Company

Ticker Symbol

Product(s)

Barr Pharmaceutical/ Duramed

BLE.DE

SEASONALE and SEAONSONIQUE

Warner Chilcott

WCRX

Loestrin 24 Fe, Femcon Fe

Name

Hospital

State

Mark Yurchisin

The Medical Center at Bowling Green

KY

John Washington

Central Carolina Gynecology

NC

Viki Forlano

Shannon Medical Center

TX

Paul Coppola

Middlesex Hospital

CT

Heidi McNaney-Flint

Martin Memorial Medical Center

FL

Harold Green

Mount Carmel Health System

OH

Linda Harrell

Private Practice

IN

Frederick Friedman

Maimonides Hospital

NJ

Ian Taras

West Hills Hospital & Medical Center

CA

Ruby Huttner

Hunterton Health Care System

NJ

Fred Duboe

St. Alexius Medical Center

IL

Question

Pages

Q1: Current practices

Please describe your current oral contraceptive prescribing practices, including the mix of products you prescribe (brands and/or generic products) and to what types of patients.

4

Q2: Product decision drivers

What are the main drivers of your choice of oral contraceptive products? Please discuss clinical factors, such as product attributes and patient characteristics, as well as non-clinical factors, such as reimbursement.

8

Q3: Drivers of switch

What drives you to switch a patient from one oral contraceptive product to another? Please explain using examples if possible.

9

Q4: Patient perspective and influence

How much influence does patient request or preference have in your choice of oral contraceptive product prescribed?

11

Q5: Branded versus generic

Please discuss the decision to use branded versus generic oral contraceptive products. When do you choose one versus the other, and why?

13

Q6: Recent product introductions and impact

What new products have been introduced in the past few years that have impacted your oral contraceptive prescribing patterns?

15

Q7: SEASONALE and SEASONIQUE

What do you know about SEASONALE and SEASONIQUE and do you prescribe these products? Prescribers: In what patient types or circumstances do you prescribe SEASONALE and SEASONIQUE? What percentage of your patient population receiving oral contraceptives receives these products? Non-prescribers: Why haven’t you prescribed SEASONALE or SEASONIQUE? What would lead you to prescribe these agents?

16

Q8: Loestrin 24 Fe

What do you know about Loestrin 24 Fe and do you prescribe it? Prescribers: In what patient types or circumstances do you prescribe Loestrin 24 Fe? What percentage of your patient population receiving oral contraceptives receives this product? Non-prescribers: Why haven’t you prescribed Loestrin 24 Fe? What would lead you to prescribe it?

18

Q9: Femcon Fe

What do you know about Femcon Fe and do you prescribe it? Prescribers: In what patient types or circumstances do you prescribe Femcon Fe? What percentage of your patient population receiving oral contraceptives receives this product? Non-prescribers: Why haven’t you prescribed Femcon Fe? What would lead you to prescribe it?

19

Q10: New products in development

What new products, if any, are you aware of that are in development that you are interested in learning more about or using in the near future?

20

Q11: Trends in next 1-3 years

What do you expect the trends in oral contraceptive prescribing patterns in the next 3 years? Please explain.

21

Q12: Other issues

Other than what has been discussed, what is important to know for someone trying to understand the prescribing patterns and likely trends in prescribing in the next few years?

22

Introduction

Welcome to this discussion among obstetrician-gynecologists and primary care physicians. We will focus on oral contraceptive prescribing practices and the impact of new product introductions on these prescribing patterns. MedPanel discussions are enhanced when you, as a panelist, not only respond to the posted questions, but also reply to comments made by our moderator and your fellow panelists. We look forward to a lively and interactive discussion. Please note: In your participation on this panel, MedPanel expects and requires that you comply with the terms of the Consultant Confidentiality Agreement to which you previously agreed. If you have any questions about the terms of that agreement, please review them through the link provided on your MedPanel home page after you've logged in.

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Q1: Current practices

Please describe your current oral contraceptive prescribing practices, including the mix of products you prescribe (brands and/or generic products) and to what types of patients.

Panelist 11: I generally prefer the lower dose (.5/20 or 1/20) products unless there are other considerations or problems. I usually tell patients how to take them in a continuous fashion rather than cyclic. Recently I have had a lot of Yaz and Loestrin 24 samples and have used them. I prefer the generics however for cost reasons.

Panelist 11: Other considerations

You mention a preference for lower dose products unless other considerations or problems. What are some examples of other considerations or problems that would lead to higher dose products?

Panelist 2: some women have difficulties with low estrogen products, esp with libido and break through bleeding

Panelist 8: history of BTB, need to suppress ovarian cyst, histroy of previous low does pill failure.....although each issue could also be solved with 24 days.

Panelist 11: Breakthrough bleeding, poor cycle control or formulary deficiencies mostly.

Panelist 10: Mostly BTB, dysmenorrhea

Panelist 7: BTB & formulary issues

Panelist 5: break through bleeding problems or those who do not withdraw on low estrogen pills

Panelist 3: Yes, I would agree that some pats need better endometrial support with a 30 or 35 mcg pill, or better suppression of ovularion

Panelist 1: breakthrough bleeding

Panelist 6: BREAK-THROUGH-BLEEDING,ACNE

Panelist 9: persistent breakthrough bleeding or amenorrhea that is problematic for the patient are the most common issues that would increase the dosing.

Panelist 12: Breakthrough bleeding, ovarian cyst suppression, status of endometriosis

Panelist 2: treat all ages from teen to 5O using all available OC products

Panelist 5: I tend to prescribe monophasic OCP's with the lowest estrogen available. I tend to be forced to use the generics b/c of cost and insurance formulary.

Panelist 9: 24 day regimens, low dose 20 mcg. preps, monophasics preferred

Panelist 4: use wide variety of ocp. often initiate with samples give 3 cycles to assess how patient responds if likes, continue, if not consider different formulation

Panelist 1: I TYPICALLY USE OCP IN WOMEN WHO NEED CONTRACEPTION, TX OF OVARIAN CYST, DYSMENORRHEA,IRREGULAR MENSES, MENSTRUAL MIGRAINES. I DONT USE IN WOMEN OVER 30 IF THEY SMOKE. I USE SEASONALLE, YAZ, YASMINE, ORTHO PRODUCT LINE. GENRICS ARE OFTEN SUBSTITUTED.

Panelist 8: Use low dose, 24 day regimen, avoid generics as much as possible. Never like triphasics

Panelist 6: I CURRENTLY USE ORTHOTRICYCLEN-LO,YAZ AND GENERICS IF REQUIRED BY PATIENTS INSURANCE.SENIQUEALSO AT TIMES

Panelist 3: New starts" mostly monophasic 20 or 25 mcg E products, esp the new 24 day pills-Yaz and loestrin 24. Some extended cycling with either seasonale/seasonique or any pills by skipping the off days. Prior pill pts I generally keep on what they are on. I dont hesitate to use generics when cost is an issue. New starts I only start on pills I have a sample pack for.

