Prediction of Medicare drug formulary drugs for treatment of overactive bladder.
OBJECTIVE
With the establishment and signing into law the Medicare and Prescription Drug Improvement and Modernization Act of 2003, also known as Medicare Part D, medical costs are expected to soar. In fact, the program is expected to cost more than a trillion dollars through 2015. Establishment of the Medicare Part D drug formulary will allow cost containment but still absorb patient and physician preferences as well as a consideration of efficacy and safety data.


METHODS
Potential Medicare formulary choices were examined in the anticholinergic class, as commonly used by urologists, and small in number of available drugs. Formulary selection parties and issues were individually analyzed, including the government in respect to cost containment, patients in relation to efficacy and cost, physicians in relation to preferences and influence and drug companies in relation to lobbying power, country of base of operations and market shares. Costs to Medicare and patients were calculated using discount Internet sites for pricing and simulated using Medicare Part D benefits.


RESULTS
Generic oxybutynin is likely to be included because it is the least expensive to patients and Medicare, but it has the lowest efficacy. Detrol LA is likely to be the long acting choice due to efficacy, cost and manufacture by a United States based company.


CONCLUSIONS
A simulation of cost analysis of anticholinergics for treatment of overactive bladder would help urologists better understand the Medicare formulary selection process.
Grocela
Joseph A
JA
Department of Urology, Massachusetts General Hospital, Bigelow 1102, Boston, MA 02114, USA. jgrocela@partners.org
Kanji
Ayesha
A
Ternullo
Joseph
J
D018680:Cholinergic Antagonists / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics; D005569:Formularies as Topic; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008333:Mandelic Acids / Q000191:economics / Q000627:therapeutic use; D006278:Medicare / Q000191:economics; D020414:Risk Sharing, Financial; D014481:United States; D014549:Urinary Incontinence / Q000188:drug therapy*
D018680:Cholinergic Antagonists; D008333:Mandelic Acids; C005419:oxybutynin