WOONSOCKET, R.I. CVS Caremark is presenting data at the Academy of Managed Care Pharmacy 2010 Educational Conference illustrating how innovative approaches to traditional plan designs can help clients reduce drug spend, improve generic dispensing rates and minimize member disruption.
The AMCP 2010 Educational Conference is being held in St. Louis from Oct. 13 to 15.
"[Pharmacy benefit managers] have a variety of tools available to help clients reduce costs and increase GDR; however, because these approaches may require a change in member behavior and can be disruptive to the member experience, clients may hesitate to fully implement these plan designs," stated Per Lofberg, head of CVS Caremark's PBM business. "Our research shows that by adapting these traditional plan design elements to provide members with appealing options, increased flexibility and proactive communications, we can minimize member disruption and increase the savings opportunity for clients."
During the conference, the company is sharing results from three different client experiences that demonstrate how by adapting such traditional plan design approaches as step therapy and 90-day prescription mail pricing, plan sponsors see improved results while members experience minimal disruption.
One of the CVS Caremark studies reviewed a new approach to driving a generics-first strategy focused on proton-pump inhibitors. This class of drugs reflected a significant pharmacy spend for an employer client, and the clients' goals were to reduce prescription spend in this drug class, without compromising access or member satisfaction. Rather than implementing a traditional plan design in which drugs in the class would be shifted to a higher tier or the member cost-share would be increased, the client opted to provide members with first-line access to generic options and a preferred brand, which was due to become available as a generic (lansoprazole) within six months of implementation. In addition, members received the CVS Caremark ExtraCare health card, a pharmacy discount card that provided them with a 20% discount on FSA-eligible store brands to help manage the costs of over-the-counter alternatives. Members and their prescribing physicians also received proactive communications about the new plan design three months prior to implementation.
Results showed that the proactive communications outreach significantly decreased potential member disruption, with 56% of eligible members converting from a nonpreferred brand to an alternative therapy in the first four months of the program before experiencing a rejected claim. In addition, one year after program implementation, the client experienced a 20% reduction in PPI spend, and the client's GDR in the PPI class of drugs increased from 53.7% (one month prior to implementation) to 75.6% in the first month and remained steady in the five subsequent months.
Asecond study examined the impact of a step therapy program designed to address concerns about potential member disruption, which is common when implementing step therapy where members are required to use preferred brand or generic drugs before nonpreferred drugs. Prior to implementation, three phases of proactive communication and outreach were conducted:
- The plan sponsor sent notification letters about the upcoming plan design change to members and physicians 60 and 30 days prior to implementation;
- A dedicated call center handled questions and prior authorization requests; and
- Physicians were able to proactively request prior authorization through the call center prior to implementation of the new plan design.
After program implementation, the average gross cost per claim for the 10 selected classes resulted in savings of 12.8%, and the GDR rose from 57.5% to 72.8% after one year of the program. Furthermore, the client reported no escalated member complaints.
Athird study highlighted the reduction in overall drug spend that can be achieved by implementing Maintenance Choice, a plan design that provides members with options for how they can receive their 90-day maintenance prescriptions in a mandatory mail plan design. The plan design allowed the client -- a health plan ASO employer group that manages 18,000 lives -- to move from a voluntary mail plan to a mandatory mail plan that also provided members with the option to receive their 90-day maintenance prescriptions either through mail order or at one of the more than 7,100 CVS/pharmacy locations nationwide for the typically lower mail co-pay and cost. The study analyzed the group's cost and utilization for 15 months before and after the implementation of Maintenance Choice to assess financial impacts, as well as changes in GDR. Results found that in the 15 months after moving from voluntary mail to Maintenance Choice, the client achieved a savings of 5.7% in average gross cost per day with 82% of eligible maintenance utilization (as measured by days supply) being dispensed at 90-day mail pricing. In addition the client's GDR increased from 59% to 68% as the result of combining Maintenance Choice with other plan design changes to drive generic utilization.