Panelist 7: 24 day regimens, low dose 20+ mcg. preps, monophasics preferred. Samples & patient ed MOST important!

Panelist 7: Samples & patient ed. most important. Next is if patient had a preference for whatever reason. Else, 24 day regimens, low dose 20 mcg. preps, monophasics preferred.

Panelist 12: I currently encourage patients to take birth control pills continuously and prefer to try 20 mcg estrogen ultralow dose pills. I prescribe by brand name usually Alesse or Miracette however I am tending to support Yaz as we have samples. I never could get insurance to pay for seasonal. I write for Yaz and Disp 4 month and Sig is take one active pill everyday to prevent period

Follow-up: Continuous

Panelist 11 mentions telling patients to take products in a continuous rather than cyclic fashion. Do others advise their patients to do this? Why/why not?

Panelist 2: extended cycle can be tailored to the patient and their desire to avoid monthly patients. This is especiallly true with dysmenorrhea and endometriosis. Also with patients wwnting to avoid a specific date for a period.

Panelist 6: PTS.WHO PREFER NOT TO HAVE MENSES OR HAVE DYSMENORRHEA SHOULD TAKE CONTINUOUS HORMNAL THERAPY ALSO TREATMENT OF ENDOMETRIOSIS

Panelist 8: Depends on the clinical situation. For the women wanting to have no menses but willing to tolerate 6 months or so of irregular spotting, this is a possible choice.

Panelist 10: I believe continuous is acceptable when trying to avoid cyling problems such as PMS, dysmenorhea, migraines, etc.

Panelist 7: I believe continuous is acceptable when trying to avoid cyling problems such as PMS, dysmenorhea, migraines, endometriosis, & certain date avoidance, but beware of the BTB potential. I only rec. 3 months in a row.

Panelist 5: I have pts take on a cyclic basis mostly just for ease of use. All pills can be taken on a continuous cycle but recommend that most pts perform better on the cyclic ones

Panelist 3: Yes, I will do so for both pt interest or indications for patients who have problematic periods, dysmenorrhea, and they would benefit from less periods.

Panelist 1: I USE THESE MONTHLY UNLESS THEY SPECIFICALLY REQUEST CONTINUOUS FASHION. I USE THOSE MEDICATIONS SPECIFICALLY APPROVED FOR THAT PURPOSE.

Panelist 9: improves patient symptoms with dysmenorrhea, menorrhagia and endometriosis. Prevention of ovarian cysts also may improve.

Panelist 6: PTS.WHO PREFER MENSESTAKE PILLS CYCCALLY;THOSE WHO DON'T OR HAVE MEDICAL INDICATIONSTAKE PILLS CONTINUOUSLY

Panelist 12: if they have premendtrual migraines, dysmenorrhea, acne, cysts

Follow-up All: Percentage mix

Some of you mention preferring monophasic versus triphasic products. Do all agree with this preference? Why/ Why not? What percentage of your patients are on monophasic versus triphasic and do you expect any trends in this mix?

Panelist 2: no particular preference unless treating for DUB, then prefer monophasic

Panelist 8: always thought triphasics were a marketing scheme with no added advantage. Seems to have been confirmed with all studies and clincally.Monophasics easier to understand when pt. has btb re. cuase.

Panelist 10: tend to see less BTB with monophasics

Panelist 7: triphasics often with more BTB, but compliance is the most important issue. i'd say that most new pills are monophasics so higher percentage of new starts will be monophasics. about 1/4 are triphasics in my population.

Panelist 5: All of my pts are on monophasic pills just because of less side effects

Panelist 1: USE DEPENDING ON BTB.

Panelist 6: TRIPHASICS=LOWER HORMONE AMOUNTS.80%TRI PHASICS20%MONOPHASICS

Panelist 9: 90% are on monophasic because of the greater predictability of response and consistency as well. Finally, I find more patients developing ovarian cysts on triphasic regimens.

Panelist 6: MOST OF MY PTS. ARE ON TRIPHASIC;IFBTB PRESENTWILLSWITCH TO MONOPHASIC; IF PATIENTS NEED/WANT LONGER CYCLE WILL GIVE MONOPHASIC

Panelist 12: prefer monophasic especially if taking continuous. 90/10 mono to triphasic

Panelist 11: I dont have any absolute preference. For non-cyclic treatment or not traditional use, the monophasic are better.

Follow-up ALL: Product choice

Several specific products were mentioned. Please explain why certain brands are selected for certain patients. a) Yaz b) Loestrin 24 c) Seasonale d) Seasonique e) Ortho Tricyclen-Lo f) Other brands (not including generics)

Panelist 2: Yaz - low dose and less fluid retention Orthotricyclen lo tricyclic low dose acne indication and no generic plenty of samples seasonique for extended cycle

Panelist 8: Often times depends on product availability and most importantly patient specific request. When they ask for it, we usually comply.In general I will use LE 24 for all new start patients absent the above

Panelist 10: I typically use Yaz when the patient has desire for oral contraception and history of PMS. I don't prescribe any Loestrin -- 24 since I have no samples, have abundant samples of low Ortho Tri-Cyclen and use it frequently. I have never been a fan of Seasonale, but now prescribing some Seasonique and observing whether or not this has lessened, the frequency of breakthrough bleeding and increased patient compliance.

Panelist 7: Not sure what part of the studies are marketing and which parts are not, so I am back to my old formula. New starts = sample supply, patient desire, patient education & pharm rep "nice to doc."

Panelist 5: yaz is good for poly cystic ovarian disease pts. Some pts request ortho tri cyclen b/c of acne concerns

Panelist 1: USE YAZ, TRICYCLEN LO FOR ACNE. SEASONALLE FOR CONTINUOUS MEDS

Panelist 6: MOST ON ORTH TRI CYCLEN-LO;2ND IS YAZNEXT SEASONIQUE AND LOESTRIN 24--BETTER RESULTSWITH THESE

Panelist 9: Ortho triycyclen lo primarily to patients who request this pill. Ortho is generous at sampling and I will not change a patient off a regimen that is working well for her. Seasonale and Seasonique for those who want 4 cycles annually, though the btb complications can drive many patients away by 3-4 months. Yaz for those with poor response to traditional progestins or who respond well to the diuretic effects of DRSP. Lo estrin 24 is used for those who request it by name or who desire a lesser flow and dysmenorrhea patients will improve with 24 day regimens.

Panelist 3: Most of the ones listed are the only ones still samples. It is difficult to start a pt who is NOT alreay on the pill without samples.

