PPIs Are Therapeutically Interchangeable and Ideal for a Managed Care Intervention Such as Therapeutic MAC

PPIs Are Therapeutically Interchangeable and Ideal for a Managed Care Intervention Such as Therapeutic MAC Mabasa and Ma recently published a pharmacy claims database review on the effect of a therapeutic MAC intervention for proton pump inhibitors (PPIs). A therapeutic MAC program establishes a therapeutic maximum allowable cost for a drug category and, unless medical necessity exists, requires patients to pay the drug cost difference when a nonpreferred agent is dispensed. In their Canadian employer group, rabeprazole 10 mg daily was the preferred agent,2 costing Can 71� daily. They found a 22.1% reduction in drug cost per patient per year (PPPY) in the intervention therapeutic MAC group (from Can $357 to Can $278 PPPY) versus a 4.1% increase in the comparison group (from Can $293 to Can $305 PPPY). In response to this study, Peter Wahlqvist, an employee of AstraZeneca, the manufacturer of esomeprazole, has written a letter to the editors of JMCP to highlight a number of fundamental flaws.