Managed Care - September 2008 - (Page 10)

MEDICATION MANAGEMENT Dose Consolidation May Not Be Worth the Trouble A low return on investment and high implementation costs keep dose optimization from taking hold in some pharmacy benefit programs By Martin Sipkoff ith more than a dollar out of every $10 in health care costs spent on drugs, health plans and pharmacy benefit management companies search for as many ways to save money as they can. But sometimes an approach does not live up to expectations. Dose consolidation, sometimes called dose optimization, may be one such idea. scription intervention letters to physicians and patients recommending consideration of single dosing for specific medications. A subsequent Express Scripts study examined cost-effectiveness in light of implementation costs and assessed the rate of consolidation that would have occurred had the physicians not been contacted. Delate and colleagues examined pharmacy claims for more than 500,000 members of a large mid-Atlantic health plan from November 2002 to February 2003. They found that about 9 percent of physicians receiving dose consolidation letters changed their patients’ prescriptions to a once-daily dose. They also found that 4 percent of physicians who were part of a randomly assigned control group that did not receive letters switched their patients to a once-daily dose even without being contacted. Taking into account program costs, dose consolidation that occurred without an intervention, and members who stopped taking the prescriptions possibly as a result of consolidation, only about .08 percent PMPM drug costs savings was achieved, “too low a rate, we believed, to overcome the concerns of some of the physicians we contacted and rationalize the expense of the intervention,” says Delate. W Sounds like a good idea The basic idea behind dose consolidation is that if plans or PBMs encourage physicians to prescribe a once-daily tablet instead of two lower-strength tablets when per-tablet cost is identical, they can lower drug costs. On the surface it seems like a good idea, but in one study, Express Scripts found that once administrative costs are taken into account, it may cause more trouble than it is worth. “We found that it works, but the problem is that there is not much return,” says Thomas Delate, PhD, clinical pharmacy research scientist for Kaiser Permanente of Colorado and former outcomes research manager for Express Scripts. He is the co-author of a study that found that although dose consolidation can save two to three cents per member per month, “that does not add up enough to risk patient and physician dissatisfaction with health plan and PBM intervention. “Researchers at Pharmaceutical Research and Manufacturers of America [PhRMA] had contacted a Medicaid program, pointing out that the program could lower its overall drug costs if it consolidated doses for certain drugs,” says Delate. “The program contacted Express Scripts to see whether an intervention at the point-ofservice level would work.” Rather than intervening directly at point of service, such as implementing on-screen notices to pharmacists, Express Scripts took what Delate calls a softer approach and sent post-pre- Not much return Although the Express Scripts consolidation intervention program did find cost-saving opportunities for some therapy classes — including calcium blockers, antihypertensives and antihyperlipidemics — the researchers found that the number of prescriptions was too small to justify implementing a program for those classes alone. In some other therapy classes with a significant number of prescriptions, such as Contributing Editor Martin Sipkoff is a long-time health care journalist. 10 MANAGED CARE / SEPTEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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