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CVS Caremark research examines health outcomes of cutting Rx co-pays post-heart attack

BY Antoinette Alexander

WOONSOCKET, R.I. — A new study by researchers at CVS Caremark, Aetna and Brigham and Women’s Hospital finds that eliminating co-pays for preventive medications prescribed for post-heart attack patients can significantly improve medication adherence and health outcomes for non-white patients, which suggests that this approach may be an effective strategy for reducing commonly recognized disparities in cardiovascular care related to patient ethnicity and race.

The findings were published today in the May issue of Health Affairs.

Racial and ethnic disparities in cardiovascular care have been widely documented in the peer-reviewed literature and persist despite overall improvements in cardiovascular mortality and risk factor control. In fact, research by CVS Caremark and Brigham and Women’s Hospital published last year in the American Heart Journal, found that non-white patients had 50% greater odds of medication nonadherence to statin medications compared with white patients.

"A series of studies have demonstrated that a Value Based Insurance Design approach that reduces or eliminates medication co-pays is a cost-effective strategy for increasing adherence and improving cardiovascular outcomes," said Niteesh Choudhry, associate physician for the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, associate professor at Harvard Medical School and the lead author of the study. "This new analysis demonstrates that VBID also can reduce disparities in cardiovascular care and health outcomes related to a patient’s race and ethnicity."

The Post-Myocardial Infarction Free Rx Event and Economic Evaluation trial conducted by Brigham and Women’s Hospital, Harvard Medical School and Aetna — full results of which were previously published in the New England Journal of Medicine in 2011 — originally compared full (i.e., no co-payments, coinsurance or deductibles) with usual drug insurance coverage for all statin, beta-blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers prescribed after a heart attack. In this new, secondary analysis, the researchers reviewed the data to see whether providing full coverage for post-MI medications had differential effects based on race and ethnicity. More than 2,300 individuals were included in the analysis, of which 22.2% self-identified as being of non-white race/ethnicity.

The study found that:

  • For all patients, full coverage significantly improved medication adherence;
  • Providing full drug coverage significantly reduced rates of a post-MI major vascular event or revascularization among patients who self-identified as being non-white, but had no impact on clinical events for individuals of white race or ethnicity; and
  • Providing full drug coverage reduced total healthcare spending by 70% among patients who self-identified as being non-white.

"There have been a lot of studies demonstrating that disparities in care exist. This study shows us a straightforward way to reduce those disparities and improve health outcomes. We think this is an important contribution," said William Shrank, SVP and chief scientific officer of CVS Caremark, and a study co-author. "We should note that the value based insurance design approach of eliminating copayments for maintenance medications after a heart attack is actually a relatively simple, low-risk change that should be considered for broader usage."

CVS Caremark’s VBID program offering is aimed at removing the barrier of cost to help improve the medication adherence of members. There are currently more than 100 clients enrolled in the program that targets seven chronic conditions. The program is able to provide an increase of 4% to 9% in adherence, as measured by medication possession ratio, and more than 10% improvement in moving members with sub-optimal adherence to optimal adherence in certain cardiovascular diseases.

This analysis of medication adherence and the impact on racial and ethnic disparities was supported by an unrestricted research grant from Aetna to Brigham and Women’s Hospital. CVS Caremark has been supporting a multi-year research collaboration with Brigham and Women’s Hospital to better understand patient behavior, particularly around medication adherence. Annual excess healthcare costs due to medication nonadherence in the United States have been estimated to be as much as $290 billion.

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Harris Poll: Last flu season ‘fairly typical’ in terms of who got flu shots and who got the flu

BY Michael Johnsen

NEW YORK — Last winter’s flu season was fairly typical of other winters over the last decade, with the prevalence of the flu and the number of people who had flu shots both fairly close to the averages for that time period, the Harris Poll reported Tuesday. The effectiveness of flu vaccines also seems to have been fairly typical.

