Potential savings from an evidence-based consumer-oriented public education campaign on prescription drugs.

Prescription drug expenditures have grown as a share of total health expenditures from 8.1 percent in 1997 to 12.1 percent in 2005, with per person spending doubling over this same period (Catlin et al. 2007; Zuvekas and Cohen 2007). Third-party payers have responded to increased drug spending by implementing tiered formularies that have increased consumer cost-sharing for many drugs (Gibson, Ozminkowski, and Geotzel 2005). Tiered formularies are also highly prevalent among Medicare Part D drug plans (Medicare Payment Advisory Commission 2006). Moreover, a substantial number of Medicare beneficiaries experience periods 4out coverage due to the “donut hole” (Stuart et al. 2005a; Stuart, Simoni-Wastila, and Chancey 2005b; Gellad et al. 2006). When faced with high out-of-pocket costs for prescription drugs, many patients, particularly the elderly and disabled, skip or take smaller doses of their medications, or stop filling prescriptions (Safran et al. 2002; Piette, Heisler, and Wagner 2004; Safran et al. 2005; Soumerai et al. 2006). As many as 29 percent of disabled Medicare beneficiaries and 13 percent of elderly Medicare beneficiaries have reported such cost-related underuse, and the rates are even higher among individuals with low incomes and/or multiple chronic conditions (Safran et al. 2005; Soumerai et al. 2006). Nonadherence to medication therapy has been shown to lead to negative health outcomes, and greater use of emergency department and inpatient hospital services (Adams, Soumerai, and Ross-Degnan 2001; Artz, Hadsall, and Schondelmeyer 2002; Safran et al. 2002; Maio et al. 2005; Hsu et al. 2006). Cost-related underuse may be avoided through more cost-effective prescribing practices including greater use of generic and/or therapeutic substitutes (Shrank et al. 2006). For example, one study reported that one-third of the most expensive medications used by Medicare beneficiaries who exceeded their pharmacy benefits in managed care plans had generic equivalents or a lower cost therapeutic alternative (Tseng et al. 2003). However, consumers and physicians often lack accurate information on the prices and quality of prescription drugs required to make more cost-effective choices (Reichert, Simon, and Halm 2000). In 2004, Consumers Union, a not-for-profit organization and publisher of Consumer Reports, launched the Consumer Reports Best Buy Drugs (CRBBD) program, a national effort to make information on the value of prescription drugs more transparent for consumers (Voelker 2005). The CRBBD program combines information on comparative effectiveness from systematic, evidence-based reviews with information on drug prices to identify “best buy drugs” in several commonly used classes. The program's goal is to reduce consumers’ out-of-pocket expenditures and improve access to medicines. In this paper, we estimate the dollars that would be saved, from a societal perspective, if the CRBBD made up a greater share of sales in four classes of drugs to prevent and treat cardiovascular disease. While several studies have estimated potential savings associated with greater generic substitution (Fischer and Avorn 2004b; Haas et al. 2005), less is known about the potential economic impact of therapeutic substitution in widely used drug classes (Fischer and Avorn 2004a). Understanding the potential economic impact of greater use of lower cost drugs can inform health policy and educational interventions such as CRBBD.