New year, new start

YARMOUTH, Maine - With a topsy-turvy 2007 behind them, nebulizer medication industry leaders say the landscape is permanently altered and will continue to experience shifts in the new year. “A lot of the smaller pharmacies have been driven out,” said Sam Jarczynski, president of RxStat in St. Petersburg, Fla. “You used to see pharmacies with 200 or 300 patients and that was profitable. Those days are gone.” A bump in the reimbursement for albuterol brought a temporary surge of optimism in July, but dimmed three months later when the ASP fell 26 cents. “To see a reimbursement drop that quickly, you understand why ASP (is self-defeating),” said Wayne Vega, a consultant with Acadiana, La.-based Stat Vial. “You need to not look at the drug as the profit center, but manage your pharmacy business based on the established dispensing fee.” And the quarterly juggling act of following the best reimbursement doesn't help patients or providers, says Mickey Letson, president of Decatur, Ala.-based Letco Companies. “The biggest backlash came from moving as many patients as possible from Xopenex to albuterol,” said Letson. “Lots of physicians really believe that Xopenex has less side effects.” While Xopenex and DuoNeb could continue to suffer falling reimbursement—and utilization rates—the introduction of two new drugs could have a positive effect on the market, say insiders. Sepracor's Brovana and Dey's Perforomist, are long-acting bronchodilators prescribed for twice-daily use that are expected to improve patient compliance. “Those drugs could be virtually interchangeable,” said Letson. “In order for either company to be successful, one is ultimately going to have to come out at a lower price.”