According to a poll of 2,300 adults surveyed online between April 16 and 21, 2014, 44% of all adults report that they had flu shots. This compares with 40%, 39%, 44%, 40% and 44% over the five previous winters. And as many as 13% of adults believe that they had the flu last winter, compared to 18%, 12%, 11%, 11% and 14% over the five previous winters.

As in most of the Harris Polls on this topic over the last ten years, the numbers of people who believe they had the flu was almost the same for people who had flu shots (12%) and those who did not (13%). However, it would be a mistake to conclude from this that the vaccine was ineffective. There is clear evidence in this poll that people who were more vulnerable were also more likely to have received shots.

For example, efforts to vaccinate the elderly, who are more vulnerable to flu, seem to have been quite effective. Fully 76% of people aged 65 and over were vaccinated, and only 7% of seniors report that they had the flu. People aged 25 to 29 years were the least likely (16%) to be have had flu shots, and they were the most likely (19%) to believe that they had the flu.

Almost half of all adults (47%) think they will get flu shots next winter. This includes the great majority (92%) of people who had one last winter and only a few (10%) of those who did not.

"The diagnosis, and particularly self-diagnosis, of the flu is not very reliable, as other infections can produce flu-like symptoms," noted Harris Poll chairman Humphrey Taylor. "This raises the question of whether some people who report having had the flu may have been mistaken." This year’s survey finds that about three quarters of these people are "certain" they had the flu (74%) and two thirds spent one or more days in bed (66%). However, only 47% visited a doctor who diagnosed the flu.

 

 

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Duane Reade shopping app updated, incorporates integration of iBeacon

BY Michael Johnsen

NEW YORK — Duane Reade on Tuesday released the first update to its app for iPhone including the integration of iBeacon for 10-select Duane Reade locations active as of May 1. 

“The Duane Reade app plays an integral role in our omnichannel customer engagement strategy,” stated Calvin Peters, PR/digital communications manager for Walgreens. “Mobile interaction is at the core of our social media success as mobile and social are intrinsically linked; the addition of these new 2.0 features, as well as the integration of iBeacon technology, will continue to fuel our digital customer experience strategy, as we strive to push forward our New York Living Made Easy mantra," he said. "It is incredibly important for Duane Reade to be where our customers are, including on their smart mobile devices. This update aligns with our goal to provide them with tools, programs and category specific consumer-generated media that offer relevant convenience, including trusted product and service insights.”

This update significantly adds to the existing features in the Duane Reade iPhone app including: the new Weekly Ads & Coupons, Pill Reminder, DR Walk-In, Preferred Store, Shopping List, Steps and QuickPrints from Instagram. The app update is part of Duane Reade’s commitment to foster greater customer engagement with its value-added loyalty offers, including digital and social content initiatives tied to the in-store shopping experience.

According to Duane Reade, the addition of iBeacon to the Duane Reade app vastly improves the customer in-store user experience. iBeacon is a technology Apple introduced with iOS 7 that uses Bluetooth Low Energy and geo-fencing to provide apps a new level of micro-location awareness, such as trail markers in a park, exhibits in a museum or product displays in stores. The inclusion of this technology to the Duane Reade app adds features such as lock screen notifications when initially approaching a select Duane Reade store location, coupon offers based on historical data and product reviews for timely content at the point-of-decision. iBeacon will initially be available at 10 select Duane Reade stores in Manhattan to test the viability of a further rollout.

The 2.0 update is the first in a series of major app announcements planned for Duane Reade in 2014, Peters said. The first wave of releases brings the app up-to-par with the features of the Walgreens’ iPhone app. Through the app’s in-store mode, customers will have quick access to their individual Balance Rewards loyalty program barcode, paperless coupons scorecard indicating the specific number clipped and the savings associated with each, a floor map displaying a bird’s eye view of the store location, product locator for item search and location plotting of the item via the in-store map, scanner options allow for instant product scans revealing detailed item information, mobile coupon clipping for immediate redemption at POS facilitating a seamless value-added experience via Balance Rewards and instant Instagram 4X4 prints directly to a Duane Reade location.

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