Managed Care - July 2008 - (Page 31) “Building a long-term relationship with the patient to ensure continued commitment to therapy and encourage healthy behaviors that can contribute to effective disease management is a form of value-based marketing,” adds Benzing. “These relationship marketing programs are most powerful when they are interactive and tailored to the individual patient.” Adherence is personal The personal relationships Benzing is referring to are essential to maintaining specialty drug compliance, say health plan officials. “Encouraging our patients to take their drugs as directed offers the very best chance for averting bad outcomes,” says Edmund Pezalla, MD, Aetna Pharmacy Management’s national medical director. “Adherence is difficult with these drugs. Many patients simply don’t like needles; many of these drugs have significant side effects; and the drugs themselves can cost patients a great deal of money. So there are significant clinical advantages to personal interventions.” Health plans and employers adopt a variety of that could indicate someone is not taking medications appropriately and communicate with the physician and the individual to try to determine any barriers and help close those gaps in care,” says Stambaugh. Cigna also stresses the advantage of a single claims platform for specialty drugs that allows for a strong coordination of care. “The information is shared with Cigna medical care managers so they can address any gaps in care during their regular interactions with the individual,” says Stambaugh. With reference to specific benefit designs, Aetna also uses its entire suite of available programs. For example, multiple sclerosis patients frequently suffer from depression, says Pezalla, which can result in non-compliance. “So we make referrals to our behavioral unit as necessary,” he said. Rates of refilling prescriptions can be an accurate measure of overall adherence in a closed pharmacy system, according to Osterberg, “provided that the refills are measured at several points in time,” he said. “A medical system that uses electronic medical records and a closed pharmacy can provide the clinician or research scientist with readily available Because multiple sclerosis patients frequently suffer from depression, which can result in nonadherence, Aetna Pharmacy Management may refer them to behavioral providers. methods to manage specialty medications. Several health plans hire companies such as McKesson to manage these expensive drugs. Several manage the drugs in-house through their own specialty pharmacies. “Our pharmacy management program takes an approach to specialty medications that integrates medical, pharmacy, and behavioral health care to help people with these conditions better manage their care and live as productive lives as possible,” says Cigna’s Stambaugh. Rather than placing expensive specialty drugs on a fourth formulary tier with very high copayments, Cigna Pharmacy Management starts with “recommending benefit plan designs that set per-prescription or annual out-of-pocket limits to help minimize financial barriers to medication compliance,” says Stambaugh. Cigna contacts patients either by postcard or phone call when prescription renewals are approaching. “We look for gaps in medication refills objective information on rates of refilling prescriptions that can be used to assess whether a patient is adhering to the regimen and to corroborate the patient’s responses to direct questions or on questionnaires. Benzing, Patient Marketing Group’s CEO, says that several technologies can help health plans evaluate compliance. Awac, a company in Augusta, Ga., for example, has software designed to do just that, says Rick Richards, MD, president and CEO. Using claims data, the company’s software measures compliance by evaluating refill rates. The data are then evaluated relative to medical histories, and if anomalies occur, Awac nurses contact patients directly. “We enhance clinical competence,” says Richards. “That’s the purpose and value of determining compliance.” “Adherence for specialty drugs is critical to quality care, maybe more so than anywhere in medicine,” says WellPoint’s Sweet. MC JULY 2008 / MANAGED CARE 31
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