Prescription Drugs
Trends in Usual and Customary Prices for Commonly Used Drugs Gao ID: GAO-11-306R February 10, 2011Prescription drug spending in 2009 totaled approximately $250 billion, of which $78 billion--or about 31 percent--was spent by the federal government. Prescription drug spending by the federal government, patients, and third-party payers, including employers, is driven by many factors, including the prices paid for drugs. In 2007 we reported on trends in retail prices--known as usual and customary (U&C) prices--for prescription drugs. We found that the average U&C price for the commonly used brand-name prescription drugs we reviewed increased about 6 percent per year from January 2000 through January 2007. Some media reports have suggested that prescription drug prices may have increased more during the debate leading up to passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010 compared to other recent years. We were requested to examine recent trends in drug prices for brand-name and generic pharmaceuticals. In this report, we (1) examine U&C price trends for commonly used prescription drugs from 2006 through the first quarter of 2010, the latest available data at the time of our analysis, and compare these trends to those of other medical consumer goods and services, and (2) examine price trends using drug prices other than U&C. Congress also asked us to provide information on the extent to which prices for individual brand-name drugs changed over the course of this analysis period. In order to determine U&C price trends from 2006 through the first quarter of 2010, we selected four baskets of drugs that were commonly used by consumers during our analysis period. To select our baskets, we used prescription drug utilization data from the Blue Cross Blue Shield Federal Employee Program (BCBS FEP), a large, nationwide insurance plan that covers nearly 5 million individuals. We selected the first basket of drugs based on drug name in order to examine overall price trends of both brand-name and generic drugs. We used BCBS FEP utilization data to identify 100 commonly used drugs, and we considered the brand-name and generic versions to be distinct drugs with distinct levels of utilization. We selected the second and third baskets of drugs to examine trends for brand-name and for generic drugs separately. The second and third baskets of drugs were subsets of the first basket and contained the 55 brand-name and the 45 generic drugs, respectively, from the first basket of 100 drugs. We selected the fourth basket of drugs in order to account for the growing national shift in consumer utilization from brand-name to generic versions of drugs. We used BCBS FEP utilization data to again select 100 commonly used drugs--this time based on the active ingredient rather than drug name. In selecting this fourth basket of drugs based on active ingredient, we considered the brand-name and generic versions of drugs with the same active ingredient to be the same drug. The degree of overlap between the contents of the fourth basket and the first basket was high: at least 95 percent of the utilization in one basket was also in the other.
We found that the U&C price index for our first basket of 100 commonly used prescription drugs increased at an average annual rate of 6.6 percent from 2006 through the first quarter of 2010 compared with a 3.8 percent average annual increase in the consumer price index for medical goods and services (medical CPI). The increase in the price index from the first quarter of 2009 through the first quarter of 2010--prior to passage of health reform in March 2010--was 5.9 percent, less than the increase for the 2 years prior but higher than in 2006. We also found that the U&C price index for our second basket of 55 brand-name drugs increased at an average annual rate of 8.3 percent during our time period. In contrast, the U&C price index for our third basket of 45 generic drugs decreased at an average annual rate of 2.6 percent. Finally, when shifts in consumer utilization between brand-name and generic versions of the same drug were included in the analysis using our fourth basket of drugs selected by active ingredient, the U&C price index increased about 2.6 percent per year, a much lower rate than the 6.6 percent annual increase observed when shifts in utilization were not included. We found that price trends for the 100 drugs in our first basket as measured using drug prices other than U&C also increased from 2006 through the first quarter of 2010, but at a somewhat slower rate than the 6.6 percent rate for the U&C price index. For example, the average wholesale prices (AWP) price index increased at an average annual rate of 6.0 percent while the average manufacturer prices (AMP) price index increased at an average annual rate of 5.3 percent. The Part D price index--which was measured from 2007 through the first quarter of 2010--increased at an average annual rate of 6.8 percent, slightly less than the U&C price index of 7.0 percent when measured across the same period.
GAO-11-306R, Prescription Drugs: Trends in Usual and Customary Prices for Commonly Used Drugs
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GAO-306R:
United States Government Accountability Office:
Washington, DC 20548:
February 10, 2011:
Congressional Requesters:
Subject: Prescription Drugs: Trends in Usual and Customary Prices for
Commonly Used Drugs:
Prescription drug spending in 2009 totaled approximately $250 billion,
of which $78 billion--or about 31 percent--was spent by the federal
government.[Footnote 1] Prescription drug spending by the federal
government, patients, and third-party payers, including employers, is
driven by many factors, including the prices paid for drugs. In 2007
we reported on trends in retail prices--known as usual and customary
(U&C) prices--for prescription drugs.[Footnote 2] We found that the
average U&C price for the commonly used brand-name prescription drugs
we reviewed increased about 6 percent per year from January 2000
through January 2007.[Footnote 3] Some media reports[Footnote 4] have
suggested that prescription drug prices may have increased more during
the debate leading up to passage of the Patient Protection and
Affordable Care Act (PPACA) in March 2010 compared to other recent
years.[Footnote 5]
We were requested to examine recent trends in drug prices for brand-
name and generic pharmaceuticals. In this report, we (1) examine U&C
price trends for commonly used prescription drugs from 2006 through
the first quarter of 2010, the latest available data at the time of
our analysis, and compare these trends to those of other medical
consumer goods and services, and (2) examine price trends using drug
prices other than U&C. You also asked us to provide information on the
extent to which prices for individual brand-name drugs changed over
the course of this analysis period. We have provided this information
in an enclosure.
In order to determine U&C price trends from 2006 through the first
quarter of 2010, we selected four baskets of drugs that were commonly
used by consumers during our analysis period. To select our baskets,
we used prescription drug utilization data from the Blue Cross Blue
Shield Federal Employee Program (BCBS FEP), a large, nationwide
insurance plan that covers nearly 5 million individuals.[Footnote 6]
We selected the first basket of drugs based on drug name in order to
examine overall price trends of both brand-name and generic drugs. We
used BCBS FEP utilization data to identify 100 commonly used drugs,
and we considered the brand-name and generic versions to be distinct
drugs with distinct levels of utilization.[Footnote 7] We selected the
second and third baskets of drugs to examine trends for brand-name and
for generic drugs separately. The second and third baskets of drugs
were subsets of the first basket and contained the 55 brand-name and
the 45 generic drugs,[Footnote 8] respectively, from the first basket
of 100 drugs. We selected the fourth basket of drugs in order to
account for the growing national shift in consumer utilization from
brand-name to generic versions of drugs. We used BCBS FEP utilization
data to again select 100 commonly used drugs--this time based on the
active ingredient rather than drug name.[Footnote 9] In selecting this
fourth basket of drugs based on active ingredient, we considered the
brand-name and generic versions of drugs with the same active
ingredient to be the same drug. The degree of overlap between the
contents of the fourth basket and the first basket was high: at least
95 percent of the utilization in one basket was also in the other.
To report the U&C price trends, we calculated quarterly changes in the
average price of each basket of drugs from 2006 through the first
quarter of 2010 using quarterly price indexes. For each index, we used
the first quarter of 2006 as a baseline with an assigned value of 100
and calculated change over each quarter as an expressed value above or
below 100. We relied on U&C data from Pennsylvania's Pharmaceutical
Assistance Contract for the Elderly (PACE) program as our main data
source because they were actual retail prices that pharmacies charged
to cash-paying consumers for prescription drugs and were available
across our entire analysis period.
We compared the drug price indexes we constructed to the average
annual change from 2006 through first quarter 2010 in the consumer
price index for medical goods and services (medical CPI) and in the
broader consumer price index for all consumer goods for urban
consumers (CPI-U), both of which are publicly available from the
Bureau of Labor Statistics. The medical CPI--which includes
prescription and nonprescription drugs, medical equipment, and
services--makes up about 6.5 percent of the CPI-U; the remaining 93.5
percent of this broader index reflects changes in prices for other
(nonmedical) consumer goods and services.[Footnote 10]
In order to determine price trends using drug prices other than U&C,
we created three separate price indexes using three additional
measures of drug prices. We calculated the indexes using these three
additional measures of drug prices for our first basket of 100 drugs
following the same methodology used to construct the U&C price index.
We used average wholesale prices (AWP), which are "list prices"
reported by manufacturers; average manufacturer prices (AMP), which
are average prices paid to manufacturers by wholesalers and other
purchasers; and Medicare Part D Plan Finder negotiated prices (Part
D), which are prices negotiated between participating Part D plans and
pharmacies for Medicare Part D consumers.[Footnote 11] We obtained AWP
data from Red Book[Footnote 12] and both AMP and Part D Plan Finder
data from the Centers for Medicare & Medicaid Services (CMS).
The results of our analyses are limited to the commonly used
prescription drugs in our baskets and cannot be generalized to all
prices nationally for all drugs. In addition, the U&C analyses are
limited to prices reported by retail pharmacies in Pennsylvania to the
PACE program and cannot be generalized to all U&C prices nationally
for all drugs. We reviewed data from BCBS FEP, CMS, Red Book, and the
PACE program for reasonableness and consistency, including screening
for outlier prices and examining possible reasons for inconsistencies
between the data sources. We also reviewed documentation and talked to
data providers about steps they take to ensure data reliability. We
determined that these data were sufficiently reliable for our
purposes. We conducted this performance audit from April 2010 through
January 2011 in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit
to obtain sufficient, appropriate evidence to provide a reasonable
basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for
our findings and conclusions based on our audit objectives. (See
enclosure I for a detailed discussion of our scope and methodology and
enclosure II for a listing of the drugs in each basket.)