Panelist 6: YAZ=YOUNGER PTS WORRIED ABOUT WEIGHT;LOESTRI-4=PTS WITH DEPRESSION,HEADACHE DURING MENSES;SEASONALE=PTS. WITH DYSMENORRHEA OR DON'T WANT MENSES;SEASONIQUE=SAME AS SEASONALEBUT WTH PROBLEMS OFF HORMONES;ORTHOTRICYCLEN-LO=BEST ALL-AROUND PILL

Panelist 12: orthotricyclenlo usually samples available- use in smokers. Seasonale great for menses suppression if insurance pays

Panelist 11: Yas: may be a little better for pms/fluid retention. Loestrin24: lots of samples, well tolerated. Seasonalle and seasonique: expensive version of the extended cycle monophasic. OrthoTricyclin Lo: pretty well toleerated, lots of samples.

Follow-up: Oral contraceptives versus other types of contraception

Do you see any trends towards using products OTHER THAN oral contraceptives, such as patches or the NuvaRing or IUDs? What are the trends you are seeing or expect to see, and why?

Panelist 2: nice to have as alternative but still see majority of patients prefer oral products

Panelist 8: Trend up with ring and down with patch

Panelist 10: I to am seeing the trend of increasing usage of Nuva ring and lessening the patch

Panelist 7: I hope there will be NuvaRing competitors & lower dose patches.

Panelist 5: people like the convenience of shots but Depo Provera causes weight gain and mood swings, not to mention irregular bleeding. Lots of people like the nuvaring b/c of convenience

Panelist 3: Most patients just prefer oral. Nuvaring is catching on, but still too many patients won't give it a try. After the reports of possible increased risk with patch due to a high circulating blood level of estrogen in patch users, combined with a decrease in effectiveness at higher weights/obese patients, its use is trending down. I'd like to see a lower patch.

Panelist 1: SOME INCREASE IN IUDS. DECLINE IN PATCH USE DUE TO CONCERNS OF SIDE EFFECTS

Panelist 6: PATCHES ARE GOOD ALTERNATIVE;NUVARING=POOR ACCEPTANCE; IMPLANTS NOT FOR MY PATIENTS

Panelist 9: Am not seeing any specific trends in the other direction.

Panelist 12: slight trend toward mirena IUD because of less bleeding and cramping

Panelist 11: Patch has bad press, Ring is great for the patients who will try it. Pills are still the default choice for most people. The implanon sounds interesting.

Panelist 10: I typically prescribed oral contraceptive pills that I have stocked in samples such as Yasmin, Yaz, low Ortho Tri-Cyclen.

Panelist 10: I typically prescribed what is available in my cabinet as samples such as Yazz, Yasmin, lo Ortho Tri-Cyclen and I do not like generics

Q2: Product decision drivers

What are the main drivers of your choice of oral contraceptive products? Please discuss clinical factors, such as product attributes and patient characteristics, as well as non-clinical factors, such as reimbursement.

Panelist 10: The main issues in my choice of contraception would-be efficacy, patient compliance, and side effect profile.

Panelist 11: Dose and cost. I prefer the lower dose products and prefer generics because of price. I usually tell patients to ignore the day labels and take them as a continuous regimine.

Panelist 2: dose, cost and side effect profile. also availability of samples

Panelist 5: The main drivers are efficacy, my familiarity and comfort level of the OCP's, side effects and cost. I avoid all estrogen containing OCP's in women with hypertension. I also do not use in any smoker over the age of 35.

Panelist 9: patient type, requests, specific cycle control needs, again prefer monophasic regimens

Panelist 4: often ask patient if they have a birth control they were interested in trying or particular side effects they wish to avoid or benefits they hope to have on ttheir therapy.

Panelist 1: PT'S MAY COME IN REQUESTING SPECIFIC DRUGS. OFTEN THEY HAVE SEEN ON TV OR IN MAGZINE ADS. THEY MAY HAVE FRIENDS WHO RECOMMEND. I OFTEN WILL GIVE RX FOR NAME BRAND BUT WHEN RX FILLED THEY END UP WITH GENERIC.I PREFER TO USE SOMETHING I HAVE SAMPLES TO START FOR 1ST TIME. SOMETIMES I WILL USE SEASONALLE BUT FORMULARY WILL NOT PAY FOR CONTINUOUS TX

Panelist 8: Efficacy, safety, tolerability Braod patient selection.......clinical trial results in overwight individuals

Panelist 6: TREAT ALL AGES ~15-55 IF WORRIED ABOUT WEIGHT /FLUID RETENTION,I USE YAZ. I LIKE EXTRA DAYS OF EST. TO DECREASE DEPRESSION/PMDD;SEASONIQUEHELPS THIS ALSO

Panelist 3: Samples are key. I favor the lower dose estrogens. I don't tend to start new starts on generics unless pts cannot afford otherwise.

Panelist 7: Samples & patient ed. most important. Next is if patient had a preference for whatever reason. Else, 24 day regimens, low dose 20 mcg. preps, monophasics preferred.

Panelist 12: my main driver is to match type of pill on feminizing to androgenic scale to problems the patient may have other then need for birth control such as acne or premenstrual migraine or pain or heavy bleeding.

Panelist 1: FORMULARY STATUS , PT REQUESTS SIDE EFFECTS

Q3: Drivers of switch

What drives you to switch a patient from one oral contraceptive product to another? Please explain using examples if possible.

Panelist 11: 1.Cost 2. Perceived lack of effect. Ie: no cycle control. 3. Side effects like migrane, acne, mood changes. Usually there is not much difference between one product and another except in the patients mind. I am not sure about the newer progestins though.

Panelist 2: symptoms experienced by a patient such as bloating, nausea or BTB are the most common reasons to switch

Panelist 5: Lack of efficacy in control of cycles, this includes BTB, continued dysmenorrhea. Unfortunately insurance formulary and cost also seem to drive pt's request to be changed

Panelist 9: given side effects, btb symptoms, specific androgenic side effects of a certain progestin, drives me to another choice

Panelist 9

You mention “… specific androgenic side effects of a certain progestin drives me to another choice.” What side effect and product are you talking about?

Panelist 2: Acne

Panelist 8: "Hyperandrogenicity" of progestins may have little clinical relevance

Panelist 10: Sometimes the more androgenic progestins can cause problems with acne and weight gain.

Panelist 7: I think this was directed to Panelist #9

Panelist 3: Older more androgeneic progestins can lead to acne, weight gain.

Panelist 1: ACNE

Panelist 9: Bloating, weight gain, hirsutism, breast tenderness and water retention.

Panelist 12: acne

Panelist 4: will switch for breakthrough bleeding or perhaps amenorrhea on a particular pill if patient not comfortable with lack of menses.

