Transcript Slide - Express Scripts

The Ripple Effects of
Trend Management
Ed Weisbart, MD, CPE, FAAFP
Express Scripts
The Ripple Effects of
Trend Management
With thanks to:
Andy Behm
Emily Cox
Mark Eatherly
Amit Kulkarni
Yakov Svirnovskiy
Doug Mager
Rebecca Sedjo
Beyond Trend Management
Trend
Management
Clinical
Outcomes
Member
Satisfaction
Beyond Trend Management
Trend
Management
Clinical
Outcomes
Member
Satisfaction
Beyond Trend Management
Formularies
Trend
Management
Adherence
CDHP Education
Clinical
Outcomes
Member
Satisfaction
Beyond Trend Management
Formularies
Trend
Management
Adherence
CDHP Education
Clinical
Outcomes
Member
Satisfaction
Two Years Ago We Said…
65%
50%
LDL
Reducing
Potency
Simvastatin:
30 – 47%
25%
0%
Two Years Ago We Said…
65%
Crestor:
45 – 63%
50%
LDL
Reducing
Potency
Vytorin:
45 – 60%
Lipitor:
39 – 60%
Simvastatin:
30 – 47%
25%
Lovastatin:
21 – 42%
0%
Low
2006 AWP
High
Did Switchers
Two Years
Ago We Said…
Compromise Their Health?
65%
Crestor:
45 – 63%
50%
LDL
Reducing
Potency
Simvastatin:
30 – 47%
25%
Vytorin:
45 – 60%
Lipitor:
39 – 60%
?
Lovastatin:
21 – 42%
Over 80% of
Lipitor used
in low dosages.
0%
Low
2006 AWP
High
Did Switchers
Two Years
Ago We Said…
Compromise Their Health?
65%
80 mg Lipitor: 60% LDL reduction
50%
LDL
Reducing
Potency
Lipitor:
39 – 60%
40 mg Lipitor: 50% LDL reduction
20 mg Lipitor: 43% LDL reduction
25%
10 mg Lipitor: 39% LDL reduction
0%
Low
2006 AWP
High
Potency Was Generally Preserved
Potency Was Generally Preserved
Potency Was Generally Preserved
Potency Was Generally Preserved
Potency Was Generally Preserved
Potency Was Generally Preserved
Potency Was Generally Preserved
Key Findings
Statin potency was generally preserved
Financial incentives did not drive
unhealthy choices
Clinically-based formulary decisions
prevent compromises in health outcomes
Beyond Trend Management
Formularies
Trend
Management
Adherence
CDHP Education
Clinical
Outcomes
Member
Satisfaction
How Does Adherence
Impact HTN Prescribing?
Same drug
Same dose
Drug A
prescribed
Same drug
Higher dose
Second
drug added
How Does Adherence
Impact HTN Prescribing?
80 - 100%
Same drug
Same dose
60 - 80%
Drug A
prescribed
40 - 60%
Same drug
Higher dose
20 - 40%
0 - 20%
Second
drug added
Odds of escalation event
Non-Adherence Adds More Drugs
Odds of escalation event
Non-Adherence Adds More Drugs
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 1
What happens when…
•Initial Rx: $32
•Escalated Rx: $30
Medication Possession Ratio
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 1
What happens when…
•Initial Rx: $32
•Escalated Rx: $30
Medication Possession Ratio
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 1
What happens when…
•Initial Rx: $32
•Escalated Rx: $30
Medication Possession Ratio
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 1
What happens when…
•Initial Rx: $32
•Escalated Rx: $30
Waste
Medication Possession Ratio
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 2
What happens when…
•Initial Rx: $24
•Escalated Rx: $101
Medication Possession Ratio
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 2
What happens when…
•Initial Rx: $24
•Escalated Rx: $101
Medication Possession Ratio
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 2
What happens when…
•Initial Rx: $24
•Escalated Rx: $101
Medication Possession Ratio
Escalation Contributes to Trend
Average monthly Rx cost
Scenario 2
Waste
What happens when…
•Initial Rx: $24
•Escalated Rx: $101
Medication Possession Ratio
Key Findings
Non-adherence drives to new
prescriptions rather than increased doses
Pattern contributes to trend overall
A subgroup has this as a significant
trend component
Beyond Trend Management
Formularies
Trend
Management
Adherence
CDHP Education
Clinical
Outcomes
Member
Satisfaction
CDHP Ripple Effects
Who selects a CDHP?
Basic demographics
What happens to their drug mix?
Do they seek out lower-cost alternatives?
If so, did Rx savings compromise health?
Are they only prudent where it’s safe?
CDHP Ripple Effects
Who selects a CDHP?
Basic demographics
What happens to their drug mix?
Do they seek out lower-cost alternatives?
If so, did Rx savings compromise health?
Are they only prudent where it’s safe?
