How To Understand The Growth Of The Cholesterol Lowering Market

Transcription

1 e-prescribing Prevalence: Cholesterol Lowering Market By: Christopher Blenk, Senior Principal, Commercial Effectiveness Services, IMS Health and Michael Kleinrock, Director, Research Development, IMS Institute for Healthcare Infomatics APRIL 2013

2 NAVIGATION IMS XXXX Both governments and the healthcare industry have recognized electronic prescribing as an increasingly significant driver of pharmaceutical prescriptions. It is therefore important to better understand the current extent and intensity of e-prescribing. In this publication, IMS seeks to expand the understanding of e-prescribing penetration within the healthcare provider population and provide perspectives on meaningful use levels of e-prescribing. It should be noted that this data is not taken from e-prescriber systems to provide actual meaningful use levels, but rather focuses on retail prescribing data across both traditional only prescribers and e-prescribers. This report provides analysis results in terms of new prescriptions (NRx) because IMS considers each e-prescription transmitted to the pharmacy as a decision point. In that decision point, a prescriber might provide a new e-prescription (enrx) or a traditional prescription (i.e., a new paper, phone call, or fax). Refilled electronic prescriptions (errx) and total prescriptions (etrx) were not included in prescription counts even though IMS has the capacity to measure those within our panel of pharmacies. The results provided herein focus on retail prescribing behavior in the calendar years 2011 and 2012 observed in the cholesterol lowering medicines market (e.g., statins, fibrates, niacin and combination products). According to IMS s National Prescription Audit-Market Dynamics (NPA-MD), 24.5 million unique patients received cholesterol lowering product prescriptions in In this analysis, IMS drew the following conclusions based upon IMS s e-panel for the cholesterol lowering market: 1) Retail e-prescribing increased in both enrx volume and in the number of e-prescribers, which grew from 222,000 in CY2011 to 257,000 in CY2012. The volume change represents a 61% increase (5.7MM) in enrx volume in a market with an 8% (2.1MM) increase in total NRx. The change in e-prescribers represents a 16% (35,500) increase. 2) Almost 90% of all prescriptions in the cholesterol lowering market were written by prescribers who had e-prescribed prior to Put another way, most prescriptions in this market continue to be from already existing e-prescribers. It may not be surprising, therefore, that the majority of new e-prescribers were lower decile writers. 3) In 2012, the average e-prescriber transmitted electronically over 50% of his or her retail prescriptions, thereby exceeding the 40% meaningful use threshold for prescribing via electronic means. More specifically, IMS observed an increase from 35.8% (2011) to 53.4% (2012) in the share of retail prescriptions written by e-prescribers which were transmitted electronically to pharmacies. As a result, almost 50% of retail prescriptions are still available for conversion to e-prescribing. 4) Meaningful use levels for e-prescribers (excluding prescribers who do not e-prescribe at all) does not vary significantly by decile, but does vary by specialty from an average of 32% to 70% for specialties having 5,000 or more cholesterol lowering market NRx in A significant amount of variation in meaningful use levels was observed at the individual e-prescriber level with a shift toward higher intensity usage of electronic transmission in IMS HEALTH E-PRESCRIBING PREVALENCE: CHOLESTEROL LOWERING MARKET 1