Panelist 1: MOSTLY DUE TO SIDE EFFECTS, FORMULARY MAY NOT COVER BRAND

Panelist 8: Unscheduled bleeding Patient desire Availabilty of samples

Panelist 6: BTB,CHANGE OF INSURANCE REQUIREMENTS OR SIDE EFFECTS

Panelist 3: I switch primarily for side effects--esp BTB, and complaints of weight gain or fluid retention or skin changes/acne.

Panelist 7: Driven by patient's complaints after requesting that they stay on it at least 2 if not 3 months and having them promise that they were compliant.

Panelist 12: I tend to use feminizing pills for acne and premenstrual migriane and use more androgenic pills for endometriosis, pain , dysmenorrhea or menorrhagia

Follow-up ALL: Feminizing and Androgenic

Panelist 12 determines product choice by desired symptom control. “I tend to use feminizing pills for acne and premenstrual migraine and use more androgenic pills for endometriosis, pain, dysmenorrhea or menorrhagia.” Do you use this approach? Why or why not? What is the approximate mix of feminizing versus androgenic prescriptions?

Panelist 2: tend to agree for most part

Panelist 8: No data

Panelist 5: I don't take these into consideration on many of my pts.

Panelist 1: DONT THINK ABOUT IN THESE TERMS

Panelist 7: I am not sure that one pill fits all in this description and how much is marketing. I have found that one pill that has acne FDA indication (i.e.-TriCyclen Lo or EstroStep) can help one patient with acne and make another ones worse.

Panelist 9: I would indeed agree with this approach, primarily because it is successful with a broad range of patients. The mix is 70% feminizing vs. 30% androgenic Rx.

Panelist 3: Well, feminizing is not a good choice of words. No pill is considered feminizing. Perhaps estrogen dominant is a better term, vs progesterone dominant. And then with progesterones, there are some who have more androgenic effects, and some that are nonadrogenic. But most of the new pills are less androgenic, estrogen dominent anyway.

Panelist 10: I believe that's certain oral contraceptive pills have a greater antigenic effect thereby having some benefits and situations such as endometriosis suppression. And there are some pills that have predominantly estrogen effects that may improve acne.

Panelist 6: OLDER PROGESTINS TENDED TO BE SLIGHTLY MORE ANDRGENIC BUT DIFFERENCE IS SLIGHT EXCEPT IN OCCASIONAL CIRCUMSTANCES

Panelist 12: I wrote this section

Panelist 10: Most typical reason for switching in my practice would be unscheduled bleeding, followed by persisting symptoms of dysmenorrhea or PMS.

Panelist 3: patient side effect/problem. Often BTB, sometimes a complain of weight gain or fluid retention or decreased libido. Sometimes nausea, or cyclic headaches. Usually due to a pt complaint.

Panelist 10: Most commonly patient complains of continued breakthrough bleeding.

Panelist 10: Most commonly patient complains of continued breakthrough bleeding, typically on a 20 µg pill, and I will change them to a 30 µg pill

Q4: Patient perspective and influence

How much influence does patient request or preference have in your choice of oral contraceptive product prescribed?

Panelist 10: Patients seem to be requesting the lowest cost form of oral contraceptive pills, that results in a high request for generic substitution. It seems that the driving force in patient selection is cost.

Panelist 6: PATIENTS NEVER SEEM NOT TO BE ABLE TO GET THEIR HAIR DONE/TINTED NO MATTER WHAT THE COST--PRIORITIES

Panelist 11: If someone believes a product is better they will perceive it as better. I usually follow a patients preferences, especially if it is a minor choice like pill brand.

Panelist 2: in most cases patient preference is acceptable

Panelist 5: This influences my choice very frequently, if someone mentions one by name I usually prescribe it or something similar to it.

Panelist 9: a patient preference is usually adhered to , if at all possible. As long as there are no contraindications, I would do my best to meet a given request

Panelist 4: if patient has something they would like to try so long as I feel it is safe I am happy to initiate that measure.

Panelist 1: I WILL USUALLY PRESCRIBE IF THERE ARE NO CONTRINDICATIONS.

Panelist 8: A lot unless choice is truly not applicable to specific patient

Panelist 6: SOME; ITRY TO INFORM PATIENTS WHY I THINK THE CHOSEN PILL IS BEST FOR THEM,BUT WILL YIELD IF THEY INSIST ON AINSURANCE PREFERRED PILL

Panelist 6: IF PATIENTS RESIST MY SUGGESTIONS,I WILL USUALLY ACCEPT THEIR WISHES

Panelist 6: I WILL CONSIDER PATIENT'S REQUEST AFTER EXPLAINING WHY ICHOSE A PARTICULAR PILL.

Panelist 3: Most patients leave it up to me, but I do take requests under consideration. I don't ask the pt, but if she asks, and esp it is low dose and has a good side effect profile, I'll prescribe it.

Panelist 7: Huge!

Panelist 12: If their preference mathes symptoms I agree otherwise I try to convince them that another pill may be best for them

Follow-up ALL: Impact of DTC advertising

Do you believe DTC advertising has had a great effect on the amount of patient requests you receive? What is your opinion on the effects of DTC advertising on OCP prescribing patterns?

Panelist 2: For BC options I do believe it has a significant effect on patients coming in with questions. However, most patients will go along with my recimmendation if I don't feel the method matches their needs or with full discussion of all the benefits vs risks

Panelist 8: Yes. Not bothered by it at all. Increases chance to educate

Panelist 10: I really don't believe that it influences the patient and physician ultimate choice and contraception.

Panelist 5: I think this just makes pt more ready to ask questions in regards to current choices.

Panelist 3: IT gets patients thinkinbg and talking. SOme ask for specific brands. When the advertising is "huge" I think it can make a difference. I recall when Ortho blasted the market with tricyclen then tricyclen lo advertising they really saw their market share rise, and patients were asking.

Panelist 1: SOME EFFECT BUT MORE OFTEN PTS WANT THE LEAST EXPENSIVE DRUGS

Panelist 7: DTC definitely helps and definitely drives my Rx pattern. If patients come in wanting it, I know they will have better compliance and that will mean less phone calls to me.

Panelist 6: DTC ADS MAKE MANY PTS. REQUEST ACERTAIN PRODUCT AND DIFFICULT TO DISSUADE; ONTV-MUST BE GOOD

Panelist 9: DTC advertising has had a mild effect on my prescribing habits. The effects on prescribing patterns is a mild rise in the Rx or newer products with novel regimens, only to convert back to our tried and true methods that have worked well for years!

