Rx Trends: Employers Crunch Data, Add Clinical Management to Pharmacy Programs


By Stephen Miller October 12, 2009

In addressing the growing problem of chronic disease, U.S. health plan sponsors are increasingly looking to integrate pharmacy and medical data to help improve health and financial outcomes, according to a national survey sponsored by Medco, a pharmacy benefit management firm.

The Medco survey polled 300 U.S. plan sponsors with at least 500 employees in the first quarter of 2009. According to the survey report, 9 Leading Trends in Rx Plan Management, 80 percent of U.S. organizations plan to integrate drug and medical data, while 73 percent intend to add clinical management programs to their pharmacy benefit to help increase patient safety and control plan costs.

"Integrating both medical and prescription claims data is a key strategy in helping to control costs related to chronic and complex conditions," says Mike Romanzo, president of Medco's Systemed Group. "It facilitates identifying medication adherence and safety issues. Pharmacists can then counsel patients to reduce the chances of more serious health problems and additional costs."

Additional survey highlights include:

  • Specialty SOS. In 2009, for the second year in a row, specialty medications are seen as the leading driver of prescription drug costs, and 83 percent of plan sponsors support quick legislative action to bring generic versions of specialty drugs to market. More than 75 percent of plan sponsors have found some relief through reduced prices by billing these drugs under the pharmacy benefit instead of the medical benefit.
  • Mail order improves adherence. Seventy percent of plan sponsors believe that mail-order pharmacies help members stick to essential drug therapies, and nearly half believe that mail-order pharmacists do a better job at identifying adherence problems. Increased medication adherence results in better health outcomes and lower overall health care costs. For example, a recent Medco study found that annual health care costs for hypertensive patients using mail order saw a $700 per-patient reduction attributable to increased adherence to prescribed drug therapy.
  • Pharmacogenomics goes mainstream. More than 60 percent of plan sponsors believe that genetic testing should become a routine part of health care, with large companies leading the trend in covering these tests—nearly half provide coverage, while only 14 percent of small companies do.

The Root of Rising Costs

The Medco survey found that 90 percent of plan sponsors believe that minimal attention to personal health and increased incidence of chronic illness such as diabetes and heart disease are at the root of rising health care costs. When asked what influences will have the greatest impact on controlling these escalating costs, nearly 60 percent of respondents said embracing the concept of wellness will yield the most savings, citing the need to control preventable and self-inflicted diseases often linked to obesity and smoking.

"Plan sponsors recognize that prevention is key to reducing costs and are looking for approaches that will help employees embrace the concept of wellness, adopt healthier habits and follow doctors’ orders when it comes to taking essential medications," comments Tim Wentworth, group president of Medco's employer accounts." A large percentage of our health care dollars are being spent on treatments for diabetes, cholesterol and hypertension—conditions that in many cases could be better controlled, and even prevented, by changing behaviors."

Sidebar 1:
Checking Up on Rx Drug Benefits

“Although in the past many employers focused on maximizing pharmacy benefit management (PBM) financial arrangements to cut costs, they have recently shown interest in efforts that ensure that plan participants are most efficiently utilizing their prescription drug benefit,” says Dr. Ritu Malhotra, vice president and clinical pharmacy consultant at The Segal Company.

She suggests using four strategic tools to improve prescription drug efficiency:

  • Diagnostic check-ups that provide an incisive review of how a plan sponsor’s drug benefit is performing from clinical, financial and plan design perspectives.
  • Streamlined financial audits that provide snapshot views of PBM performance against major financial terms (drug discounts, dispensing fees, rebates) assuring delivery at contracted levels. Snapshot reports also provide valuable market benchmark data and identify areas where additional savings can be realized.
  • Enhanced prescription drug program analyses fill gaps in information provided by medical vendors and PBMs and provide data for fraud and Rx abuse detection and specialty drug utilization.
  • Value-based prescription drug plan design strategies encourage appropriate Rx utilization and help align co-pays and other out-of-pocket costs with effective chronic disease management and prevention. An example: free medication for diabetics to help them better manage their condition.


Sidebar 2:
Small Business Employees and Women Most Likely to Seek Medication Savings

A 2009 CIGNA survey of consumers across the U.S. found that employees at small companies are more likely than those employed by large companies to look for ways to save money on prescription drugs. The study found that 60 percent of consumers are willing to spend 30 minutes on a web site comparing costs and services if it will save them $100. Yet, only 40 percent say that they have compared prices for their prescriptions, even though switching from a brand name drug to a generic drug can save $200 per year on average per prescription.

Additional survey findings include:

  • Employees of small companies (with up to 250 employees) are more likely than those employed by large employers to ask their doctor (65 percent) and pharmacist (61 percent) for ways to save money.
  • Compared to those employed by large companies (over 250 employees), people who work at small companies are more likely to ask their physician for the most cost-effective drug.
  • Regardless of the size of their company, men are more likely (43 percent) than women (30 percent) to take what their doctor tells them to without asking questions about generic alternatives.

A separate survey from CIGNA found that when consumers did comparison shop, only one-third (31 percent) used the Internet to compare drug prices. Of those who do use the Internet to comparison shop for drugs, more than one in five (22 percent) were between the ages of 18 and 34.

Stephen Miller
is an online editor/manager for SHRM.

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