Results in Brief:
We found that the U&C price index for our first basket of 100 commonly
used prescription drugs increased at an average annual rate of 6.6
percent from 2006 through the first quarter of 2010 compared with a
3.8 percent average annual increase in the medical CPI.[Footnote 13]
The increase in the price index from the first quarter of 2009 through
the first quarter of 2010--prior to passage of health reform in March
2010--was 5.9 percent, less than the increase for the 2 years prior
but higher than in 2006. We also found that the U&C price index for
our second basket of 55 brand-name drugs increased at an average
annual rate of 8.3 percent during our time period. In contrast, the
U&C price index for our third basket of 45 generic drugs decreased at
an average annual rate of 2.6 percent. Finally, when shifts in
consumer utilization between brand-name and generic versions of the
same drug were included in the analysis using our fourth basket of
drugs selected by active ingredient, the U&C price index increased
about 2.6 percent per year, a much lower rate than the 6.6 percent
annual increase observed when shifts in utilization were not included.
We found that price trends for the 100 drugs in our first basket as
measured using drug prices other than U&C also increased from 2006
through the first quarter of 2010, but at a somewhat slower rate than
the 6.6 percent rate for the U&C price index. For example, the AWP
price index increased at an average annual rate of 6.0 percent while
the AMP price index increased at an average annual rate of 5.3
percent. The Part D price index--which was measured from 2007 through
the first quarter of 2010--increased at an average annual rate of 6.8
percent, slightly less than the U&C price index of 7.0 percent when
measured across the same period.
For additional details on our results, see enclosure III. We also
provide information on the extent to which prices for individual brand-
name drugs changed over the course of our analysis period in enclosure
IV.
We did not obtain external comments on a draft of this report because
we did not evaluate the programs of the organizations that provided us
data.
As agreed with your offices, unless you publicly announce the contents
of this report earlier, we plan no further distribution until 30 days
from the report date. At that time, we will send copies of this report
to relevant congressional committees and other interested members. The
report also will be available at no charge on the GAO Web site at
[hyperlink, http://www.gao.gov].
If you or your staff have any questions regarding this report, please
contact me at (202) 512-7114 or dickenj@gao.gov. Contact points for
our Offices of Congressional Relations and Public Affairs may be found
on the last page of this report. GAO staff members who made key
contributions to this report are listed in enclosure V.
Signed by:
John E. Dicken:
Director, Health Care:
Enclosures - 5:
List of Requesters:
The Honorable Henry A. Waxman:
Ranking Member:
Committee on Energy and Commerce:
House of Representatives:
The Honorable Sander M. Levin:
Ranking Member:
Committee on Ways and Means:
House of Representatives:
The Honorable Pete Stark:
Ranking Member:
Subcommittee on Health:
Committee on Ways and Means:
House of Representatives:
The Honorable John Lewis:
Ranking Member:
Subcommittee on Oversight:
Committee on Ways and Means:
House of Representatives:
The Honorable Charles B. Rangel:
House of Representatives:
[End of section]
Enclosure I: Scope and Methodology:
In order to determine usual and customary (U&C) price trends from 2006
through the first quarter of 2010, we selected four baskets of drugs
that were commonly used by consumers during our analysis period.
[Footnote 14] To select our baskets, we used prescription drug
utilization data from the Blue Cross Blue Shield Federal Employee
Program (BCBS FEP), a large, nationwide insurance plan that covers
nearly 5 million individuals.[Footnote 15] We used data from the first
quarter of 2006 to identify the most commonly dispensed 30-day supply
for each drug and then used this quantity to determine the
corresponding number of 30-day equivalents represented by each claim.
We also used data from the Food and Drug Administration (FDA) and Red
Book[Footnote 16] to determine the brand-name or generic status of
each drug at the beginning and end of our analysis period.
We selected the first basket of drugs based on drug name in order to
examine overall price trends of both brand-name and generic drugs over
our time period. We used BCBS FEP utilization data to select 100
commonly used drugs. We aggregated all claims with the same drug name,
strength, route of administration, and dosage form in order to
determine which drugs had the highest utilization. For example, all
claims for "Zocor/10mg/oral/tablet" were combined as one drug. Using
this drug name approach, the brand-name and generic versions of a drug
were aggregated separately. For example, "Zocor/10mg/oral/tablet" and
"simvastatin/10mg/oral/tablet" would be considered different drugs for
purposes of our first basket because they have different names, even
though they are the brand-name and generic versions of drugs
containing the same active ingredient. The first drug basket contained
45 percent of all BCBS FEP 30-day equivalent prescriptions from the
first quarter of 2006.
We selected the second and third baskets of drugs to examine trends
for brand-name and for generic drugs separately. The second basket
contained the 55 brand-name drugs from among the 100 commonly used
drugs in the first basket, including 35 drugs that were single-source
throughout our analysis period and 20 drugs that transitioned from
single-source to brand-name multisource during the analysis
period.[Footnote 17] Because these two groups of drugs experienced
similar price changes, we included both in our second basket of 55
brand-name drugs. The third basket contained the remaining 45 drugs
from among the 100 commonly used drugs in the first basket, including
40 generic drugs and 5 drugs that were brand-name multisource during
the entire analysis period.[Footnote 18] Because these two groups of
drugs experienced similar price changes, we included both in our third
basket of 45 generic drugs.
We selected the fourth basket of drugs in order to account for the
growing national shift in consumer utilization from brand-name to
generic versions of drugs. We used BCBS FEP utilization data to again
select 100 commonly used drugs--this time based on the active
ingredient rather than drug name. We aggregated all claims with the
same active ingredient, strength, route of administration, and dosage
form. For example, all claims with "simvastatin" as the active
ingredient and "10mg/oral/tablet" as the strength, route of
administration, and dosage form were aggregated as a single drug.
Using this approach, the brand-name and generic versions of a drug
were combined and counted as one drug. For example,
"Zocor/10mg/oral/tablet" and "simvastatin/10mg/oral/tablet" would be
considered the same drug for purposes of this fourth basket because
they are the brand-name and generic versions of drugs with the same
active ingredient, even though they have different names. Under this
approach for example, if consumer utilization of a particular drug in
the basket shifts over time from a higher priced brand-name drug to a
lower priced generic version of that drug, the generic version becomes
increasingly more heavily weighted and thus will have an increasingly
greater influence on the price change for the basket. The fourth drug
basket contained 49 percent of all BCBS FEP 30-day equivalent
prescriptions from the first quarter of 2006. The degree of overlap
between the contents of the fourth basket and the first basket was
high: at least 95 percent of the utilization in one basket was also in
the other.
To report the U&C price trends, we calculated quarterly changes in the
average price of each basket of drugs from 2006 through the first
quarter of 2010 using utilization-weighted price indexes as described
below. We relied on U&C prices as our main data source because they
were actual retail prices that pharmacies charged to cash-paying
consumers for prescription drugs and were available across our entire
analysis period. The U&C prices were obtained from Pennsylvania's
Pharmaceutical Assistance Contract for the Elderly (PACE) program.
[Footnote 19]
We used quarterly price indexes to compare drug prices from our
baseline quarter (the first quarter of 2006) to prices in subsequent
quarters. Price indexes were constructed by dividing the average
quarterly price for a basket of drugs by the average price of the
basket in the first quarter of 2006 and multiplying by 100. As a
result, if the average price for a basket of drugs in a given quarter
was higher than the average price in the baseline quarter, the
resulting price index for that quarter was above 100, while an average
quarterly price that was lower than the baseline price resulted in a
price index below 100. To calculate average quarterly prices for each
drug in our baskets, we first determined the average quarterly price
for each national drug code (NDC) and multiplied that price by its
BCBS FEP utilization for that quarter, then summed the results for all
NDCs corresponding to a given drug. To calculate an average quarterly
price for each basket, we multiplied the resulting quarterly price for
each drug by its BCBS FEP utilization during the first quarter of 2006
and summed across all drugs in the basket. We then divided the
resulting average quarterly price for each basket by its average price
in the baseline quarter to produce quarterly price indexes with a
baseline of 100 in the first quarter of 2006.
We compared the U&C price indexes we constructed to the average annual
change from 2006 through first quarter 2010 in the consumer price
index for medical goods and services (medical CPI) and in the broader
consumer price index for all consumer goods for urban consumers (CPI-
U), both of which are publicly available from the Bureau of Labor
Statistics. The medical CPI--which includes prescription and
nonprescription drugs, medical equipment, and services--makes up about
6.5 percent of the CPI-U; the remaining 93.5 percent of this broader
index reflects changes in prices for other (nonmedical) consumer goods
and services.[Footnote 20]
In order to determine price trends using drug prices other than U&C,
we created three separate price indexes using three additional
measures of drug prices. We calculated the indexes for our first
basket of 100 drugs following the same methodology used to construct
the U&C price index. We used average wholesale price (AWP)--"list
prices" reported by manufacturers--from Red Book; average manufacturer
price (AMP)--average prices paid to manufacturers by wholesalers and
other purchasers--from the Centers for Medicare & Medicaid Services
(CMS); and Medicare Part D Plan Finder (Part D) data--prices
negotiated between participating Part D plans and pharmacies for
Medicare Part D consumers--from CMS.[Footnote 21] The price index that
we calculated using AMP data should be interpreted with caution for
several reasons. First, CMS changed the calculation of AMP in
accordance with the Deficit Reduction Act of 2005 starting on October
1, 2007.[Footnote 22] In addition, we previously reported significant
variations in the monthly AMP data reported to CMS for many drugs.
