Managed Healthcare Executive - March 2009 - (Page 18) { PHARMACY BEST PRACTICES } Five ways to make CDHP drug plans work MCOs can encourage CDHP members to use appropriate medications and adhere to their drug regimens despite the rising cost of drugs and cost share. Provide rst-dollar coverage for preventive care, which allows medications to bypass the deductible. “The member receives a lower cost share, easing one of the primary barriers to adherence,” says Glenn Sungela, director, consumer solutions for Medco Health Solutions. He says that sponsors have wide discretion on the medications they cover prior to meeting the deductible in a CDHPs with a health reimbursement account. Those plans with HSAs are subject to IRS quali cation rules, which allow sponsors to provide rst-dollar coverage for preventive medications only. Offer an actuarially equivalent/bene t-neutral plan design, which means bene ts that are comparable to previously offered traditional plans. CDHP plans should reduce costs year-over-year without shifting costs to the individual by featuring employer-funded accounts, such as HRAs and HSAs, says Thom Stambaugh, chief clinical of cer of CIGNA Pharmacy Management. 1 2 3 4 5 persistency—in their CDHP populations. Medco’s recent adherence study for patients prescribed medications for high blood pressure, high cholesterol and diabetes compares members who were enrolled in a traditional bene t plan in 2006 to those who opted for a CDHP in 2006. The compliance and persistency rates for the new CDHP members dropped by as much as 9%. Sungela attributes the drop to a variety of reasons: 1) CDHP members tend to keep funds in their accounts, even forgoing preventive care; 2) members tend to be young and healthy and maintain the perception that they do not need healthcare; 3) a donut hole in the CDHP bene t, in which members pay 100% of costs, deters healthcare purchasing; and 4) compliance can decrease when communication decreases, depending on cash ow and health literacy of the population. OTHER DATA Stockbyte/Getty Images Develop a plan design option that allows members to pay three 30day installments aligned to their income ow rather than requiring full payment of a 90-day prescription up front, says Sungela. Offer robust quality and cost decision support tools to help individuals make more informed health choices that can improve health outcomes and cost ef ciency. Steven Johnson, senior director of clinical consultative services for Prime Therapeutics, supports the use of tools and programs that discuss the value of lower cost-effective therapies, including generics and over-the-counter products, and that encourage members to engage in conversations with their physicians about the value (safety and effectiveness of the drug therapy) for the medical condition for which they are being treated. Provide proactive health coaching, such as the CIGNA Health Advisor program, and maintain the communication channels. — Mari Edlin A study published in the July/August issue of Health A airs supports Medco’s ndings. It reported the impact of CDHPs on prescription drug use and found that enrollees in high-deductible plans were much more likely than those in other plans to discontinue their chronic-illness medicines in two classes: antihypertensives and lipid-lowering medications. The study examined patterns in prescription drug use in the rst year that CDHPs were o ered along side traditional plans. Enrollment in a CDHP did not, however, reduce adherence among those continuing their medications, nor did it greatly in uence the use of generic drugs. MHE FOR MORE INSIGHT See more Pharmacy Best Practices on managedhealthcareexecutive.com 18 MARCH 2009 http://www.managedhealthcareexecutive.com
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