Panelist 6: GREAT EFFECTON MOSTPTS;YOU HAVE TO CONVINCE THEM THAT SOMETHING ELSE IS MORE APPROPRIATE

Panelist 12: rarely do I have patients requesting a certain pill so don't think that there is much of an effect

Panelist 10: I am not going to prescribe a contraception that the patient would be unwilling more compliant in its usage. Of course, patient selection and choice would play a predominant role in physician selection.

Q5: Branded versus generic

Please discuss the decision to use branded versus generic oral contraceptive products. When do you choose one versus the other, and why?

Panelist 10: With the trend towards lowering of the total estrogen content and birth control pills, I find that the generic equivalency of a 20 µg pill may actually be insufficient quantity of hormone in order to provide a contraceptive effect. Therefore, I feel very uncomfortable about the generic substitution of 20 µg estrogen-containing pills.

Panelist 11: Cost. Most of the pills are all made in the same plac. Tri-Levlin and TriPhasil were even made on the sam machines, just with a change in the color and imprinting of the pills.

Panelist 2: always prescribe branded and will allow generic at patient request

Panelist 5: If available I chose generics just b/c it saves pt's money. The only time I use brand name are for the newer ones such as Yaz.

Panelist 9: I try to prescribe brand name due to better quality control and consistency. If a patient requests a specific generic, I will comply.

Panelist 4: typically only write generic if patient requests them. i let them know there may be differences in the formulation pill to pill.

Panelist 1: I AM MORE COMFORTABLE WITH NAME BRAND BUT A LRGE PERCENTAGE ARE GETTING GENERIC.PT'S PREFER GENERICS DUE TO LOWER COST

Panelist 8: Always always always eschew generic

Panelist 6: I USE GENERICS ONLY WHEN FORCED TO QUALITY AND POTENCY VARY WITH MANUFACTURER AND POTENCY RANGE IS GREATER TNAN WITH BRANDED PRODUCTS

Panelist 3: Usually for pt request due to cost. This can be because pt is paying for the entire cost, or because her formulary will only cover generic pills at a reasonable cost. If the pt has no history of BTB, other problems, I will switch. If we already switched and the pt is "finally" doing well, I remind her of what it took to get here, and generally encourage her not to switch, as usually she is asking for a generic that is NOT the equivalent of the pill she is on.

Panelist 7: Branded usually have patient ed & samples so I reach for those 1st. Generic Rx is for a patient with a generic request.

Panelist 12: I am not familiar with the name of the generics so usually just prescribe brand name but am aware that the pharmacy often changes it to nearest generic

Follow-up ALL: Trends in this mix

What is the approximate mix of branded versus generic prescriptions in your OCP patient population? Do you see or expect any trends in the mix of branded versus generic prescriptions?

Panelist 2: 60% branded, 40% generic and will increase

Panelist 8: Try to stay away from generics. Never proven efficacious by FDA standards

Panelist 10: I too am trying to stay away from generic oral contraceptive pills, especially the low estrogenic pills, which may increase the risk of pregnancy, but I believe the public at large is not aware of this risk. The trend would be that insurance companies are pressuring the patient's to except generic coverage and pain less for branded names

Panelist 12: 100 % brands as the generics are too numerous and confusing to keep track of. Probably be told by insurance in the future which exact generic to use first

Panelist 5: I see more and more generics being used.

Panelist 3: I think that my patients are getting 70% branded and 30 % generic. As health care costs rise, I expect more patients may ask. But every patient is receptive to taking a brand when there is a specific indication and no generic equivalent exists.

Panelist 1: MORE GENERICS ARE USE. USUALLY USE NAME BRANDS FOR CONTINUOUS RX

Panelist 7: Maybe 10-20% of my patients ask for a generic for cost reasons. As "new & improved" come out and do DTC, the name brand request will always be there.

Panelist 6: 10 5 GENERIC;INCREASE WILL OCCUR AS HMO'S REQUIREGENERICS; QUALITY NOT SAME BUT PRICEPRICE ISFACTOR. WHEN PATENT LOST MANUFACTURERS SHOULD DROP PRICE TO GENERIC LEVEL OR LESS AND BRANDS WOULD PREVAIL

Panelist 9: Branded for our patients=75% Generic=25% I see more HMO formularies converting to generics in the future. CEO's have to keep their multimillion salaries intact and their investors' profits up!

Panelist 6: 10% ONGENERICS; THIS WILL INCREASE DUE TO PLAN REQUIREMENTS AND/OR COSTS(WHY FROM $30 TO $70/MONTH)

Follow-up ALL: Quality

There seems to be a difference in opinion on the issue of quality concerns with generics. For example: Panelist 11: “Most of the pills are all made in the same place. Tri-Levlin and TriPhasil were even made on the same machines, just with a change in the color and imprinting of the pills.” Panelist 6: “I use generics only when forced to. Quality and potency vary with manufacturer and potency range is greater than with branded products.” Do you believe that generics are of inferior quality than branded products in most or all cases? Are you concerned for patients taking generic products? How does quality concerns affect your prescribing patterns?

Panelist 2: In general no, just easier to remember branded and have samples in office

Panelist 8: Agree that inferior quality is a real concern in drugs of narrow therapeutic index. OCP's fall in that category given potential serious outcome of failure...i.e.pregnancy

Panelist 10: I believe that the generic versions are less efficacious in pregnancy prevention

Panelist 5: I use generics mostly b/c of pt preference and cost preferences

Panelist 3: I no longer consider generics to be inferior from a manufacturing standpoint, and have never seen a higher pregnancy rate documneted. I do not care to use most of them, as I do not get the kind of product support and samples and pt ed materials. Some of the generics are "branded" generics, and the company does provie samples and some support.

Panelist 1: I DONT HAVE CONCERNS ABOUT GENERICS. I JUST DONT HAVE SAMPLES TO GIVE FOR TRIAL

Panelist 7: Generics compromise the side effect profile. If I have a patient calling in with side effects, my 1st question is if they are using a generic & 90% of the time, they are.

Panelist 6: IN AIR FORCE WE CHANGED PILLS Q3MO,ORTH NOVUM 2 AND NORINYL BOTH CONTAINED SAME ACTIVE INGREDIANTS BUT SOME PTS HAD VOMITING OR BTB FROM SWITCHING COMPOUNDS. THERE ARE DIFFERENT FILLERS ,DIFFERENT COMPRESSION RATIOS ,SO THE PILLS WHILE SIMILAR ARE DIFFERENT.

Panelist 9: I am concerned about quality control and consistency with generics. These concerns are significant and DO affect my Rx patterns. I Rx generics only if I HAVE to and if a patient so requests.

Panelist 10: I professionally believed that the generic sub 30 µg estrogen pills have more failures.