[Footnote 23] Finally, a 2010 report by the Department of Health and
Human Services Office of Inspector General (HHS OIG) found significant
manufacturer noncompliance with the requirements for reporting AMPs to
CMS.[Footnote 24] In addition, 11 of the 100 drugs in our first basket
did not have Part D pricing data for one or more quarters of our
analysis period and therefore were removed from the basket when
calculating the Part D price indexes to ensure that the same number of
drugs were present in each quarter. These 11 drugs represent 8.0
percent of the utilization of this basket.
Our analyses are limited to the commonly used prescription drugs in
our basket and cannot be generalized to all prescription drugs. In
addition, our U&C analyses are limited to prices reported by retail
pharmacies in Pennsylvania to the PACE program and cannot be
generalized to all U&C prices nationally for all drugs. We reviewed
all data from BCBS FEP, CMS, Red Book, and the PACE program for
reasonableness and consistency, including screening for outlier prices
and examining possible reasons for inconsistencies between the data
sources. We also reviewed documentation and talked to data providers
about steps they take to ensure data reliability. We determined that
these data were sufficiently reliable for our purposes. We conducted
this performance audit from April 2010 through January 2011 in
accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe
that the evidence obtained provides a reasonable basis for our
findings and conclusions based on our audit objectives.
[End of Enclosure I]
Enclosure II: Drugs Included in Analyses:
Table 1 lists the 100 commonly used prescription drugs based on drug
name that were used in constructing quarterly price indexes from the
first quarter of 2006 through the first quarter of 2010 for our first,
second, and third baskets of drugs. Of these 100 drugs used in our
first basket, 35 were single-source brand-name drugs throughout our
analysis period and 20 additional drugs changed status from single-
source to brand-name multisource during our analysis period. Because
these two groups of drugs experienced similar price changes, we
included both in our second basket of 55 brand-name drugs. Of the
remaining 45 commonly used prescription drugs, 40 were generic and 5
were brand-name multisource throughout our analysis period. Because
these two groups of drugs experienced similar price changes, we
included both in our third basket of 45 generic drugs. Table 2 lists
the drugs in our fourth basket of 100 commonly used prescription drugs
based on active ingredient that were used in constructing quarterly
price indexes that included shifts in BCBS FEP enrollee utilization
between brand-name and generic versions of the same drug from the
first quarter of 2006 through the first quarter of 2010.
Table 1: The 100 Commonly Used Prescription Drugs Used to Construct
Quarterly Price Indexes from 2006 through the First Quarter of 2010,
by Drug Name:
The 55 brand-name drugs:
Drug name, strength, route of administration, and dosage form: Aciphex
(20mg/oral/tablet, ente);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Actonel
(35mg/oral/tablet)[A];
Most common 30-day supply: 4.
Drug name, strength, route of administration, and dosage form: Advair
Diskus 250/50 (0.25mg-0.05m/inhalation/disk);
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form: Altace
(10mg/oral/capsule)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Altace
(5mg/oral/capsule)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Ambien
(10mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Aricept
(10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Avandia
(4mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Celebrex (200mg/oral/capsule);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Clarinex (5mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Cozaar
(50mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Crestor
(10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Detrol
LA (4mg/oral/capsule (ER));
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Diovan
(160mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Diovan
(80mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Diovan
HCT (12.5mg-160mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Effexor-
XR(150mg/oral/capsule (ER));
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Effexor-
XR (75mg/oral/capsule (ER));
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Evista
(60mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Flomax
(0.4mg/oral/capsule);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Flonase
(0.05mg/actua/nasal/spray)[A];
Most common 30-day supply: 16.
Drug name, strength, route of administration, and dosage form: Fosamax
(70mg/oral/tablet)[A];
Most common 30-day supply: 4.
Drug name, strength, route of administration, and dosage form: Hyzaar
(25mg-100mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Lantus
(100u/1ml/subcutaneous/solution);
Most common 30-day supply: 10.
Drug name, strength, route of administration, and dosage form: Lexapro
(10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Lexapro
(20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Lipitor
(10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Lipitor
(20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Lipitor
(40mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Lotrel
(5mg-20mg/oral/capsule)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Lumigan
(0.03%/ophthalmic/solution);
Most common 30-day supply: 5.
Drug name, strength, route of administration, and dosage form: Mobic
(7.5mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Nasonex
(0.05mg/actua/nasal/spray);
Most common 30-day supply: 17.
Drug name, strength, route of administration, and dosage form: Nexium
(40mg/oral/capsule (DR));
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Niaspan
(500mg/oral/tablet (ER));
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Norvasc
(10mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Norvasc
(5mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Plavix
(75mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Pravachol (40mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Premarin (0.625mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Prevacid (30mg/oral/capsule (DR))[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Protonix (40mg/oral/tablet, ente)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Singulair (10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Toprol
XL (100mg/oral/tablet (ER))[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Toprol
XL (25mg/oral/tablet (ER))[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Toprol
XL (50mg/oral/tablet (ER))[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Tricor
(145mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Vytorin
(10mg-20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Vytorin
(10mg-40mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Xalatan
(0.005%/ophthalmic/solution);
Most common 30-day supply: 2.
Drug name, strength, route of administration, and dosage form: Zetia
(10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Zocor
(20mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Zocor
(40mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Zoloft
(100mg/oral/tablet)[A];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Zoloft
(50mg/oral/tablet)[A];
Most common 30-day supply: 30.
The 45 generic drugs[B]:
Drug name, strength, route of administration, and dosage form:
Allopurinol (100mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Allopurinol (300mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Alprazolam (0.5mg/oral/tablet);
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form:
Amitriptyline HCL (25mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Atenolol (100mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Atenolol (25mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Atenolol (50mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Clonazepam (0.5mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Clonazepam (1mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Enalapril maleate (20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Fexofenadine HCL (180mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Fluoxetine HCL (20mg/oral/capsule);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Furosemide (20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Furosemide (40mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Gabapentin (300mg/oral/capsule);
Most common 30-day supply: 90.
Drug name, strength, route of administration, and dosage form:
Glimepiride (4mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Glyburide (5mg/oral/tablet);
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form: HCTZ/
lisinopril (12.5mg-20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: HCTZ/
triamterene (25mg-37.5mg/oral/capsule);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: HCTZ/
triamterene (37.5mg-25mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Hydrochlorothiazide (12.5mg/oral/capsule);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Hydrochlorothiazide (25mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Isosorbide mononitrate (30mg/oral/tablet (ER));
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Klor-
Con 10 (10meq/oral/tablet (ER))[C];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form: Klor-
Con m20 (20meq/oral/tablet (ER))[C];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Levothyroxine sodium (0.05mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Lisinopril (10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Lisinopril (20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Lisinopril (40mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Lisinopril (5mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Lorazepam (1mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Metformin HCL (1000mg/oral/tablet);
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form:
Metformin HCL (500mg/oral/tablet (ER));
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form:
Metformin HCL (500mg/oral/tablet);
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form:
Metoprolol tartrate (50mg/oral/tablet);
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form:
Paroxetine HCL (20mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Prednisone (10mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Prednisone (5mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Ranitidine HCL (150mg/oral/tablet);
Most common 30-day supply: 60.
Drug name, strength, route of administration, and dosage form:
Spironolactone (25mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Synthroid (0.05mg/oral/tablet)[C];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Synthroid (0.075mg/oral/tablet)[C];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Synthroid (0.1mg/oral/tablet)[C];
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Trazodone HCL (50mg/oral/tablet);
Most common 30-day supply: 30.
Drug name, strength, route of administration, and dosage form:
Warfarin sodium (5mg/oral/tablet);
Most common 30-day supply: 30.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program, drug status data from the Food and
Drug Administration and Red Book, and national drug code data from Red
Book.
Notes: Eleven of the 100 drugs had no Medicare Part D data for one or
more quarters of our analysis period and were therefore excluded from
the calculation of Part D price indexes. These 11 drugs represented
8.0 percent of the total utilization for the basket.
[A] Drug transitioned from single-source to brand-name multisource
during our analysis period.
[B] Five of these drugs were brand-name multisource drugs during our
entire analysis period. Because these five drugs had generic
equivalents available from multiple manufacturers, were marketed under
their brand name, and experienced price changes most similar to the 40
generic drugs in our sample, we included them in our third basket of
generic drugs.
[C] Drug was brand-name multisource during our entire analysis period.
[End of table]
Table 2: The 100 Commonly Used Prescription Drugs Used in Constructing
Quarterly U&C Price Indexes That Included Shifts in Blue Cross Blue
Shield Federal Employee Program Enrollee Utilization between Brand-
name and Generic Versions of the Drugs from 2006 through the First
Quarter of 2010, by Active Ingredient:
Active ingredient, strength, route of administration, and dosage form:
Alendronate sodium (70mg/oral/tablet);
Most common 30-day supply: 4.
Active ingredient, strength, route of administration, and dosage form:
Allopurinol (300mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Alprazolam (0.5mg/oral/tablet);
Most common 30-day supply: 60.
