WellPoint, one of the nation’s largest health insurance agencies, sparred off against the drug Boniva, which is marketed by Genentech. In 2009, WellPoint made it more difficult for beneficiaries to use Boniva, which is used to treat osteoporosis, after conducting a study on the drug. Sufferers of osteoporosis are primarily women, who experience weak bones and a greater risk of suffering bone fractures. Post-menopausal women have the highest risk of developing osteoporosis because they lose estrogen, a key element in strengthening bones.
Boniva is a bisphosphonate, among one of the most common treatments for the bone-thinning disease. Bisphosphonates treat osteoporosis by slowing down bone thinning, preventing bones from weakening and deteriorating. Osteoporosis patients who take bisphosphonates will preserve their bone density and avoid bone fractures—so long as the drug is effective.
The WellPoint study considered more than 25,000 of members who are treated by osteoporosis drugs, comparing Boniva, Actonel, and Fosamax. Although the drugs should provide the same treatment to patients, WellPoint noted key differences between Boniva and the other two drugs. Ultimately, Fosamax and Actonel were more effective than Boniva: Fosamax and Actonel users spent less money on health care and were less likely to fracture their bones than patients on Boniva. Plus, patients were more likely to continue and comply with treatment on Actonel.
As a result, the health insurance giant decided to restrict Boniva, and kept on the third tier of non preferred drugs on the WellPoint drug formulary. Another health insurance leader, Aetna, has also placed Boniva on its formulary’s third tier, preferring Actonel and the generic drug Fosamax. Luckily for Boniva, it is still the first tier preferred drug for Cigna ahead of its two competitors. WellPoint’s Medicare prescription drug plan still lists Boniva as a second tier prescription in the plan formulary.
Like many other health insurance companies, WellPoint hopes to reduce treatment costs by using the most effective medications at the best prices. The 2010 health care reform provided $1 billion worth of funding to conduct comparative-effectiveness studies, hoping to both improve quality of care and cut health care costs. If such studies are effective, they could truly slash costs and cut down on unnecessary expenses.
Earlier research linked Boniva use to bone fractures (specifically in the femur) and a higher risk of heart disease, although the Food and Drug Administration later found no correlation between Boniva, heart disease, and bone fractures. WellPoint’s research also did not find a correlation between Boniva and other bisphosphonates and certain femur fractures. Boniva is also linked to heartburn.
Genentech, the company that produces Boniva, claims that Boniva is cost effective. Contrary to the WellPoint study, the company also states that patients find it very easy to comply with Boniva doses.
Ultimately, the most important point of the WellPoint study is the growing need to use cost-effective prescription drugs. As health care costs rise in the United States, comparative-effectiveness research will grow ever more important. With widespread health care reform around the corner, comparative-effectiveness studies could be key to making health care affordable for all.