Trends in statin prescribing in a 4,000-member physician-hospital organization

The Advocate Physician Partners (APP) physician-hospital organization (PHO) located in northern Illinois is comprised of 11 hospitals, 500,000 covered lives, and more than 4,000 physician members. In addition to contracting with most major payers, APP became a Medicare Accountable Care Organization (ACO) in January 2012.

BACKGROUND

Physicians are in a pay-for-performance (P4P) environment and receive quarterly report cards.  Report cards include anywhere from one to 3 (out of a possible of 4 total) generic prescribing measures depending upon each physician’s medical specialty.  A generic statin prescribing measure has been in place for the last several years.  Each generic prescribing measure has a specific percentage goal and point value determined annually in the third quarter for the following year. 

APP employs clinical pharmacists to perform academic detailing activities with physicians, nurse practitioners, and physician assistants. One area of focus is the promotion of clinically appropriate, lower-cost generic [and over-the-counter (OTC) medications] as first-line therapeutic options, where clinically appropriate. APP does not have a formulary. We defer to the unique formularies and plan designs of each individual insurer and employer. 

The data presented is prescription claims data provided by insurers which have contracts with APP.  Data is not available for cash pay, Medicaid or Medicare claims. The data described is for the period Q1 2011 through Q3 2012. It contains 30- and 90-day prescription claims. 

EXPERIENCE

Crestor utilization remained flat throughout the observation period.  Lescol, Lescol XL, and Livalo utilization remained well under 1%. Lescol became available as a generic in April 2012 which may account for further decrease in Lescol brand claims beginning in Q2 2012. Lipitor utilization peaked in Q3 2011 representing 16.24% of total statin claims. Physicians may have moved patients from simvastatin to Lipitor in response to FDA labeling changes to simvastatin announced in Q2 2011. Interestingly, no corresponding increase in Crestor claims data were observed. 

Atorvastatin claims began to appear in Q4 2011 with the introduction of an authorized generic form of Lipitor in December 2011.  Percentage of generic atorvastatin claims are as follows:

• Q4 2011 (25.04%)

• Q1 2012 (74.42%)

• Q2 2012 (79.56%)

• Q3 2012 (91.42%)

Pfizer’s Lipitor $4 Co-Pay Card program does not appear to have negatively impacted atorvastatin utilization as evidenced by Q1 2012 and Q2 2012 atorvastatin percentages of 74.42% and 79.56%, respectively. Our data appear to indicate that the introduction of additional generic manufacturers of atorvastatin in Q2 2012, resulted in significant increase in atorvastatin ­utilization. 

Lovastatin claims trended down from 5.77% to 4.58%. Pravastatin utilization remained flat in Q1 2011 and Q2 2011 (9% range) and then increased in Q3 2011 and subsequent quarters to approximately 11%. The simvastatin percentage of statin claims remained approximately 57% in Q1 2011 and Q2 2011 and began trending downward from Q1 2011 through Q3 2012. The decrease observed in simvastatin utilization appears to have been offset by an increase in pravastatin, Lipitor, and later atorvastatin utilization following the Q2 2011 FDA changes to simvastatin labeling.

Source:  APP Prescription Claims Data Q1 2011 through Q3 2012