Active ingredient, strength, route of administration, and dosage form:
Amlodipine besylate (10mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Amlodipine besylate (5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Amlodipine besylate-benazepril hydr (5mg-20mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Atenolol (25mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Atenolol (50mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Atorvastatin calcium (10mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Atorvastatin calcium (20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Atorvastatin calcium (40mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Bimatoprost (0.03%/ophthalmic/solution);
Most common 30-day supply: 5.
Active ingredient, strength, route of administration, and dosage form:
Celecoxib (200mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Clonazepam (0.5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Clonazepam (1mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Clopidogrel hydrogen sulfate (75mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Conjugated estrogens (0.625mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Desloratadine (5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Digoxin (0.125mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Digoxin (0.25mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Diltiazem hydrochloride (240mg/oral/capsule (ER);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Enalapril maleate (20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Escitalopram oxalate (10mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Escitalopram oxalate (20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Esomeprazole magnesium (40mg/oral/capsule (DR));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Ezetimibe (10mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Ezetimibe-simvastatin (10mg-20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Ezetimibe-simvastatin (10mg-40mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Fenofibrate (145mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Fexofenadine hydrochloride (180mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Fluoxetine hydrochloride (20mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Fluticasone propionate (0.05mg/actua/nasal/spray);
Most common 30-day supply: 16.
Active ingredient, strength, route of administration, and dosage form:
Fluticasone propionate-salmeterol x (0.25mg-0.05m/inhalation/disk);
Most common 30-day supply: 60.
Active ingredient, strength, route of administration, and dosage form:
Furosemide (20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Furosemide (40mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Gabapentin (300mg/oral/capsule);
Most common 30-day supply: 90.
Active ingredient, strength, route of administration, and dosage form:
Glimepiride (4mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Hydrochlorothiazide (12.5mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Hydrochlorothiazide (25mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Hydrochlorothiazide-lisinopril (12.5mg-20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Hydrochlorothiazide-losartan potass (25mg-100mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Hydrochlorothiazide-triamterene (25mg-37.5mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Hydrochlorothiazide-triamterene (25mg-37.5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Hydrochlorothiazide-valsartan (12.5mg-160mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Insulin aspart (100u/1ml/subcutaneous/solution);
Most common 30-day supply: 15.
Active ingredient, strength, route of administration, and dosage form:
Insulin human glargine (100u/1ml/subcutaneous/solution);
Most common 30-day supply: 10.
Active ingredient, strength, route of administration, and dosage form:
Lansoprazole (30mg/oral/capsule (DR));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Latanoprost (0.005%/ophthalmic/solution);
Most common 30-day supply: 2.
Active ingredient, strength, route of administration, and dosage form:
Levothyroxine sodium (0.025mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Levothyroxine sodium (0.05mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Levothyroxine sodium (0.075mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Levothyroxine sodium (0.088mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Levothyroxine sodium (0.125mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Levothyroxine sodium (0.15mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Levothyroxine sodium (0.1mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Lisinopril (10mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Lisinopril (20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Lisinopril (40mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Lisinopril (5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Lorazepam (1mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Losartan potassium (50mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Meloxicam (7.5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Metformin hydrochloride (1000mg/oral/tablet);
Most common 30-day supply: 60.
Active ingredient, strength, route of administration, and dosage form:
Metformin hydrochloride (500mg/oral/tablet (ER));
Most common 30-day supply: 60.
Active ingredient, strength, route of administration, and dosage form:
Metformin hydrochloride (500mg/oral/tablet);
Most common 30-day supply: 60.
Active ingredient, strength, route of administration, and dosage form:
Metoprolol succinate (100mg/oral/tablet (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Metoprolol succinate (25mg/oral/tablet (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Metoprolol succinate (50mg/oral/tablet (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Metoprolol tartrate (50mg/oral/tablet);
Most common 30-day supply: 60.
Active ingredient, strength, route of administration, and dosage form:
Mometasone furoate (0.05mg/actua/nasal/spray);
Most common 30-day supply: 17.
Active ingredient, strength, route of administration, and dosage form:
Montelukast sodium (10mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Niacin (500mg/oral/tablet (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Pantoprazole sodium (40mg/oral/tablet, ente);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Paroxetine hydrochloride (20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Potassium chloride (10meq/oral/tablet (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Potassium chloride (20meq/oral/tablet (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Pravastatin sodium (40mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Prednisone (5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Rabeprazole sodium (20mg/oral/tablet, ente);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Raloxifene hydrochloride (60mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Ramipril (10mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Ramipril (5mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Ranitidine hydrochloride (150mg/oral/tablet);
Most common 30-day supply: 60.
Active ingredient, strength, route of administration, and dosage form:
Risedronate sodium (35mg/oral/tablet);
Most common 30-day supply: 4.
Active ingredient, strength, route of administration, and dosage form:
Rosiglitazone maleate (4mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Rosuvastatin calcium (10mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Sertraline hydrochloride (100mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Sertraline hydrochloride (50mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Simvastatin (20mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Simvastatin (40mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Spironolactone (25mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Tamsulosin hydrochloride (0.4mg/oral/capsule);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Tolterodine tartrate (4mg/oral/capsule (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Trazodone hydrochloride (50mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Valsartan (160mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Valsartan (80mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Venlafaxine hydrochloride (75mg/oral/capsule (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Verapamil hydrochloride (240mg/oral/tablet (ER));
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Warfarin sodium (5mg/oral/tablet);
Most common 30-day supply: 30.
Active ingredient, strength, route of administration, and dosage form:
Zolpidem tartrate (10mg/oral/tablet);
Most common 30-day supply: 30.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program and national drug code data from Red
Book.
[End of table]
[End of Enclosure II]
Enclosure III: Changes in Drug Price Indexes, 2006 through the First
Quarter of 2010:
Figure 1: Annual Change in the Usual and Customary (U&C) Price Index
for a Basket of 100 Commonly Used Prescription Drugs and the Medical
CPI, 2006 through the First Quarter of 2010:
[Refer to PDF for image: vertical bar graph]
Calendar year: 2006, Q1 - 2007, Q1;
U&C: 5.4%;
Medical CPI: 4.2%.
Calendar year: 2007, Q1 - 2008, Q1;
U&C: 8.1%;
Medical CPI: 4.7%.
Calendar year: 2008, Q1 - 2009, Q1;
U&C: 7.0%;
Medical CPI: 2.8%.
Calendar year: 2009, Q1 - 2010, Q1;
U&C: 5.9%;
Medical CPI: 3.6%.
Calendar year: Average 2006, Q1 - 2010, Q1;
U&C: 6.6%.
Medical CPI: 3.8%[A].
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program, U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program, and
Medical CPI data from the Bureau of Labor Statistics.
[A] The broader CPI-U increased at an average annual rate of 2.2
percent from the first quarter of 2006 through the first quarter of
2010.
[End of figure]
Figure 2: Usual and Customary (U&C) Price Index for a Basket of 100
Commonly Used Prescription Drugs, 2006 through the First Quarter of
2010:
[Refer to PDF for image: line graph]
Date: 2006 Q1;
Index: 100.
Date: 2006 Q2;
Index: 101.4.
Date: 2006 Q3;
Index: 102.5.
Date: 2006 Q4;
Index: 102.8.
Date: 2007 Q1;
Index: 105.4.
Date: 2007 Q2;
Index: 106.1.
Date: 2007 Q3;
Index: 107.8.
Date: 2007 Q4;
Index: 109.4.
Date: 2008 Q1;
Index: 113.9.
Date: 2008 Q2;
Index: 115.5.
Date: 2008 Q3;
Index: 116.7.
Date: 2008 Q4;
Index: 118.2.
Date: 2009 Q1;
Index: 121.8.
Date: 2009 Q2;
Index: 123.8.
Date: 2009 Q3;
Index: 125.5.
Date: 2009 Q4;
Index: 125.3.
Date: 2010 Q1;
Index: 129.1.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program and U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program.
Note: The index value of 129.1 indicates an increase of 29.1 percent
in the average U&C price for the basket of 100 commonly used drugs
during our analysis period.
[End of figure]
Figure 3: Annual Change in the Usual and Customary (U&C) Price Index
for a Basket of Commonly Used Brand-name Drugs (55) and Generic Drugs
(45), 2006 through the First Quarter of 2010:
[Refer to PDF for image: vertical bar graph]
Date: 2006 Q1 - 2007 Q1;
Brand-name: 8.1%;
Generic: -6.9%.
Date: 2007 Q1 - 2008 Q1;
Brand-name: 9.6%;
Generic: -0.1%.
Date: 2008 Q1 - 2009 Q1;
Brand-name: 8.5%;
Generic: -1.7%.
Date: 2009 Q1 - 2010 Q1;
Brand-name: 7.1%;
Generic: -1.5%.
Date: Average 2006 Q1 - 2010 Q1;
Brand-name: 8.3%;
Generic: -2.6%.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program and U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program.
Notes: The brand-name drug basket included 35 single-source drugs and
20 drugs that changed from single-source to brand-name multisource
during our analysis period. The generic drug basket included 40
generic drugs and 5 brand-name multisource drugs.
[End of figure]
Figure 4: Usual and Customary (U&C) Price Indexes for a Basket of
Commonly Used Brand-name Drugs (55) and Generic Drugs (45), 2006
through the First Quarter of 2010:
[Refer to PDF for image: multiple line graph]
Date: 2006, Q1;
Brand-name: 100;
Generic: 100.