Panelist 6: IF I PRESCRIBE APILL FROM J&J,I KNOW THE QUALITY AND POTENCY;IF PT GETS PILLTODAY FROM MANUFACTURER X AND NEXT MONTH FROM Y WHO KNOWS WHAT COULD HAPPEN. ALSO OUTDATED OR COUNTERFEIT PILLS COULDBE PRESENT;ALSO AS HAPPENED TO ORTHO YEARS AGO,THE BLUE DYE IN PILLS CAUSED MORE RAPID DETERIOATION OF PILLS.

Panelist 12: I am very concerned about generic quality and who monitors it.So I prescribe by brand and if pharmacy or insurance changed prescription it is their responsibility

Panelist 11: I dont mind the use of generics. I have not seen problems with them. Most patients end up on generics if their formulary requires it and dont seem to have problems.

Q6: Recent product introductions and impact

What new products have been introduced in the past few years that have impacted your oral contraceptive prescribing patterns?

Panelist 10: Yaz, with its FDA approved indications for PMS and acne.

Panelist 11: The drospirone progestin is interesting.I stil havent decided if it is worth the hype. The comercial version of the continuous, and 24/3 day cycles are nice for the patients who dont like to color outside of the lines. I use seasonique, yaz and loestrin for people who have the money but I recommend using generic pills in a continuous fashion for people who have to pay for their meds.

Panelist 2: extended cycle pill use and new progesterone such as in Yasmin have had most impact

Panelist 5: Yaz and Seasonique have opened a new realm for pts request.

Panelist 9: 24 day extended regiments and drsp containing compounds have improved our options.

Panelist 4: drospiranone, less progestagenic and mild diuretic

Panelist 1: SEASONALLE, SEASONIQUE, YAZ, YASMINE. THE ONLY NOVEL IDEA OF RECENT YEARS IS THE SEASONALLE/IQUE. THESE ARE 12 WKS OF CONTINUOUS TX. MANY PTS WITH DYSMENORRHEA, PMDD, MENSTRUAL MIGRAINE CAN BENEFIT FROM CONTINUOUS TX

Panelist 8: Introduction of 24 days. I feel the benfits of proven NE far surpass the hype of DSPR.

Panelist 6: THE PRODUCTS USING DROSPIRANONE AND EXTRAACTIVE PILLS REPLACING PLACEBOS,AND CHANGING CYCLE LENGTH;ALSO SC DEPO-PROVERA

Panelist 3: I was showing patients how to do extended cycling long before it was "approved" and the newer products have made this concept easier for patients. I like the 24 on 4 days off pills also.

Panelist 7: While 24 day, newer progestins & 3 month pills have had profound impact, the largest has been the canibalization of the OCP market by NuvaRing!

Panelist 12: yaz is very interesting for its 24 day active pills . Seasonal is an interesting concept but may times I would prescribe only to have either patient call or the pharmacy call saying it wasn't covered by their insurance or health group

Q7: SEASONALE and SEASONIQUE

What do you know about SEASONALE and SEASONIQUE and do you prescribe these products? Prescribers: In what patient types or circumstances do you prescribe SEASONALE and SEASONIQUE? What percentage of your patient population receiving oral contraceptives receives these products? Non-prescribers: Why haven’t you prescribed SEASONALE or SEASONIQUE? What would lead you to prescribe these agents?

Panelist 10: My personal experience with patient taking Seasonale has been high number of discontinuations secondary to continued breakthrough bleeding or spotting. Therefore, because of repeated callbacks, I have curtailed my prescribing practices. I have now started to use Seasonique in hopes that it has a better bleeding profile. The predominant use is in those patients that have medical disorders complicated by having menstrual cycles such as, dysmenorrhea, PMS, menstrually associated . migraines

Panelist 11: I use them. But I have also been giving people continuous program pills for years. The seasonalle/ique are just an expensive way to do this.

Panelist 2: extended cycle pill such as seaonale and seasonique provide options for patients especially with dysmenorrhea and menorrhagia. Also with patients who are athletes and travel frequently.

Panelist 5: I have not had any success in prescribing these b/c of cost to pt. I also think the cheaper generics can be used in a continuous fashion

Panelist 9: I do prescribe these two but many patients have problems with btb sx and are impatient to have these symptoms abate. THis makes it more difficult to

Panelist 4: I use both but have been using the seasonique moreso to try to avoid estrogen withdrawal headaches. 10-15% of my pill takers on these products

Panelist 1: SEE PREVIOUS ANSWER

Panelist 8: Until long term safety data becomes available for continuous dosing I am hesitant to use it. Can't get pateints to tolerate six months of BTB

Panelist 6: PATIENTS WHO HAVE DYSMENORRHEA EVEN ON BCP ARE CANDIDATES.THE EST/PROG. ARE OLD TIMERS

Panelist 3: I use these. I offer them to most new starts. New starts that are prior users in the past generally like the idea. Young teens sometimes worry that it is not healthy and prefer not to. I esp like them for pts with cycle control problems, or cycle associated problems, as 4 periods or less a year is a good thin

Panelist 7: 3 month Seasonale had a good concept, but a lot of BTB. Seasonique says that the extra 1/2 dose E2 pills in the 13th week will help with the next cycle BTB, but the BTB that was bothersome always came in the 1st 3 months & not subsequent. If a patient wants it, I will give it to them with a strong BTB warning. I'd say it is about 5-10% of my OCP market.

Panelist 12: Seasonale has 84 active pills and 7 inert . Seasonique has 84 active pills and last 7 have small dose of estrogen. Both designed to prevent period for 3 months

Follow-up ALL: Trends in next 12 months, next 24 months

Panelists 4 and 7 mention 5-15% of their patients are on Seasonale or Seasonique. What percent of your current OCP patients are on these products? What do you expect this percentage to be 1 year from now? How about 2 years from now? Please explain any trends you anticipate.

Panelist 2: 5-7% is about right and as more experience with these extended cycle pills be comes available I think it will increase some

Panelist 8: 1% and no change

Panelist 10: I have not had good luck with the extended use Seasonale and I am optimistically evaluating the use of Seasonique in my practice. Major driving force away from the use of this product has been continued breakthrough bleeding.

Panelist 5: doubt that these will change much since cost higher.

Panelist 3: I probably have 10-15 percents on these pills, and think their use wil increase slightly and then plateau.

Panelist 1: PTS ARE INTERESTED BUT MANY ARE NOT ON FORMULARY. MANY PTS DONT THINK IT IS NATURAL TO NOT HAVE MONTHLY MENSES.

Panelist 7: As DTC marketing campaigns gear up, especially also for that once/year period pill, these 2 OCP will get more traffic.

