Managed Healthcare Executive - March 2009 - (Page 15) { PHARMACY BEST PRACTICES } New data suggests CDHP members maintain levels of care One of the main criticisms of consumer-directed health plans questions whether members avoid needed medications to save money BY MARI EDLIN Mari Edlin is a frequent contributor to MANAGED HEALTHCARE EXECUTIVE. She is based in Sonoma, Calif. of members: individuals with out-ofpocket outlays of $1,000 to $1,999, or families with $2,000 to $3,999 out-ofpocket (Level l); individuals with out-ofpocket of $2,000 to $3,999, or families with $4,000 to $7,999 (Level 2); and individuals with more than $4,000 in out-of-pocket, or families with more than $8,000 in outlays (Level 3). Nearly 94% of those examined were Level 1 or Level 2. The study shows that the higher the deductible, the fewer drugs used, falling from 82.5 prescriptions per 100 members per month in Level 1, to 69.4 in Level 2, and 41.9 in Level 3. When prescriptions for key chronic medications were observed, the pattern remained the same, but the discrepancy was not nearly as wide: 31.3 prescriptions per 100 members per month in Level 1, 26.7 per 100 per month in Level 2, and 17 per 100 per month in Level 3. Prime Therapeutics’ commercial bank of business showed 95.8 prescriptions per 100 members per month for all drugs and 38.7 for chronic disease medications. The use of generONSUMER-DRIVEN HEALTH plans ics did not di er substantially between (CDHPs) emerged in 2000 as a remedy for the levels. controlling costs, but some believe the design Steven Johnson, senior director of also discourages the use of helpful medications and clinical consultative services for Prime services. The ultimate answer to the question has Therapeutics, says the study has proyet to be determined. Studies of member utiliza- voked quite a few questions about the tion have found the impetuses behind spending implications of the results, includtrends in these plans: high costs of services, more ing what constitutes the most e ecprudent buying habits, healthier individuals and tive CDHP plan and deductible levhigher cost-sharing. els and the impact on adherence and A study by Prime Therapeutics supports the continuation of therapy rates. He will notion that costs in uence drug utilization in say, however, that the more people are CDHPs. The Minneapolis-based pharmacy ben- asked to pay, the less they will use, most e ts manager (PBM) investigated three groups likely based on the number of dollars Rubberball/Getty Images C MARCH 2009 15
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