Date: 2006, Q2;
Brand-name: 101.8;
Generic: 99.6.
Date: 2006, Q3;
Brand-name: 102.2;
Generic: 99.3.
Date: 2006, Q4;
Brand-name: 104.3;
Generic: 95.8.
Date: 2007, Q1;
Brand-name: 108.1;
Generic: 93.1.
Date: 2007, Q2;
Brand-name: 109.1;
Generic: 92.2.
Date: 2007, Q3;
Brand-name: 111.1;
Generic: 92.8.
Date: 2007, Q4;
Brand-name: 113.1;
Generic: 92.8.
Date: 2008, Q1;
Brand-name: 118.5;
Generic: 93.0.
Date: 2008, Q2;
Brand-name: 120.3;
Generic: 94.0.
Date: 2008, Q3;
Brand-name: 121.8;
Generic: 93.7.
Date: 2008, Q4;
Brand-name: 124.0;
Generic: 91.6.
Date: 2009, Q1;
Brand-name: 128.6;
Generic: 91.4.
Date: 2009, Q2;
Brand-name: 131.1;
Generic: 90.9.
Date: 2009, Q3;
Brand-name: 133.0;
Generic: 91.1.
Date: 2009, Q4;
Brand-name: 132.7;
Generic: 91.4.
Date: 20010, Q1;
Brand-name: 137.7;
Generic: 90.1.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program and U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program.
Notes: The brand-name drug basket included 35 single-source drugs and
20 drugs that changed from single-source to brand-name multisource
during our analysis period. The generic drug basket included 40
generic drugs and 5 brand-name multisource drugs.
The index value of 137.7 indicates an increase of 37.7 percent in the
average U&C price for the basket of 55 commonly used brand-name drugs
during our analysis period, and the index value of 90.1 indicates a
decrease of 9.9 percent in the average U&C price for the basket of 45
commonly used generic drugs during our analysis period.
[End of figure]
Figure 5: Annual Change in the Usual and Customary (U&C) Price Index
for a Basket of 100 Commonly Used Prescription Drugs When Shifts in
Consumer Utilization Between Brand-name and Generic Versions of the
Drugs Were Included, 2006 through the First Quarter of 2010:
[Refer to PDF for image: vertical bar graph]
Date: 2006 Q1 - 2007 Q1;
Percentage change: 1.0%.
Date: 2007 Q1 - 2008 Q1;
Percentage change: 1.8%.
Date: 2008 Q1 - 2009 Q1;
Percentage change: 3.4%.
Date: 2009 Q1 - 2010 Q1;
Percentage change: 4.3%.
Date: Average 2006 Q1 - 2010 Q1;
Percentage change: 2.6%.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program and U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program.
[End of figure]
Figure 6: Usual and Customary (U&C) Price Index for a Basket of 100
Commonly Used Prescription Drugs When Shifts in Consumer Utilization
Between Brand-name and Generic Versions of the Drugs Were Included,
2006 through the First Quarter of 2010:
[Refer to PDF for image: line graph]
Date: 2006 Q1;
Index: 100.
Date: 2006 Q2;
Index: 101.0.
Date: 2006 Q3;
Index: 100.3.
Date: 2006 Q4;
Index: 99.9.
Date: 2007 Q1;
Index: 100.0.
Date: 2007 Q2;
Index: 99.8.
Date: 2007 Q3;
Index: 99.8.
Date: 2007 Q4;
Index: 100.4.
Date: 2008 Q1;
Index: 102.8.
Date: 2008 Q2;
Index: 103.3.
Date: 2008 Q3;
Index: 103.5.
Date: 2008 Q4;
Index: 103.9.
Date: 2009 Q1;
Index: 106.3.
Date: 2009 Q2;
Index: 107.3.
Date: 2009 Q3;
Index: 108.9.
Date: 2009 Q4;
Index: 108.5.
Date: 2010 Q1;
Index: 110.8.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program and U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program.
Note: The index value of 110.8 indicates an increase of 10.8 percent
in the average U&C price for a basket of 100 commonly used drugs when
shifts in consumer utilization between brand-name and generic versions
of the drugs were included.
[End of figure]
Figure 7: Annual Change in the Price Indexes Using Usual and Customary
(U&C) and Other Drug Pricing Measures for a Basket of 100 Commonly
Used Prescription Drugs, 2006 through the First Quarter of 2010:
[Refer to PDF for image: multiple vertical bar graph]
Date: 2006 Q1-2007 Q1;
U&C: 5.4%;
AWP: 4.3%;
AMP: 1.9%;
Part D: N/A[A].
Date: 2007 Q1-2008 Q1;
U&C: 8.1%;
AWP: 5.8%;
AMP: 9.5%;
Part D: 6.8%.
Date: 2008 Q1-2009 Q1;
U&C: 7%;
AWP: 6.5%;
AMP: -2.5%;
Part D: 5.3%.
Date: 2009 Q1-2010 Q1;
U&C: 5.9%;
AWP: 7.6%;
AMP: 12.3%;
Part D: 8.4%.
Date: Average 2006 Q1-2010 Q1;
U&C: 6.6%;
AWP: 6%;
AMP: 5.3%;
Part D: 0%.
Date: Average 2007 Q1-2010 Q1;
U&C: 0%;
AWP: 0%;
AMP: 7%;
Part D: 6.8%.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program, U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program, AWP from
Red Book, and AMP and Medicare Part D prices from CMS.
Notes: The AMP price index should be interpreted with caution for
several reasons. First, CMS changed the calculation of AMP in
accordance with the Deficit Reduction Act of 2005 starting on October
1, 2007 (see footnote 21). In addition, we previously reported
significant variations in the monthly AMP data reported to CMS for
many drugs (see GAO, Medicaid Outpatient Prescription Drugs: Second
Quarter 2008 Federal Upper Limits for Reimbursement Compared with
Average Retail Pharmacy Acquisition Costs, GAO-10-118R (Washington,
D.C.: Nov. 30, 2009)). Finally, a 2010 report by the Department of
Health and Human Services Office of Inspector General found
significant manufacturer noncompliance with the requirements for
reporting AMPs to CMS (see Department of Health and Human Services
Office of Inspector General, Drug Manufacturers' Noncompliance with
Average Manufacturer Price Reporting Requirements, OEI-03-09-00060
(Philadelphia, Pa.: September 2010)).
[A] The Part D price index runs from the first quarter of 2007 through
the first quarter of 2010. Of the 100 drugs in our basket, 11 did not
have Part D pricing data for one or more quarters of our analysis
period and thus were removed from the basket when calculating the Part
D price indexes. These 11 drugs represented 8.0 percent of the total
utilization for the basket.
[End of figure]
Figure 8: Price Indexes Using Usual and Customary (U&C) and Other Drug
Pricing Measures for a Basket of 100 Commonly Used Prescription Drugs,
2006 through the First Quarter of 2010:
[Refer to PDF for image: multiple line graph]
Date: 2006 Q1;
U&C: 100;
AWP: 100;
AMP: 100;
Date: 2006 Q2;
U&C: 101.4;
AWP: 100.7;
AMP: 100.8.
Date: 2006 Q3;
U&C: 102.5;
AWP: 101.0;
AMP: 98.0.
Date: 2006 Q4;
U&C: 102.8;
AWP: 101.6;
AMP: 97.6.
Date: 2007 Q1;
U&C: 105.4;
AWP: 104.3;
AMP: 101.8.
Date: 2007 Q2;
U&C: 106.1;
AWP: 105.0;
AMP: 99.5.
Date: 2007 Q3;
U&C: 107.8;
AWP: 106.5;
AMP: 97.2.
Date: 2007 Q4;
U&C: 109.4;
AWP: 107.8;
AMP: 112.2.
Date: 2008 Q1;
U&C: 113.9;
AWP: 110.3;
AMP: 111.5.
Date: 2008 Q2;
U&C: 115.5;
AWP: 111.2;
AMP: 102.3.
Date: 2008 Q3;
U&C: 116.7;
AWP: 112.6;
AMP: 106.8.
Date: 2008 Q4;
U&C: 118.2;
AWP: 114.1;
AMP: 106.8.
Date: 2009 Q1;
U&C: 121.8;
AWP: 117.5;
AMP: 108.7.
Date: 2009 Q2;
U&C: 123.8;
AWP: 119.5;
AMP: 113.2.
Date: 2009 Q3;
U&C: 125.5;
AWP: 120.8;
AMP: 117.3.
Date: 2009 Q4;
U&C: 125.3;
AWP: 121.7;
AMP: 118.7.
Date: 2010 Q1;
U&C: 129.1;
AWP: 126.4;
AMP: 122.1.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program, U&C prices from Pennsylvania‘s
Pharmaceutical Assistance Contract for the Elderly program, AWP from
Red Book, and AMP from CMS.