3 5) The higher tendency for generic usage was observed to have continued in this market in 2011 and 2012 with a significantly higher percentage drop in market share from Lipitor to generic atorvastatin in retail e-prescribing relative to traditional prescribing. IMS s e-prescribing pharmacy panel shows that approximately 50% of the prescribers wrote prescriptions electronically in the cholesterol lowering market in recent years with a significant increase in the number of eprescribers from 222,000 in 2011 to 257,000 in 2012 (See Chart 1). These results were obtained using pharmacies that supplied data in both 2011 and CHART 1: CHANGE IN POPULATION OF E-PRESCRIBERS CY2011 TO CY2012 All Prescribers Cholesterol Lowering Market Jan-Dec 2011 All Prescribers Cholesterol Lowering Market Jan-Dec 2012 No Visible erx 52.6% e-prescriber 47.4% No Visible erx 47.5% e-prescriber 52.5% Chart 2 demonstrates that an overwhelming 88% of all retail prescriptions (both e- prescriptions and traditional) in the cholesterol lowering market were written over this time period by e-prescribers, (i.e., prescribers who showed at least one e-prescription in 2011 and/or 2012). It should be noted that the percentage of prescriptions (e-prescribing and traditional) by these e-prescribers remained relatively flat, decreasing from 88.2% in 2011 to 88.0% in CHART 2: CHANGE IN POPULATION OF E-PRESCRIBERS CY2011 TO CY2012 Cholesterol Lowering e-prescriptions By Group Jan-Dec 2011 Cholesterol Lowering e-prescriptions By Group Jan-Dec 2012 % of overall Market Rx written by Prescribers with no e-prescribing history 11.8% % of overall Market Rx written by Prescribers with no e-prescribing history 12% % of overall Market Rx written by e-prescribers regardless of method 88.2% % of overall Market Rx written by e-prescribers regardless of method 88% IMS HEALTH E-PRESCRIBING PREVALENCE: CHOLESTEROL LOWERING MARKET 2

4 A further analysis of the data supports this finding, given that e-prescribing is and has been more prevalent among highly active prescribers. In Chart 3, prescribers are broken into 10 groups or deciles. The deciles contain different numbers of prescribers, but are each responsible for an equivalent number of prescriptions. For instance, in the time period studied, the 3,739 prescribers in decile 10 generated the same number of new prescriptions (regardless of channel) as the 351,058 prescribers in decile 1. CHART 3: 2012 E-PRESCRIBERS BY DECILE % of Prescribers Within Decile 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% e-prescriber Breakout by NRx Decile Cholesterol Lowering Market % Non e-prescribers 215,513 7,607 3,324 2,101 1, e-prescribers 135,545 34,955 22,067 16,345 13,193 10,630 8,688 7,085 5,482 3,488 Number of Prescribers By Type By Decile Increasing Traditional & e-prescribing Volumes Source: IMS e-prescribing Panel of Pharmacies, Cholesterol Lowering Market January to December 2012 The high (88%) and relatively flat percentage of overall prescriptions written by e-prescribers is explained by the fact that most high volume prescribers have been e-prescribing for some time. While the number of e-prescribers who wrote in the cholesterol lowering market in the IMS panel increased by approximately 35,500 from CY2011 to CY2012, the bulk of e-prescribers added in 2012 are lower volume writers in this retail market as can be seen in Chart 4. Chart 4 does not imply that high decile writers stopped e-prescribing. Rather, the chart shows that the majority of new e-prescribers were low decile writers in this market. To understand this chart, consider that when the 35,500 e-prescribers were added to IMS panel in 2012 the overall size of each decile increased. As more prescribers were added to the equivalent prescriber count deciles, the weighting of e-prescribers shifted across deciles (based on both e-prescribers and non-e-prescribers). Accordingly, the average retail productivity per prescriber dropped from 112 NRx per e-prescriber in 2011 to 108 NRx per e-prescriber in None of these findings should be interpreted to assume that existing e-prescribers are e-prescribing less. In fact, based on the results in Chart 5, it is evident that e-prescribers are using their systems more often, which may be indicative of increasing comfort with e-prescribing. IMS HEALTH E-PRESCRIBING PREVALENCE: CHOLESTEROL LOWERING MARKET 3

