The fragility of bisphosphonate formulary policy
Author(s): ,
Shawn Bugden
BScPharm MSc PharmD
Kevin J Friesen
Jamie Falk
Olasumbo Ojo
BSc (Pharm) MSc (candidate)
Canadian Pharmacists Conference ePoster Library. Lane C. 06/04/17; 174265; 63
Cole Lane
Cole Lane
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To evaluate the impact of the change from pharmacist managed (Part 2 Exception Drug Status EDS) to physician controlled (Part 3 EDS) restricted access to bisphosphonates.

Utilization of oral bisphosphonates was assessed using data from the Manitoba Drug Program Information Network (DPIN) from 1998-2014. Incident use, overall utilization and medication costs were assessed before and after EDS coverage policy changes. Administrative data was used to assess the proportion of new users meeting one of three criteria (osteoporotic fractures, bone mineral density t-scores 2.5, or x-ray diagnosis of osteoporosis) using linked data from the Manitoba Population Research Data Repository.

Alendronate and risedronate were the most common oral bisphosphonates used, comprising 68% and 20% of the new users (n = 61,260), respectively. Since restricting bisphosphonate coverage, the proportion of users meeting coverage criteria increased modestly from 29.5% [95% CI: 27.0%-32.0%] to 34.3% [95% CI: 31.6%-37.0%] (ANOVA F2, 12; P =0.034). During the pharmacist-managed coverage period (1998 to 2004) use increased with a mean number of incident users of 3,829/year [95% CI: 3,311-4,347] over that period. Since the implementation of a physician controlled system the number of incident users has fallen dramatically by 43% to 2,199/year [95% CI: 1,780-2,618] (P<0.0001). This decline in use occurred despite generic price reduction of more than 70% over the study period due to the release of generic equivalents.

Physician-managed formulary restriction to oral bisphosphonates appears to have been a substantial regressive barrier and has dramatically reduced bisphosphonate utilization. In light of lower generic cost and the modest difference in the proportion of users meeting EDS criteria, consideration should be given to returning to a pharmacy-managed approach that eliminates barriers but encourages appropriate utilization.

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