Note: The AMP price index should be interpreted with caution for
several reasons. First, CMS changed the calculation of AMP in
accordance with the Deficit Reduction Act of 2005 starting on October
1, 2007 (see footnote 21). In addition, we previously reported
significant variations in the monthly AMP data reported to CMS for
many drugs (see GAO, Medicaid Outpatient Prescription Drugs: Second
Quarter 2008 Federal Upper Limits for Reimbursement Compared with
Average Retail Pharmacy Acquisition Costs, GAO-10-118R (Washington,
D.C.: Nov. 30, 2009)). Finally, a 2010 report by the HHS OIG found
significant manufacturer noncompliance with the requirements for
reporting AMPs to CMS (see Department of Health and Human Services
Office of Inspector General, Drug Manufacturers' Noncompliance with
Average Manufacturer Price Reporting Requirements, OEI-03-09-00060
(Philadelphia, Pa.: September 2010)).
The Part D price index is excluded because Part D data were not
available for 2006 or for the fourth quarter of each year.
The index value of 129.1 indicates an increase of 29.1 percent in the
average U&C price for the basket of 100 commonly used drugs during the
period. The index value of 126.4 indicates an increase of 26.4 percent
in the average AWP for the basket of 100 commonly used drugs during
the period. The index value of 122.1 indicates an increase of 22.1
percent in the average AMP for the basket of 100 commonly used drugs
during our analysis period.
[End of figure]
[End of Enclosure III]
Enclosure IV: Percentage Change in Usual and Customary (U&C) Price for
55 Commonly Used Brand-Name Drugs, 2006 through the First Quarter of
2010:
Drug name, strength, route of administration, and dosage form: Flomax
(0.4mg/oral/capsule);
Percentage change in U&C price:
2006 Q1-2007 Q1: 9.8;
2007 Q1-2008 Q1: 15.1;
2008 Q1-2009 Q1: 20.7;
2009 Q1-2010 Q1: 24.9;
Average 2006 Q1-2010 Q1: 17.6.
Drug name, strength, route of administration, and dosage form: Ambien
(10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 37.5;
2007 Q1-2008 Q1: 4.2;
2008 Q1-2009 Q1: 11.6;
2009 Q1-2010 Q1: 7.7;
Average 2006 Q1-2010 Q1: 15.3.
Drug name, strength, route of administration, and dosage form:
Clarinex (5mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 20.0;
2007 Q1-2008 Q1: 16.3;
2008 Q1-2009 Q1: 8.9;
2009 Q1-2010 Q1: 4.6;
Average 2006 Q1-2010 Q1: 12.5.
Drug name, strength, route of administration, and dosage form:
Premarin (0.625mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 12.0;
2007 Q1-2008 Q1: 13.2;
2008 Q1-2009 Q1: 11.6;
2009 Q1-2010 Q1: 11.8;
Average 2006 Q1-2010 Q1: 12.2.
Drug name, strength, route of administration, and dosage form: Altace
(5mg/oral/capsule);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.1;
2007 Q1-2008 Q1: 16.7;
2008 Q1-2009 Q1: 13.2;
2009 Q1-2010 Q1: 10.4;
Average 2006 Q1-2010 Q1: 11.6.
Drug name, strength, route of administration, and dosage form: Altace
(10mg/oral/capsule);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.9;
2007 Q1-2008 Q1: 13.7;
2008 Q1-2009 Q1: 14.8;
2009 Q1-2010 Q1: 10.4;
Average 2006 Q1-2010 Q1: 11.5.
Drug name, strength, route of administration, and dosage form: Effexor-
XR (75mg/oral/capsule (ER));
Percentage change in U&C price:
2006 Q1-2007 Q1: 7.9;
2007 Q1-2008 Q1: 15.3;
2008 Q1-2009 Q1: 6.5;
2009 Q1-2010 Q1: 15.1;
Average 2006 Q1-2010 Q1: 11.2.
Drug name, strength, route of administration, and dosage form: Lantus
(100u/1ml/subcutaneous/solution);
Percentage change in U&C price:
2006 Q1-2007 Q1: 12.7;
2007 Q1-2008 Q1: 12.4;
2008 Q1-2009 Q1: 13.7;
2009 Q1-2010 Q1: 5.7;
Average 2006 Q1-2010 Q1: 11.1.
Drug name, strength, route of administration, and dosage form: Lotrel
(5mg-20mg/oral/capsule);
Percentage change in U&C price:
2006 Q1-2007 Q1: 9.8;
2007 Q1-2008 Q1: 16.2;
2008 Q1-2009 Q1: 10.2;
2009 Q1-2010 Q1: 8.2;
Average 2006 Q1-2010 Q1: 11.1.
Drug name, strength, route of administration, and dosage form: Effexor-
XR (150mg/oral/capsule (ER));
Percentage change in U&C price:
2006 Q1-2007 Q1: 8.9;
2007 Q1-2008 Q1: 14.1;
2008 Q1-2009 Q1: 5.8;
2009 Q1-2010 Q1: 15.1;
Average 2006 Q1-2010 Q1: 11.0.
Drug name, strength, route of administration, and dosage form: Hyzaar
(25mg-100mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 7.3;
2007 Q1-2008 Q1: 11.2;
2008 Q1-2009 Q1: 16.6;
2009 Q1-2010 Q1: 8.5;
Average 2006 Q1-2010 Q1: 10.9.
Drug name, strength, route of administration, and dosage form: Crestor
(10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 5.8;
2007 Q1-2008 Q1: 10.7;
2008 Q1-2009 Q1: 14.8;
2009 Q1-2010 Q1: 12.1;
Average 2006 Q1-2010 Q1: 10.9.
Drug name, strength, route of administration, and dosage form: Aciphex
(20mg/oral/tablet, ente);
Percentage change in U&C price:
2006 Q1-2007 Q1: 7.9;
2007 Q1-2008 Q1: 7.6;
2008 Q1-2009 Q1: 14.0;
2009 Q1-2010 Q1: 13.1;
Average 2006 Q1-2010 Q1: 10.7.
Drug name, strength, route of administration, and dosage form: Xalatan
(0.005%/ophthalmic/solution);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.5;
2007 Q1-2008 Q1: 12.4;
2008 Q1-2009 Q1: 14.6;
2009 Q1-2010 Q1: 7.8;
Average 2006 Q1-2010 Q1: 10.3.
Drug name, strength, route of administration, and dosage form: Aricept
(10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 7.6;
2007 Q1-2008 Q1: 10.0;
2008 Q1-2009 Q1: 9.6;
2009 Q1-2010 Q1: 13.0;
Average 2006 Q1-2010 Q1: 10.1.
Drug name, strength, route of administration, and dosage form: Actonel
(35mg/oral/tablet);
2006 Q1-2007 Q1: 8.7;
2007 Q1-2008 Q1: 10.3;
2008 Q1-2009 Q1: 11.8;
2009 Q1-2010 Q1: 6.9;
Average 2006 Q1-2010 Q1: 9.4.
Drug name, strength, route of administration, and dosage form: Diovan
(160mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 7.5;
2007 Q1-2008 Q1: 10.5;
2008 Q1-2009 Q1: 10.6;
2009 Q1-2010 Q1: 8.0;
Average 2006 Q1-2010 Q1: 9.2.
Drug name, strength, route of administration, and dosage form: Zoloft
(50mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 8.2;
2007 Q1-2008 Q1: 19.9;
2008 Q1-2009 Q1: 8.0;
2009 Q1-2010 Q1: -0.2;
Average 2006 Q1-2010 Q1: 9.0.
Drug name, strength, route of administration, and dosage form: Avandia
(4mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 11.5;
2007 Q1-2008 Q1: 3.1;
2008 Q1-2009 Q1: 7.6;
2009 Q1-2010 Q1: 13.4;
Average 2006 Q1-2010 Q1: 8.9.
Drug name, strength, route of administration, and dosage form: Diovan
(80mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.6;
2007 Q1-2008 Q1: 10.6;
2008 Q1-2009 Q1: 8.8;
2009 Q1-2010 Q1: 9.5;
Average 2006 Q1-2010 Q1: 8.9.
Drug name, strength, route of administration, and dosage form: Vytorin
(10mg-40mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 11.3;
2007 Q1-2008 Q1: 7.8;
2008 Q1-2009 Q1: 7.5;
2009 Q1-2010 Q1: 8.5;
Average 2006 Q1-2010 Q1: 8.8.
Drug name, strength, route of administration, and dosage form: Diovan
HCT (12.5mg-160mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.6;
2007 Q1-2008 Q1: 8.6;
2008 Q1-2009 Q1: 11.8;
2009 Q1-2010 Q1: 7.6;
Average 2006 Q1-2010 Q1: 8.7.
Drug name, strength, route of administration, and dosage form: Zetia
(10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.7;
2007 Q1-2008 Q1: 13.5;
2008 Q1-2009 Q1: 9.0;
2009 Q1-2010 Q1: 5.2;
Average 2006 Q1-2010 Q1: 8.6.
Drug name, strength, route of administration, and dosage form: Vytorin
(10mg-20mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 12.4;
2007 Q1-2008 Q1: 6.2;
2008 Q1-2009 Q1: 7.1;
2009 Q1-2010 Q1: 8.7;
Average 2006 Q1-2010 Q1: 8.6.
Drug name, strength, route of administration, and dosage form: Norvasc
(5mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 8.5;
2007 Q1-2008 Q1: 15.6;
2008 Q1-2009 Q1: 6.7;
2009 Q1-2010 Q1: 3.4;
Average 2006 Q1-2010 Q1: 8.6.
Drug name, strength, route of administration, and dosage form: Mobic
(7.5mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 5.3;
2007 Q1-2008 Q1: 9.6;
2008 Q1-2009 Q1: 14.2;
2009 Q1-2010 Q1: 4.8;
Average 2006 Q1-2010 Q1: 8.5.