Panelist 6: 1-2% MAYBE IN 1 YR 2-3%. NEDDBETTER HORMONES IN EXTENDED PILLS--TOO MUCH BTB

Panelist 9: About 5% of my patients are on Seasonale or Seasonique. I expect that this will increase somehwhat due to aggressive marketing in the media

Panelist 6: I HAVE 5-10% ON THESE.% MAY INCREASE IF OTHER MONOPHASICS DECIDE TO COMPETE WITH SIMILARPROGRAMS. ONE MAY COME OUT WITH A NO MENSES FOR 6 MONTHS OR EVEN 1YR

Panelist 12: 2% now. 5% 1 year from now and maybe 15 to 20 % in 2 years.Due to patient preference for no menses.

Panelist 11: That probably depends on DTC advertising. They are expensive.

Panelist 10: I usually don't use Seasonale or Seasonique because of the high incidence of breakthrough bleeding that my patients have experienced. I do find them advantageous for extended cycle use in those patients who have PMS, severe dysmenorrhea, masterly associated migraines. I would be more inclined to use these agents, if there was lessened side effects of breakthrough bleeding

Q8: Loestrin 24 Fe

What do you know about Loestrin 24 Fe and do you prescribe it? Prescribers: In what patient types or circumstances do you prescribe Loestrin 24 Fe? What percentage of your patient population receiving oral contraceptives receives this product? Non-prescribers: Why haven’t you prescribed Loestrin 24 Fe? What would lead you to prescribe it?

Panelist 10: When Loestrin became initially available, I prescribed a fair amount in hopes of diminishing the length and menstrual blood losses. I have been finding a lot of early cycle breakthrough bleeding in the first three cycles of use that often diminishes patience compliance.

Panelist 11: Yes, I use it and will continue to do so as long as my samples hold out. It is an expensive way of getting an extra few days of med per month. Any pill taken 24 days on and 4 days off works the same.

Panelist 2: Have not prescribed yet

Panelist 5: I do prescribe this, but usually b/c we have samples. I do like the less day cycle

Panelist 9: I rx lo estrin 24 in patients with heavy flows or who desire shorter menses. Many patient types are appropriate for this regimen.

Panelist 4: use it often, recently changed to femcon for patent issues like monophasics well for cycle control

Panelist 1: I KNOW THAT IT HAS FE ADDED BUT DONT USE MUCH DUE TO NO SX AND NO DETAIL

Panelist 8: my first choice for new start patients. best clinical data. Patients love shorter and lighter menses. best combination of proven ingredients.

Panelist 6: THERE ARE 24 ACTIVE PILLS AND 3 PLACEBO THUS SHOTENING HORMONE-FREE DAYS=LESS BLEEDING&LESS DEPRESSION/MOODINESS

Panelist 3: I prescripe a good amount of this as I have said. I use for just about any patient, esp those with long/heavy period. But the low dose suits anyone. A good perimenapausal pill.

Panelist 7: Love Lo24. Love the 24 vs. 21 for HA, BTB, etc. reasons. Love the samples. 25% of my market.

Panelist 12: designed to shorten periods but i have had no samples so haven't prescribed it

Follow-up ALL: Trends in next 12 months, next 24 months

Currently what percentage of your OCP patients are taking Loestrin 24 Fe (if you did not already answer)? What do you expect this percentage will be 1 year from now? How about 2 years from now? Please explain any expected trends.

Panelist 2: Haven't used and have no samples. Like the concept and will use when I get samples

Panelist 8: 80%.80%

Panelist 10: I initially prescribed it when it was first released, no longer have sample availability so no longer prescribe

Panelist 5: just the ones that I have given samples to

Panelist 3: I think the use of ALL 24 day pills will rise, and the 24 days decreased the perl index as the dose of estrogen drops. Also less bleeding problems.

Panelist 1: HAVENT USED YET. MAY USE AFTER HAVE BEEN DETAILED

Panelist 7: Lo 24 is a great pill, but they are already sampling a lot and doing heavy DTC marketing. I believe that their market share will NOT go up any further than it will be within the next 3-6 months.

Panelist 6: 1% 2-3% NEEDBETTER PROGESTN

Panelist 9: I have about 35% of my patients on Lo Estrin 24. The reps have been VERY available, generous and knowledgeable on this pill. Sampling has been outstanding. Therefore, I DO use it !

Panelist 6: LESS THAN 5%; IT WILLPRBABLY INCREASE SOMEWHAT

Panelist 12: Don't prescribe it now . Not sure about future

Panelist 9: I also would expect that this percentage may increase somewhat to 40% over the next 1-2 years.

Q9: Femcon Fe

What do you know about Femcon Fe and do you prescribe it? Prescribers: In what patient types or circumstances do you prescribe Femcon Fe? What percentage of your patient population receiving oral contraceptives receives this product? Non-prescribers: Why haven’t you prescribed Femcon Fe? What would lead you to prescribe it?

Panelist 10: I'm not sure what birth control formulation this is.

Panelist 10: Don't see any real advantage to this product.

Panelist 11: It is a niche pill for people who need a slightly different e/p ratio. I use it a lot for dfub. The chewable part is pretty silly.

Panelist 2: Have not

Panelist 5: I am not familiar with this at all

Panelist 9: I use this in the chewable form. Women who are fine with Ovcon will be informed that this is equivalent and generally accept this brand.

Panelist 4: chewable monophasic pill good cycle control use it

Panelist 1: NEVER HEARD OF IT

Panelist 8: My go to drug fro bleeding

Panelist 6: HAVE NOT SEEN IT ADVERTISED OR DETAILED

Panelist 3: This is the "NEW" name for Ovcon, and it can be chewed or swallowed whole. Funny, but patients who don;t have a problem swallowing pills often say they don't want this, even when I tell then chewing is optional. And patients previously on Ovcon are confused about the new name. I good idea that ran into problems with marketing. And when lots of patients went to get their Ovcon refilled, pharmacists simply told them it was not available.

Panelist 7: Ovcon replacement has not been as "good" as Ovcon, but better than other generic alternatives for Ovcon. The chewable pill does not seem to be a big seller so I tell them they can swallow it. I do have a lot of samples which helps to sell it. Probably at 10%.

Panelist 12: it is a chewable pill but I have never had sample no had anyone request it yet. It is not an ultralow dose as it has 35 mcg estrogen

Follow-up ALL: Trends in next 12 months, next 24 months

Panelists 3, 4, 8, 9, 11, 12: What percent of your OCP patients are on Femcon Fe? All panelists: What do you expect the trends in use will be in the next 1 year? How about in the next 2 years? Please explain.

Panelist 2: Doesnpt seem to be very appealing and have no samples

Panelist 8: as above

Panelist 10: I don't have any patients on this contraception

Panelist 5: I don't think that the trends will change all that much

Panelist 3: 2-3 & maybe. Use will increase if patients tell me that they have a problem swallowing pills.

