugs are important to a lot of people with chronic conditions. Adults aged 65 to 79 use an average of 20 prescription medications annually, women more than men. They also pay more out of pocket for their medications than any other age group.

Pharma Guy's insight:

"[Senior Citizens] pay more out of pocket for their medications than any other age group."

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OMG! Drug Side Effects (Almost) Killed Granny! ER Study Shows

OMG! Drug Side Effects (Almost) Killed Granny! ER Study Shows | Pharmaguy's Insights Into Drug Industry News |

The study has a lot of interesting information, and here are some highlights:


Side effects from medication are causing more older Americans to visit emergency rooms and leading to more hospitalizations, according to an analysis of ER data from 2005-2006 and 2013-2014. And across all age groups, the drugs most often causing side effects that sent people to an ER were the same ones identified a decade ago —anticoagulants, antibiotics, diabetes agents, and opioid analgesics.


These were among the findings in a study that examined emergency department visits for adverse reactions to medicines in 2013 and 2014, compared with 2005 and 2006.


An estimated four ER visits for adverse drug events occurred per 1,000 individuals annually. The rate of ER visits among older adults, aged 65 years and older, was 9.7 visits per 1,000 individuals compared with 3.1 visits per 1,000 individuals for those younger than 65 years.


An estimated 35 percent of ER visits for adverse drug events occurred among adults aged 65 years or older in 2013 and 2014 compared with nearly 26 percent in 2005 and 2006.


Even after accounting for prescribing frequency, the authors found that the rate of ER visits for adverse drug events per prescription was previously significantly higher for anticoagulants and diabetes medicines than for most other drugs.


Prescribing more medicine than needed or taking excess dosages was the most common type of adverse drug event. Medication errors were documented in 1 of 10 ER visits for adverse drug events and an estimated 27 percent of visits hospitalization.


The proportion of ER visits due to side effects involving anticoagulants rose during the last decade along with increased use. From 2009 to 2014, oral anticoagulant use increased by approximately 38 percent, whereas the proportion of ER visits for anticoagulants increased by 57 percent.


Among children, aged 5 years and younger, antibiotics were most commonly implicated as well as among older children and adolescents, aged 6 to 19 years old. Among older adults — aged 65 and older — anticoagulants, diabetes drugs, and opioid analgesics were implicated in approximately 60 percent of ER visits for adverse drug events.


Among older children and adolescents, antipsychotics were the second most commonly implicated type of drug in ER visits for adverse drug events. This occurred, the authors noted, as antipsychotic prescribing increased sharply during the last two decades. “Up to 75 percent of antipsychotic use in children and adolescents is estimated to be for off-label indications and there is evidence of low adherence to recommendations for safety monitoring,” they wrote.


Compared with 2005 and 2006, the rates of ER visits increased among older adults — 5.2 visits per 1,000 individuals in 2005 and 2006 versus 9.7 visits per 1,000 individuals in 2013- 2014 — and among adults aged 50 years to 64 years — 2.5 visits per 1,000 individuals in 2005 and 2006 versus 4.3 visits per 1,000 individuals in 2013 and 2014. The rates for other age groups were similar for both periods.

Pharma Guy's insight:

From JAMA Editorial:

Preventing, identifying, and addressing ADEs from prescribed medications will require systematic rethinking and redesign of how medications are prescribed, monitored, and discontinued, particularly medications for chronic conditions. Clinicians across the continuum of care must be involved in this redesign. Patients with ADEs often seek care in the ED, but these visits are frequently isolated from the rest of the patient’s clinical care. The most effective interventions for preventing ADEs will require greater involvement and integration of pharmacists, meaningful implementation and use of medication reconciliation, and the inclusion of patients and their caregivers. Overcoming the insidious and pervasive diffusion of responsibility within the current health care system must be a key component in preventing, identifying, and addressing ADEs from prescribed medications.

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