Drug name, strength, route of administration, and dosage form: Norvasc
(10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 8.2;
2007 Q1-2008 Q1: 15.1;
2008 Q1-2009 Q1: 7.2;
2009 Q1-2010 Q1: 3.0;
Average 2006 Q1-2010 Q1: 8.4.
Drug name, strength, route of administration, and dosage form: Advair
Diskus 250/50 (0.25mg-0.05m/inhalation/disk);
Percentage change in U&C price:
2006 Q1-2007 Q1: 12.6;
2007 Q1-2008 Q1: 7.3;
2008 Q1-2009 Q1: 6.5;
2009 Q1-2010 Q1: 6.7;
Average 2006 Q1-2010 Q1: 8.3.
Drug name, strength, route of administration, and dosage form: Toprol
XL (25mg/oral/tablet (ER));
Percentage change in U&C price:
2006 Q1-2007 Q1: 1.9;
2007 Q1-2008 Q1: 13.1;
2008 Q1-2009 Q1: 13.1;
2009 Q1-2010 Q1: 3.9;
Average 2006 Q1-2010 Q1: 8.0.
Drug name, strength, route of administration, and dosage form: Cozaar
(50mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.3;
2007 Q1-2008 Q1: 6.2;
2008 Q1-2009 Q1: 10.9;
2009 Q1-2010 Q1: 8.6;
Average 2006 Q1-2010 Q1: 8.0.
Drug name, strength, route of administration, and dosage form:
Celebrex (200mg/oral/capsule);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.3;
2007 Q1-2008 Q1: 16.9;
2008 Q1-2009 Q1: 5.4;
2009 Q1-2010 Q1: 3.1;
Average 2006 Q1-2010 Q1: 7.9.
Drug name, strength, route of administration, and dosage form:
Protonix (40mg/oral/tablet, ente);
Percentage change in U&C price:
2006 Q1-2007 Q1: 8.5;
2007 Q1-2008 Q1: 5.0;
2008 Q1-2009 Q1: 6.5;
2009 Q1-2010 Q1: 11.4;
Average 2006 Q1-2010 Q1: 7.9.
Drug name, strength, route of administration, and dosage form: Toprol
XL (50mg/oral/tablet (ER));
Percentage change in U&C price:
2006 Q1-2007 Q1: 5.4;
2007 Q1-2008 Q1: 7.8;
2008 Q1-2009 Q1: 11.9;
2009 Q1-2010 Q1: 6.2;
Average 2006 Q1-2010 Q1: 7.8.
Drug name, strength, route of administration, and dosage form: Lexapro
(20mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 9.4;
2007 Q1-2008 Q1: 8.9;
2008 Q1-2009 Q1: 7.8;
2009 Q1-2010 Q1: 5.2;
Average 2006 Q1-2010 Q1: 7.8.
Drug name, strength, route of administration, and dosage form: Lexapro
(10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 9.2;
2007 Q1-2008 Q1: 8.6;
2008 Q1-2009 Q1: 8.7;
2009 Q1-2010 Q1: 4.7;
Average 2006 Q1-2010 Q1: 7.8.
Drug name, strength, route of administration, and dosage form: Detrol
LA (4mg/oral/capsule (ER));
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.2;
2007 Q1-2008 Q1: 14.5;
2008 Q1-2009 Q1: 7.0;
2009 Q1-2010 Q1: 3.4;
Average 2006 Q1-2010 Q1: 7.8.
Drug name, strength, route of administration, and dosage form: Nasonex
(0.05mg/actua/nasal/spray);
Percentage change in U&C price:
2006 Q1-2007 Q1: 8.9;
2007 Q1-2008 Q1: 5.5;
2008 Q1-2009 Q1: 10.8;
2009 Q1-2010 Q1: 5.9;
Average 2006 Q1-2010 Q1: 7.8.
Drug name, strength, route of administration, and dosage form: Toprol
XL (100mg/oral/tablet (ER));
Percentage change in U&C price:
2006 Q1-2007 Q1: 5.7;
2007 Q1-2008 Q1: 7.8;
2008 Q1-2009 Q1: 11.8;
2009 Q1-2010 Q1: 5.7;
Average 2006 Q1-2010 Q1: 7.8.
Drug name, strength, route of administration, and dosage form:
Singulair (10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.6;
2007 Q1-2008 Q1: 7.8;
2008 Q1-2009 Q1: 9.0;
2009 Q1-2010 Q1: 7.2;
Average 2006 Q1-2010 Q1: 7.7.
Drug name, strength, route of administration, and dosage form: Zoloft
(100mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 5.8;
2007 Q1-2008 Q1: 18.8;
2008 Q1-2009 Q1: 10.9;
2009 Q1-2010 Q1: -5.5;
Average 2006 Q1-2010 Q1: 7.5.
Drug name, strength, route of administration, and dosage form: Nexium
(40mg/oral/capsule (DR));
Percentage change in U&C price:
2006 Q1-2007 Q1: 5.7;
2007 Q1-2008 Q1: 9.5;
2008 Q1-2009 Q1: 7.9;
2009 Q1-2010 Q1: 6.3;
Average 2006 Q1-2010 Q1: 7.4.
Drug name, strength, route of administration, and dosage form: Plavix
(75mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 2.9;
2007 Q1-2008 Q1: 5.2;
2008 Q1-2009 Q1: 7.9;
2009 Q1-2010 Q1: 12.3;
Average 2006 Q1-2010 Q1: 7.1.
Drug name, strength, route of administration, and dosage form: Niaspan
(500mg/oral/tablet (ER));
Percentage change in U&C price:
2006 Q1-2007 Q1: 10.1;
2007 Q1-2008 Q1: 6.0;
2008 Q1-2009 Q1: 6.6;
2009 Q1-2010 Q1: 4.7;
Average 2006 Q1-2010 Q1: 6.9.
Drug name, strength, route of administration, and dosage form: Lumigan
(0.03%/ophthalmic/solution);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.7;
2007 Q1-2008 Q1: 9.0;
2008 Q1-2009 Q1: 7.6;
2009 Q1-2010 Q1: 2.4;
Average 2006 Q1-2010 Q1: 6.4.
Drug name, strength, route of administration, and dosage form: Evista
(60mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.3;
2007 Q1-2008 Q1: 7.7;
2008 Q1-2009 Q1: 4.4;
2009 Q1-2010 Q1: 7.2;
Average 2006 Q1-2010 Q1: 6.4.
Drug name, strength, route of administration, and dosage form:
Pravachol (40mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 2.1;
2007 Q1-2008 Q1: 17.7;
2008 Q1-2009 Q1: 5.3;
2009 Q1-2010 Q1: 0.3;
Average 2006 Q1-2010 Q1: 6.4.
Drug name, strength, route of administration, and dosage form: Tricor
(145mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 5.1;
2007 Q1-2008 Q1: 5.6;
2008 Q1-2009 Q1: 9.0;
2009 Q1-2010 Q1: 5.6;
Average 2006 Q1-2010 Q1: 6.3.
Drug name, strength, route of administration, and dosage form:
Prevacid (30mg/oral/capsule (DR));
Percentage change in U&C price:
2006 Q1-2007 Q1: 8.2;
2007 Q1-2008 Q1: 9.0;
2008 Q1-2009 Q1: 4.1;
2009 Q1-2010 Q1: 3.5;
Average 2006 Q1-2010 Q1: 6.2.
Drug name, strength, route of administration, and dosage form: Lipitor
(10mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.9;
2007 Q1-2008 Q1: 5.9;
2008 Q1-2009 Q1: 6.7;
2009 Q1-2010 Q1: 5.0;
Average 2006 Q1-2010 Q1: 6.1.
Drug name, strength, route of administration, and dosage form: Lipitor
(40mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.8;
2007 Q1-2008 Q1: 5.9;
2008 Q1-2009 Q1: 6.5;
2009 Q1-2010 Q1: 4.4;
Average 2006 Q1-2010 Q1: 5.9.
Drug name, strength, route of administration, and dosage form: Lipitor
(20mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.5;
2007 Q1-2008 Q1: 6.5;
2008 Q1-2009 Q1: 6.0;
2009 Q1-2010 Q1: 4.2;
Average 2006 Q1-2010 Q1: 5.8.
Drug name, strength, route of administration, and dosage form: Flonase
(0.05mg/actua/nasal/spray);
Percentage change in U&C price:
2006 Q1-2007 Q1: 10.2;
2007 Q1-2008 Q1: 5.4;
2008 Q1-2009 Q1: 1.6;
2009 Q1-2010 Q1: 3.2;
Average 2006 Q1-2010 Q1: 5.1.
Drug name, strength, route of administration, and dosage form: Fosamax
(70mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 6.5;
2007 Q1-2008 Q1: 6.6;
2008 Q1-2009 Q1: 2.2;
2009 Q1-2010 Q1: 3.1;
Average 2006 Q1-2010 Q1: 4.6.
Drug name, strength, route of administration, and dosage form: Zocor
(20mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 2.5;
2007 Q1-2008 Q1: 4.3;
2008 Q1-2009 Q1: 3.7;
2009 Q1-2010 Q1: 5.6;
Average 2006 Q1-2010 Q1: 4.0.
