Managed Care - May 2008 - (Page 14) NEWS AND COMMENTARY Lower Expenses, Fewer Rxs Follow Multitiered Drug Benefit Design edicare beneficiaries in health plans with a three-tiered drug benefit had lower drug expenses and filled fewer prescriptions than people in plans with no tiers after controlling for demographic factors, health status, and medical copayments according to a study published in Health Services Research. On average, beneficiaries in employer-sponsored retiree health plans incurred $313 less in annual drug expenses and filled 6.7 fewer prescriptions than those in plans without tiers. This was a 14.3 percent and 14.6 percent reduction in drug cost and use, respectively. However, those in three-tiered plans had higher out-of-pocket expenses than those in plans with no tiers. When the researchers looked specifically at expenses for long-term maintenance drugs to treat chronic conditions, they found that Medicare beneficiaries were less responsive to cost-sharing requirements and more likely to shift into generic substitutes, implying that “multitiered plans may curtail inefficient use, without necessarily curtailing utilization of drugs that have beneficial consequences,” says Boyd Gilman, senior researcher at Mathematica Policy Research. “Multitiered copayment structures may be effective in controlling costs for the plan, but insurers have to be careful because they may also introduce barriers to care. Insurers need to be sensitive to whether or not you sacrifice access to important, necessary drugs for greater cost control,” says Gilman. “Our results show that multitiered plans may induce more efficient use of drug resources without sacrificing access to essential medications,” adds John Kautter, coauthor and senior economist at RTI International, a research company. The study was based on drug claims before the implementation of the Medicare Part D outpatient drug program. M Plan Design Helps Poor Get Coverage Before enrolling in a consumerdirected health plan (CDHP), people may want to take stock of their financial assets. Relatively few uninsured households have enough financial assets to cover the cost sharing in CDHPs that are tied to a health savings account (HSA), according to a recent study conducted by Kaiser Family Foundation researchers and published in Health Affairs. An HSA allows beneficiaries to pay for current health expenses and to save for future qualified medical and retiree health expenses on a tax-free basis. While premiums for these plans are relatively low, families with low-tomoderate income levels don’t have the financial assets to cover the deductible should a member get sick. The new study examined the asset levels of households with two or more uninsured members in 2004 and compared it to the range of costsharing features in HSA-qualified health plans. Assets are an important consideration because these families may not have adequate income to pay the potentially high cost sharing under these policies and would have to dip into any savings they might have to pay their bills. “Although lower premiums may increase the ability of the uninsured to buy some coverage, high out-ofpocket liability may leave families exposed to costs that they cannot meet,” write the authors, Kaiser researchers Paul Jacobs and Gary Claxton. Kirk Pion, executive director of consumer initiatives at Health Care Services Corp., which operates the Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas, says this problem can often be addressed during discussions about benefit design between the employer and insurer. “Employers are funding part of the HSA account, so they can offset the member’s exposure and try to fund the HSA appropriately,” Pion says. As a result, HSAs can have a rich preventive benefits package that includes annual physical examinations, immunizations, and mammograms, for example, that are covered 100 percent, Pion says. “Medical directors and pharmacy directors can provide their clinical expertise to the Internal Revenue Service when it comes to what should and what shouldn’t be covered,” says Pion. “Insurers are having some difficulty trying to figure out the IRS’s guidelines about taxable benefits. The guidelines are vague. The government needs some clinical guidance about what constitutes preventive care,” Pion says. E-Prescribing Tools Touted Adverse drug events and low adherence to medication regimens are two concerns addressed by the newest electronic prescribing tools that will be implemented by the Centers for 14 MANAGED CARE / MAY 2008
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