5 % of eprescribers CHART 4: CHANGE IN POPULATION OF CHOLESTEROL MARKET E-PRESCRIBERS BY DECILE CY2011 TO CY2012 Percentage of Overall Growth in eprescribers 30% 25% 20% 15% 10% 5% 0% -5% Relative Growth by Decile in e-prescribers (Years Ending 2011 & 2012) Decile (With Equivalent Numbers of Prescribers Each) Relative % Growth in eprescribers Increasing Traditional & e-prescribing Volumes CHART 5: INTENSITY OF E-PRESCRIBING BY E-PRESCRIBERS FROM CY2011 TO CY2012 Intensity of e-prescribing Across All e-prescribers Cholesterol Lowering Market 25.0% % % 10.0% 5.0% 7.6% 6.0% 5.6% 7.4% 10.2% 7.8% 11.4% 14.6% 13.1% 16.2% 0.0% 0-10% 10-20% 20-30% 30-40% 40-50% 50-60% 60-70% 70-80% 80-90% % Intensity of eprescribing (enrx as a % of NRx) The findings in Chart 5 demonstrate the opportunity for growth in e-prescribing remains high given the current amount of prescriptions transmitted electronically to pharmacies in Chart 6 demonstrates all prescribing deciles on average exceeded the meaningful use regulation percentage of 40% in 2012, leaving an average of almost 50% of traditional retail prescribing available for conversion to e-prescribing. IMS HEALTH E-PRESCRIBING PREVALENCE: CHOLESTEROL LOWERING MARKET 4

6 CHART 6: NRX BY CHANNEL WRITTEN BY E-PRESCRIBERS CY2011 TO CY2012 e-prescribing NRx Breakdown Traditional vs. e-prescribing by NRx Decile CY 2011 & CY 2012 % of NRx NRx Decile 2012 Trad. NRx 2012 Incremental enrx % 2011 enrx% Increasing Traditional & e-prescribing Volumes While e-prescribing usage varies by specialty, the top specialties in this market who do e- prescribe each averaged above 50% in 2012 based on the IMS panel as shown in Chart 7. CHART 7: E-PRESCRIBER CHANNEL USAGE FOR TOP 5 NRX SPECIALTIES CY2011 TO CY2012 e-prescribing Specialty NRx Breakdown Traditional vs. e-prescribing - CY 2011 & CY 2012 % of NRx Family Medicine (38.3%) Internal Medicine (33.9%) Cardiology (9.7%) Nurse Practitioner (5.1%) Physician s Assistant (3.4%) Specialty and % of 2012 Chol. Lowering Market NRx 2012 Trad. % 2012 Incremental enrx % 2011 enrx % IMS HEALTH E-PRESCRIBING PREVALENCE: CHOLESTEROL LOWERING MARKET 5

7 For other specialties having over 5,000 e-panel market enrx in 2012, e-prescribing usage varied considerably by specialty from 32% for General Practice (GP) to 65% for Pediatric Internal Medicine (MPD) specialties. In this market, GPs account for 1.7% of total NRx in IMS e-panel and MPDs account for 0.7%. Together, specialties averaging 5,000 or more e-panel enrx account for 96.6% of the prescriptions written. Overall, in the cholesterol lowering market e-panel, 35.8% (2011) and 53.4% (2012) of the retail prescriptions by e-prescribers were transmitted electronically to pharmacies. Of the prescriptions filled in the retail setting via traditional format (i.e., paper, phone or fax prescriptions), it is likely that a significant percentage were printed from electronic medical records/e-prescribing systems and provided directly to patients. Finally, we examine brand/generic dynamics in e-prescribing relative to traditional prescribing. As shown in Chart 8 each individual brand has a slightly lower or equivalent erx market share when compared to traditional shares. Since the differences are not pronounced one might argue that generics are not utilized significantly more than the brands in e-prescribing as compared to traditional prescribing. However, a few combined factors lend credibility to the belief that generics are still favored in e-prescribing: 1) eprescription market shares across brands in 2011 and 2012 were all lower or equal to their traditional market shares. If there were not forces driving generic usage, one would expect that some brands would have higher e-prescribing market share in at least one of the years. 2) The opposite effect holds true for generics across years in both calendar years. CHART 8: 2011 VS 2012 CHOLESTEROL LOWERING MARKET SHARE BY PRESCRIPTION CHANNEL Cholesterol Market NRx Share e-prescribers in Deciles CY 2011 Cholesterol Market NRx Share e-prescribers in Deciles CY Percentage of NRx Percentage of NRx erx Share Trad NRx Share erx Share 2012 Trad NRx Share 2012 ZETIA TRICOR OTHER GENERICS OTHER BRANDS VYTORIN LIPITOR CRESTOR ATORVASTATIN CA Source: IMS e-prescribing Panel of Pharmacies, Cholesterol Lowering Market January to December 2011, January to December 2012 IMS HEALTH E-PRESCRIBING PREVALENCE: CHOLESTEROL LOWERING MARKET 6

