Alavert

NEW YORK -- Lilly Icos, maker of the erectile dysfunction drug Cialis, is so confident in its drug that it's offering patients a voucher for a free sample dispensed with a physician's prescription. If the patient isn't completely satisfied, Lilly will pay for the patient to try a competing product.

Minus the glitzy gimmick, pharmacy benefit managers are pushing their own agenda quietly, instituting generic sampling programs across the country. And by most measures, the outcome of this sampling effort has proved a success.

Medco Health Solutions, for instance, is finding success with its Generics First program, which combines in-person visits to physicians, a direct mail sampling program customized to a physician's prescribing patterns and a patient education component.

Medco applied its Generics First program in western Pennsylvania, where it partnered with Highmark, an independent licensee of the Blue Cross and Blue Shield Association. Physicians were offered free generic drug samples from three high-cost categories: anti-hypertensives, antidepressants and gastrointestinal agents. Medco also provided samples of over-the-counter medications in the high-spend, non-sedating antihistamine and pain relief categories.

Figures show that in 2003, 465 western Pennsylvania physicians ordered nearly 50,000 generic samples, accounting for more than 360,000 days of therapy.

To date, on a nationwide basis, the Generics First program has provided more than 2.2 million patient samples, equaling more than 15.6 million days of therapy for products, including enalapril, hydro-chlorothiazide, furosemide, metoprolol, atenolol, ranitidine, cimetidine, fluoxetine, buspirone and the OTC drugs Alavert, Advil and Prilosec.

Other PBMs have instituted similar programs.

Beginning in summer 2002, select members of Blue Cross Blue Shield of Rhode Island received a letter as part of a pilot program alerting them they could save money by substituting less-expensive generic versions of the brand name drugs they currently were on. Blue Cross Blue Shield conducted the GENesis Voucher Program, which piloted in Minnesota and Rhode Island, in conjunction with the PBM PharmaCare. It proved so successful it was rolled out nationally in mid-2003.

Currently, a sister project, GENesis Sampling, is under way.

Bob McKay, vice president of product development for PharmaCare, said between 5,000 and 6,000 members initially were identified through the GENesis Voucher Program from the patient population. Each of those patients, he noted, were on multiple medications. "So we picked about 65 [branded drugs] and said these products all have generics available," McKay explained. "We sent a letter to patients to inform them a generic was available, that they had the opportunity to refill their prescription with a generic drug at their own request and that they could go to a pharmacist directly to fill it.

"The most important part was that Blue Cross Blue Shield was willing to waive the co-pay," he added.

To gauge patient response, PharmaCare added a 45-day window during which patients could take advantage of the offer. It found that 21 percent of targeted patients took advantage of the offer in the first 45 days. Data showed more than 95 percent of the patients who opted for the generic drug stayed on the generic and did not switch back to the branded drug.

The conversion saved from $98 to $110 per year per converting member, and members also saved by forfeiting co-pays, according to the PBM.

GENesis conversions by therapeutic class, in descending order, include hypertension, antianxiety, pain management, antidepressants and attention deficit/hyperactivity disorder.

The GENesis Sampling pilot program, launched in Minnesota and now under way in Rhode Island, takes things one step further. Currently, six drugs are included in the GENesis sampling program: lisinopril, fluoxetine capsules, lovastatin, amoxicillin capsules, metformin and naproxen.

Under the program, instead of handing patients a sample of a branded drug, doctors will hand over a card to the patient. The patient then takes that card to a pharmacist, who dispenses a generic without charging a co-pay. The beauty of the GENesis program, McKay said, is that the prescription is processed against the patient's health care plan, and the dispensing pharmacist is not required to do anything besides fill the generic prescription. To facilitate that process, patient profiles include a prior authorization from Blue Cross Blue Shield for the $0 co-pay.

"We designed the program around the needs of everyone. We said in order for it to work, we couldn't ask pharmacists to change their normal routine. They don't do any special keying or coding. They undertake the same activity they normally do, except they fill the generic," McKay said.

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