Managed Healthcare Executive - March 2009 - (Page 16) { PHARMACY BEST PRACTICES } available in their healthcare reimbursement arrangements (HRAs) or health savings account (HSAs). Other studies show similar results. Nearly 75% of CDHP members indicate that they factor in cost when deciding whether to see a doctor or ll a prescription, compared with 47% in a traditional plan, according to the Employee Bene t Research Institute (EBRI) in a 2008 study. The Institute also says that 38% of those with consumer-directed coverage say they have delayed or avoided necessary healthcare because of cost. DRUG TREND DROPS members was 5% higher. Each percent higher generates 2% in cost savings. In the rst year, overall medical trend for CIGNA Choice Fund plans was -3.3% versus +10.6% for traditional plans. In addition, the study shows that the lower medical trend for CDHPs continues in subsequent years. Stambaugh says that the survey has helped to dispel existing myths about CDHPs, namely that members don’t use appropriate quality care because it is too expensive and that employers only accrue savings for cost-shifting during the rst year. EXECUTIVE VIEW 75% of CDHP members factor in cost when deciding whether to see a doctor or fill a prescription, compared with 47% in a traditional plan. Individuals in CIGNA CDHPs reduced costs, but maintained or improved their levels of care. Generally, CDHP members are apt to be thriftier because they have financial incentive to do so. A positive note comes from the results of the 2009 CIGNA Consumer Driven Health Plan Claims Experience Study, which compared claims data for 22,000 members with diabetes and hypertension in both CDHPs and traditional HMOs and PPOs. The objective was to determine whether members were cutting costs by scaling back care. The multiyear study shows that while individuals in CDHPs reduced costs, they maintained or improved their levels of care. Medical cost trend was substantially less for CIGNA Choice Fund members (CIGNA’s high-deductible plan) with diabetes (20%) or hypertension (18%) than for individuals with either of those diseases in traditional CIGNA health plans. Since all members maintained similar treatment regimens, the results suggest that CDHP individuals’ lower cost trend is likely a result of better chronic disease management, rather than because of patients forgoing recommended care. In the rst year, pharmacy cost trend for those enrolled in a CDHP was 10% lower than traditional plan cost trend. Thom Stambaugh, chief clinical o cer of CIGNA Pharmacy Management, anticipates that in the second year, the pharmacy drug trend will drop 4%. The use of generics by CDHP 16 MARCH 2009 “As an integrated PBM, our value proposition is to optimize clinical outcomes through drugs by demonstrating the lowest net pharmacy costs, which should affect total costs,” Stambaugh says. YOUNGER, HEALTHIER MEMBERS Glenn Sungela, director, consumer solutions for Medco Health Solutions, believes that individuals in CDHPs use fewer medications because they are healthier—an idea borne out by data. “In general, CDHP members use less of the overall bene t [than their counterparts in traditional plans] and are apt to be better shoppers and more thrifty because 100% of the cost share is theirs before the deductible [is met],” he says. “When a lower cost drug is available, they are more likely to consistently choose that less-expensive drug.” Sungela also suggests that well-informed members are better consumers of care. To complement Medco’s Consumer Choice Plan, a CDHP o ering, the PBM created My Rx Choices, which provides information on the drugs members are taking and potential savings if they select a generic alternative or use mail-order services. More than half of the Consumer Choice Plan members made a switch from brand to generic drugs after using the tool. Despite evidence backing cost control as the primary objective of CDHPs, Medco Health Solutions found that more than half of national health plan sponsors in a recent survey believe that CDHPs are the least likely approach to have an impact on controlling prescription drug costs compared with generic use, mailorder service and disease management programs. Upon detecting potential gaps in care, Medco alerts members to reinforce the importance of following their physician’s recommended drug regimen and provides resources, which helps counteract the temptation to avoid or delay therapies. Medco also encourages physicians and pharmacists to help members better understand the use of their medication. CIGNA Pharmacy Management also encourages compliance with regimens with a pricing tool for members. Its online Prescription Drug Price Quote tool provides real-time, actual out-ofpocket cost information for prescriptions at 57,000 pharmacies nationwide. Individuals can see how much they will save over the course of a year. On the other hand, some healthcare organizations are witnessing a negative impact on drug utilization—primarily adherence and
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