Drug name, strength, route of administration, and dosage form: Zocor
(40mg/oral/tablet);
Percentage change in U&C price:
2006 Q1-2007 Q1: 3.7;
2007 Q1-2008 Q1: 1.0;
2008 Q1-2009 Q1: -1.4;
2009 Q1-2010 Q1: 5.5;
Average 2006 Q1-2010 Q1: 2.2.
Source: GAO analysis of utilization data from the Blue Cross Blue
Shield Federal Employee Program and U&C prices from Pennsylvania's
Pharmaceutical Assistance Contract for the Elderly program.
[End of table]
[End of Enclosure IV]
Enclosure V: GAO Contact and Staff Acknowledgments:
GAO Contact:
John E. Dicken, (202) 512-7114 or dickenj@gao.gov:
Staff Acknowledgments:
In addition to the contact named above, key contributors to this
report were Randy DiRosa, Assistant Director; Krister Friday; Karen
Howard; Julian Klazkin; Dan Ries; and Carla Willis.
[End of Enclosure V]
Footnotes:
[1] NHE Web Tables, National Health Expenditures data for 2009 (the
most recent available at the time of our analysis), [hyperlink,
http://www.cms.gov/nationalhealthexpenddata/02_nationalhealthaccountshis
torical.asp] (accessed Jan. 20, 2011).
[2] The U&C price is the price an individual without prescription drug
coverage would pay at a retail pharmacy.
[3] See GAO, Prescription Drugs: Trends in Usual and Customary Prices
for Drugs Frequently Used by Medicare and Non-Medicare Health
Insurance Enrollees, [hyperlink,
http://www.gao.gov/products/GAO-07-1201R] (Washington, D.C.: Sept. 7,
2007). For additional GAO reports on drug pricing, see Prescription
Drugs: Trends in Usual and Customary Prices for Drugs Frequently Used
by Medicare and Non-Medicare Enrollees, [hyperlink,
http://www.gao.gov/products/GAO-05-104R] (Washington, D.C.: Oct. 6,
2004) and Prescription Drugs: Price Trends for Frequently Used Brand
and Generic Drugs from 2000 through 2004, [hyperlink,
http://www.gao.gov/products/GAO-05-779] (Washington, D.C.: Aug. 15,
2005).
[4] See Duff Wilson, "Drug Makers Raise Prices in Face of Health Care
Reform," The New York Times, Nov. 16, 2009 and Emily Brandon, "Drug
Prices Outpace Inflation," US News, Nov.17, 2009.
[5] Pub. L. No. 111-148, 124 Stat. 119 (2010).
[6] In selecting our four baskets of drugs, we excluded drugs with
fewer than 10 claims in Pennsylvania's Pharmaceutical Assistance
Contract for the Elderly program and drugs with zero BCBS FEP claims
in one or more of the quarters to assure the drugs were commonly used
and continuously marketed throughout our analysis period.
[7] For example, all claims for "Zocor/10mg/oral/tablet" were combined
as one drug. Using this approach, the brand-name and generic versions
of a drug were aggregated separately. For example, "Zocor/10mg/oral/
tablet" and "simvastatin/10mg/oral/tablet" would be considered
different drugs for purposes of our first basket because they have
different names, even though they are the brand-name and generic
versions of drugs containing the same active ingredient.
[8] Five of these drugs were brand-name multisource drugs that had
generic equivalents available from multiple manufacturers and were
marketed under their brand name during our entire analysis period.
These 5 brand-name multisource drugs experienced price changes most
similar to the 40 generic drugs in our sample and were therefore
included in our third basket of generic drugs.
[9] For example, all claims with "simvastatin" as the active
ingredient and "10mg/oral/tablet" as the strength, route, and dosage
form were combined as one drug. Using this approach, the brand-name
and generic versions of a drug were combined as one drug. For example,
"Zocor/10mg/oral/tablet" and "simvastatin/10mg/oral/tablet" would be
considered the same drug for purposes of this fourth basket because
they are the brand-name and generic versions of the same drug, even
though they have different names.
[10] We compared our price indexes to both the medical CPI and the CPI-
U because the CPI-U, which describes price changes across a wide range
of consumer goods and services, may not appropriately reflect price
changes that occur within the health care industry--particularly
during the recent economic downturn--and therefore may not provide
appropriate context for increases in drug prices. Prescription drugs
account for about 18.8 percent of the medical CPI and about 1.2
percent of the CPI-U.
[11] The Part D price index runs from the first quarter of 2007
through the first quarter of 2010. We used the first quarter of 2007
as the baseline when calculating the Part D price index because
reliable Part D data for 2006 were not available; fourth quarter data
for each year were also not available. In addition, 11 of the 100
drugs in our first basket did not have Part D pricing data for one or
more quarters of our analysis period and therefore were removed from
the basket when calculating the Part D price indexes. These 11 drugs
represented 8.0 percent of the total utilization of the basket.
[12] Red Book is a drug pricing compendium with information about
prices and other characteristics of drug products, published by
Thomson Reuters.
[13] The broader CPI-U increased at an average annual rate of 2.2
percent from 2006 through the first quarter of 2010.
[14] For all drugs selected for our baskets, we obtained corresponding
11-digit national drug codes (NDCs) from Red Book. NDCs are three-
segment numbers that are the universal product identifiers for drugs
for human use. The Food and Drug Administration assigns the first
segment of the NDC, which identifies the firm that manufactures,
repackages, or distributes a drug. The second segment identifies a
specific strength, dosage form, and formulation for a particular firm.
The third segment identifies the package size and type. A drug can
have multiple NDCs associated with it. For example, a drug made by one
manufacturer, in one strength or dosage form, but in three package
sizes would have three NDCs.
[15] In selecting our four baskets, we excluded any drug that had zero
BCBS FEP claims in one or more quarters of our analysis period--first
quarter 2006 through first quarter 2010--and any drugs that had fewer
than 10 claims in Pennsylvania's Pharmaceutical Assistance Contract
for the Elderly program in one or more of the quarters to assure the
drugs were commonly used and continuously marketed throughout our
analysis period.
[16] Red Book is a drug pricing compendium with information about
prices and other characteristics of drug products, published by
Thomson Reuters.
[17] Single-source drugs include those brand-name drugs that have no
generic equivalent on the market and are generally available from only
one manufacturer. Brand-name multisource drugs include those brand-
name drugs that have generic equivalents available from multiple
manufacturers and are marketed under their brand names.
[18] Generic drugs include multisource drugs that have the same active
ingredient as their branded counterparts and are generally marketed by
multiple manufacturers under a nonproprietary name.
[19] We removed PACE claims for which the U&C drug price fell outside
two standard deviations from the mean price per 30-day supply for each
quarter.
[20] We compared our price indexes to both the medical CPI and the CPI-
U because the CPI-U, which describes price changes across a wide range
of consumer goods and services, may not appropriately reflect price
changes that occur within the health care industry--particularly
during the recent economic downturn--and therefore may not provide
appropriate context for increases in drug prices. Prescription drugs
are responsible for about 18.8 percent of the medical CPI and about
1.2 percent of the CPI-U.
[21] The Medicare Prescription Drug Plan Finder data were provided by
a CMS contractor as average, utilization-weighted negotiated prices
across all plans for each drug under Medicare Part D as reported to
CMS by Part D plan sponsors. The data did not include non-Part D
plans; national Program of All-Inclusive Care for the Elderly plans;
employer sponsored plans; demonstration plans; or plans whose pharmacy
data were suppressed in the Public Use File reporting period because
of plan request, data inaccuracy, or other issues identified by CMS.
The contractor considered the 2006 data unreliable and was not able to
provide pricing data for the fourth quarter of any year in our
analysis period because of the way those data are reported. Medicare
Part D Plan Finder data are based on proxy NDCs and do not include
data for all NDCs. A unique proxy NDC is assigned by CMS to each drug
at the brand name, generic name, dosage form, and strength level. CMS
recommends that this same proxy NDC be used for all therapeutically
equivalent versions of a drug. Therefore, we applied the prices for
proxy NDCs to all NDCs associated with the same name, strength, and
dosage form when calculating the Part D price indexes.
[22] The AMP definition was amended again with the enactment of PPACA.
We did not factor this change into our analysis because the analysis
included data only through the end of the first quarter of 2010, prior
to the effective date of the pertinent changes made by PPACA. See Pub.
L. No. 111-148, § 2503(a)(2), d, 124 Stat. 119, 310-12 (2010), as
amended by the Health Care and Education Reconciliation Act of 2010
(HCERA), Pub. L. No. 111-152, § 1101(c), 124 Stat. 1029, 1039 and Pub.
L. No. 111-226, § 202, 124 Stat. 2389, 2394 (2010); Pub. L. No. 109-
171, § 6001(c), 120 Stat. 4, 54-6 (2006); 72 Fed. Reg. 39142 (July 17,
2007).
[23] See GAO, Medicaid Outpatient Prescription Drugs: Second Quarter
2008 Federal Upper Limits for Reimbursement Compared with Average
Retail Pharmacy Acquisition Costs, [hyperlink,
http://www.gao.gov/products/GAO-10-118R] (Washington, D.C.: Nov. 30,
2009).
[24] See Department of Health and Human Services Office of Inspector
General, Drug Manufacturers' Noncompliance with Average Manufacturer
Price Reporting Requirements, OEI-03-09-00060 (Philadelphia, Pa.:
September 2010).
[End of section]
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