8 3) The e-prescribing market share of Lipitor remained significantly lower than the traditional Lipitor market share in both 2011 and While a 1.4% Lipitor market share difference in 2012 across e-prescribing and traditional prescribing might seem small, it equates to a 38% lower market share in Lipitor e-prescribing when considering 3.7% traditional market share as the baseline. 4) Furthermore, Lipitor s market share dropped 84% (from 14.8% to 2.3%) for e-prescriptions from 2011 to 2012 while Lipitor s market share dropped 75% (from 15.72% to 3.7%) for traditional prescribing in the same timeframe. 5) Atorvastatin shows a 1.6% higher e-prescribing share (19.3%) in 2012 when compared to 19.0% for traditional prescribing. In 2011, atorvastatin had a 60% higher e-prescribing share (1.7%) compared to 1.1% for traditional prescribing. It should be noted that 2011 prescription volume percent difference is on a lower base of its 1.1% market share. It should be noted that the cholesterol market is not necessarily representative of e-prescribing impact in other markets. Furthermore, when excluding generics from the analysis and looking only at branded products relative to one another, IMS often sees cases where e-prescribing benefits a particular brand over other branded products. Therefore, it is important to use caution in drawing conclusions on this information outside of the scope of analysis presented. IMS has completed analyses in a number of areas such as understanding increased payer influence in e-prescribing. Increased payer influence may be observed in (1) the higher e- prescribing rate and degree of change in brand market shares when payers take action to exert influence; and (2) the differences in steady state e-prescribing vs. traditional brand market shares which align with payer incentives. AUTHORS NOTE IMS continues to identify data sources that allow us to quantify the impact of e-prescribing since 2009 using objective, third party information. IMS maintains a record of both e-prescriptions and traditional (i.e., paper, phone, and fax) prescriptions from our e-prescribing panel of 23,000 independent pharmacy, regional chain, national chain, food store, and mass merchandiser data suppliers. This panel represents an estimated 40% of the retail pharmacies in the US. To perform this analysis, IMS extracted unprojected prescription data from January 2011 to December This data includes an identifier for the channel (paper, phone, fax, or e-prescription) by which a prescription was submitted to the pharmacy. IMS then limited the dataset to prescriptions from a constant pharmacy panel to avoid anomalies in the analysis results due to the timing of pharmacies entering or leaving the panel. This method allowed a higher level of confidence to be attributed to trends visible in the data. IMS then performed statistical analyses on the prescription data to develop the results provided here. Since the data used in this analysis is unprojected, readers should not expect it to match the prescription levels, numbers of prescribers, or other metrics in IMS projected prescription datasets or publications. Furthermore, the data used in this analysis is from the IMS eprescription Pharmacy Panel which is a subset of the pharmacies reporting data to IMS. Caution should be used, therefore, in comparing this data to IMS or other published datasets. The authors would like to thank Keith Loehlein, Murray Aitken, Murat Aka, and Dennis Boznango for their material review. ABOUT THE AUTHORS Chris Blenk is a Senior Principal in IMS Health s Commercial Effective Services practice. Chris is responsible for IMS data management, analytics and reporting services for key IMS clients. Chris brings 15 years of experience providing sales and marketing services and consulting to the life sciences industry. Michael Kleinrock is the Director, Research Development for the IMS Institute for Healthcare Informatics., leading the development of reports and projects focused on the current and future role of biopharmaceuticals in healthcare in the US and globally. Michael joined IMS in 1999 and held roles in customer service, marketing, product management, and in 2006 joined the Market Insights team which in 2011 became the IMS Institute for Healthcare Informatics. IMS has the ability to perform a broad and diverse set of analyses and is considering future e-prescribing publications in other markets and perspectives. For more information please contact IMS Health directly or via our website at IMS HEALTH E-PRESCRIBING PREVALENCE: CHOLESTEROL LOWERING MARKET ED