Managed Care - September 2008 - (Page 11)

MEDICATION MANAGEMENT anti-inflammatories, anti-ulcers drugs, and antidepressants, the cost savings were too small to justify implementing a program because of the availability of generic or over-the-counter (OTC) drugs in the class. Express Scripts discovered that physicians had several rationales for continuing twicedosing regimens. For elderly patients, several physicians expressed concern about impaired kidney function and, as a result, preferred lower dosing. For patients on antipsychotics, compliance was an issue. “Some physicians said that their patients were more likely to take at least part of their medications if they had two opportunities a day to remember,” says Delate. Another rationale was that some physicians wanted patients to take their medications with morning and evening meals. Limits According to Robert Oscar, president of RxEOB in Richmond, Va., which sells pharmacy benefit management software for use in consumer-directed plans, the Express Scripts study highlights the cost-savings limits of what he calls “traditional physician education, mailings, and prior authorization programs.” “The idea is to lower the cost of programming to encourage dose consolidation when it does make sense,” says Oscar. “Less expensive programs such as Internet-based messaging and emerging e-prescribing support could make dose consolidation cost-effective.” A study by researchers at Provider Service Network (PSN), a management services company in Boston, found that the types of programs Oscar is referring to can be cost-effective. According to David Calabrese, RPh, director of pharmacy services at PSN, the problem with the Express Scripts research was that the PBM only looked at potential interventions “randomized to either a letter to the physician or a letter to the physician and patient. Sending a letter to a physician, who is not at risk for pharmacy costs, without a recent drug profile, new prescription, or patient letter to sign, would result in poor physician compliance with the requested intervention.” His company’s approach to dose consolida- tion is aggressive and demonstrates higher savings. “Our materials are presented to physicians during one-on-one and group educational sessions where the physicians are asked to review the patient-specific request for conversion, indicate whether it is clinically appropriate, and sign the patient letter and new prescription if they are in agreement with the change,” says Calabrese. As a result of this aggressive approach, PSN achieved savings of 5 cents to 9 cents PMPM. PSN states that investment in their dose consolidation program results in a 5:1 return on investment. Some PBMs and plans do find that dose consolidation programs are cost effective. Cigna Pharmacy Management has used dose consolidation interventions since 2001 for its fully insured members. Cigna contacts physicians recommending that they change to a once-daily dose, but only if the physician deems the change appropriate, says Thom Stambaugh, PharmD, vice president for clinical pharmacy. He adds that physicians are receptive because they believe single dosing improves compliance — although the number of patients switching to a single dose is apparently small. Medco Health Solutions also uses dose consolidation intervention to save money, says Woody Eisenberg, MD, vice president and chief medical officer of the PBM. “It is most appropriate for drugs with a long half-life.” Dose consolidation works, “but the problem is that there is not much return,” says Thomas Delate, PhD, clinical pharmacy research scientist for Kaiser Permanente of Colorado. 70 percent change rate In 2005, Medco saved its plan sponsors up to 0.3 percent PMPM of total drug spending through dose consolidation, Medco officials report. Some state Medicaid programs are aggressive in promoting dose consolidation. Wisconsin pays pharmacists to contact physicians and recommend consolidation for a specific list of drugs, mostly antidepressants and antipsychotics. Kansas reported saving nearly $38,000 in 2005 as the result of dose consolidation. “There are possible savings. Dose consolidation does work, but we concluded that our clients were just not getting that much out of such a program,” says Delate. MC SEPTEMBER 2008 / MANAGED CARE 11

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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