Panelist 1: NEVER HEARD OF IT BEFORE. SMALL NUMBER OVER NEXT FEW YRS

Panelist 7: FemCon is a step-child of Lo24 in the marketing. I do not see any significant benefit of chewable & do not see any further niche for "Ovcon." Can't believe that you will see much more market share for FemCon over & above the current to 3-6 month numbers.

Panelist 6: 0% IF I FIND OUT ABOUT IT MAYBE MORE

Panelist 9: We used Ovcon for years. Very predictable response. I have not used as much Femcon since it replaced the Ovcon, even though I suspect it is the same compound, minus the "chewable" aspect. I have NOT found this to be a real attractive selling point. The reps from this company are pusing the LoEstrin 24 more aggressively than the Femcon. We do Rx both, but the Femcon less so. This may improve in the next 1-2 years, however.

Panelist 6: AS NOONE HAS DETAILED ME NOR GIVEN ME SAMPLES,I WILLWAIT TO SEE ITS VALUE

Panelist 12: 3 % now , maybe 5 % next year

Panelist 9: I would also say that about 7% of my patients are on the Femcon.

Q10: New products in development

What new products, if any, are you aware of that are in development that you are interested in learning more about or using in the near future?

Panelist 11: None that I know of.

Panelist 2: Have heard about OC product with only yearly withdrawl bleeding

Panelist 5: I am not for sure what is in research currently

Panelist 9: I am unaware of new products in development

Panelist 4: bleeding profiles of implanon

Panelist 1: NOT AWARE OF ANY

Panelist 8: Lybrel and 365

Panelist 6: I PRESUME THERE WILLBE VARIATIONS IN SHORTENING EST.FREE DAYS,OR EXTENDING CYCLE LENGTHS SO THAT NO MENSES OCCUR

Panelist 3: continous pills with no W/D bleeding. I understand there is a loestrin 10 mcg or even 5 mcg (???)type product under development, and I heard that the 5 mcg product will have an indication for smokers. For nonoral products, a lower dose patch.

Panelist 7: No more periods pill

Panelist 12: More continuous dose pills to prevent period for 1 year or longer. Lower and lower dose estrogen pills. Some single stick implantable device. Some IUD designed to stop periods better than Mirena

Panelist 10: I'm interested in trying Implanon and observing the usage of extended cycle birth control pills menses elimination.

Q11: Trends in next 1-3 years

What do you expect the trends in oral contraceptive prescribing patterns in the next 3 years? Please explain.

Panelist 10: I believe that we have arrived at the lowest effective contraceptive dose of birth control pills that seems to be no less than 20 µg of branded estrogen pills. I don't believe that any further progress can be made in finding the lowest effective dose for an oral contraceptive pill, but I do believe that improvements in breakthrough bleeding, cycle control, and continuous oral contraceptive pills with the elimitation of menstrual cycles altogether is the future. Patient acceptances the next hurdle.

Panelist 7: Will there be any NuvaRing competitors? Will there be a lower dose OrthoEvra patch?

Panelist 11: I have no idea.

Panelist 2: possibly more use of extended cycle products and newer progestins

Panelist 5: as low of hormone level as possible with no cycles vs few cycles a year.

Panelist 9: unsure of newer trends in this regard.

Panelist 9: lower dose, changes in progestin type, extended cycle regimens all appear to be likely

Panelist 4: continued low dosing and fewer cycles per year

Panelist 1: OCP WITH SSRI ADDED TO LUTEAL PHASE TO REDUCE PMDD SYMPTOMS

Panelist 8: shorter pill free intervals

Panelist 6: INCREASED REQUIREMENTS BY HMO TO USE SELECTED PRODUCTS(THOSE THAT COST THEM LESS)

Panelist 3: lower doses of E, extended cycles with more than 21 days of active pills.

Panelist 12: trend toward prevention of periods, acne , PMS, and lower doses of estrogen and progesterone

Panelist 7: Will there be any NuvaRing competitors? Will there be a lower dose OrthoEvra patch?

Q12: Other issues

Other than what has been discussed, what is important to know for someone trying to understand the prescribing patterns and likely trends in prescribing in the next few years?

Panelist 10: I believe that the prescriber needs to know that generic oral contraceptive pills, especially the sub 20 µg estrogenic pills dto have data that show an increased failure rate. I believe that transdermal preparations and the possible diminished risk of DVT with these preparations should be thoroughly evaluated. I believe that patient education with respect to amenorrhea induced from taking continuous oral contraceptive pills would be a benefit to our patient population so that the physician does not have to answer extensive questioning with the respect to the induction of this amenorrhea and its perceived health risks.

Panelist 11: Not sure what you are talking about.

Panelist 2: The impact of sales reps and sampling

Panelist 5: The less side effects including acne, break through bleeding will make any formulation a popular choice

Panelist 9: The next few years will bring lower estrogen dosages, unlikely to fall lower than 20 mcg. Extended, continuous regimens will prove more common.

Panelist 4: population looking for option to ocp for better compliance

Panelist 1: OCP SAFE TO USE IN PTS WHO SMOKE, HAVE HTN OR DVTS.

Panelist 8: better compliance safety incertain pt populations

Panelist 6: THE EFFECT THAT MANAGED CARE WILL HAVE ON PRESCRIBING

Panelist 3: It appears that as the dose of E is reduced, that failures may increase unless the cycle is extended. BUt that with extended cycling, even lower doses are possible. Lower dose patches, and other transdermal options would be a boost.

Panelist 7: Can't underestimate the power of patient ed, direct to consumer marketing, samples & dining with the docs!

Panelist 12: More of attempt to address other problems of the patient who also desires birth control such as treating patient with multiple complaints with one pill. Never met any woman who preferred a period over possibility of no periods if possible chemically. Trend to reduce possibilty of blood clots. Trend to develop pill safe for smokers. Trend to develop pill that reduces chance of breast cancer and or heart disease or stroke.

CLOTTING FACTORS

DOES ANY ONE COSIDER TESTING FOR LEIDEN OR CYSTIC FIBROSES?

Panelist 3: I have tested for Leiden factor V when there is a strong family history of DVT in mom or sis on OCPs or in pregnancy.

Panelist 7: Not sure why testing for CF unless you are population screening for pre-conception, which I do. Yes on the Factor V as well as MTHFR (Methyl Tetra Hydro Folate Reductase) enzymatic mutations, though the latter is so new that most cardiologist/intenist/hematologist have no idea what to do with these patients! UGH!

Panelist 12: For monetary reasons usually no I do not think about testing unless family history of clotting disorder

Panelist 10: I too usually don't test for this problem unless there is a strong medical or family history

Panelist 8: The at risk patient gets tested for several thrombophilias. At preconceptional visit all patients are tested for CF

Panelist 11: No, but I do ask about family history of clotting problems.

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