A Common Benefit Design
Baseline (2005)
Retail: $10/$20/$50
Mail: $20/$60/$100
Traditional
Deductibles:
•$50 Ind./$100 Family
CDHP
Not offered
A Common Benefit Design
Baseline (2005)
Retail: $10/$20/$50
Mail: $20/$60/$100
Traditional
Deductibles:
•$50 Ind./$100 Family
CDHP
Not offered
Year 1 (2006)
No change
A Common Benefit Design
Baseline (2005)
Retail: $10/$20/$50
Mail: $20/$60/$100
Traditional
Deductibles:
•$50 Ind./$100 Family
CDHP
Not offered
Year 1 (2006)
No change
Retail: Generics 10% ($5
min)
Brands 25% ($20 min)
Deductibles:
•$2,500 ind./$5,000 family
Out-of-pocket maximum:
•$3,500 individual
•$7,000 family
HSA: 100% match ($500
ind./$1000 family)
A Common Benefit Design
Baseline (2005)
Retail: $10/$20/$50
Mail: $20/$60/$100
Traditional
Deductibles:
•$50 Ind./$100 Family
CDHP
Not offered
Year 1 (2006)
No change
Retail: Generics 10% ($5
min)
Brands 25% ($20 min)
Deductibles:
•$2,500 ind./$5,000 family
Out-of-pocket maximum:
•$3,500 individual
•$7,000 family
HSA: 100% match ($500
ind./$1000 family)
Year 2 (2007)
No change
A Common Benefit Design
Baseline (2005)
Retail: $10/$20/$50
Mail: $20/$60/$100
Traditional
Deductibles:
•$50 Ind./$100 Family
CDHP
Not offered
Year 1 (2006)
No change
Retail: Generics 10% ($5
min)
Brands 25% ($20 min)
Deductibles:
•$2,500 ind./$5,000 family
Out-of-pocket maximum:
•$3,500 individual
•$7,000 family
HSA: 100% match ($500
ind./$1000 family)
Year 2 (2007)
No change
No change
Added
ChoiceMatters
They Attract Different Groups
50
40
Cardholder Age Household Age
45
Household Size
3
2.8
44
2
42
36
30
20
1
0
10
2
75%
0%
Traditional
All significant at p<0.05
CDHP
64%
50%
25%
0
Male Cardholders
-25%
25%
CDHP Ripple Effects
Who selects a CDHP?
What happens to their drug mix?
Do they seek out lower-cost alternatives?
If so, did Rx savings compromise health?
Are they only prudent where it’s safe?
CDHP Ripple Effects
Who selects a CDHP?
Younger, male, larger household
What happens to their drug mix?
Do they seek out lower-cost alternatives?
If so, did Rx savings compromise health?
Are they only prudent where it’s safe?
CDHP Ripple Effects
Who selects a CDHP?
Younger, male, larger household
What happens to their drug mix?
Do they seek out lower-cost alternatives?
If so, did Rx savings compromise health?
Are they only prudent where it’s safe?
Traditional Plan 2005-2006:
14% Increase in PMPY Claims
14
12
10
PMPY Claims
8
6
4
2
0
Total Rxs
2005 Trad.
Generics Rxs
2006 Trad.
Adults only; CDS Matched; **p<.01
2005 Pre-CDHP
Brand Rxs
2006 CDHP
14
Traditional Plan 2005-2006:
Generics Up, Brands Flat
12
10
PMPY Claims
8
6
4
2
0
Total Rxs
2005 Trad.
Generics Rxs
2006 Trad.
Adults only; CDS Matched; **p<.01
2005 Pre-CDHP
Brand Rxs
2006 CDHP
14
CDHP 2005-2006:
Slight Drop in Total Claims
12
10
PMPY Claims
8
6
4
2
0
Total Rxs
2005 Trad.
Generics Rxs
2006 Trad.
Adults only; CDS Matched; **p<.01
2005 Pre-CDHP
Brand Rxs
2006 CDHP
14
CDHP 2005-2006:
Generics Up, Brands Down
12
10
PMPY Claims
8
6
4
2
0
Total Rxs
2005 Trad.
Generics Rxs
2006 Trad.
Adults only; CDS Matched; **p<.01
2005 Pre-CDHP
Brand Rxs
2006 CDHP
CDHP Ripple Effects
Who selects a CDHP?
Younger, male, larger household
What happens to their drug mix?
Did Rx savings compromise health?
Are they only prudent where it’s safe?
CDHP Ripple Effects
Who selects a CDHP?
Younger, male, larger household
What happens to their drug mix?
Increased generics, decreased brands
Did Rx savings compromise health?
Are they only prudent where it’s safe?
CDHP Ripple Effects
Who selects a CDHP?
Younger, male, larger household
What happens to their drug mix?
Increased generics, decreased brands
Did Rx savings compromise health?
Are they only prudent where it’s safe?
2006: We Were Concerned
Q1 2006 persistence rates
*p<.05
2007: ChoiceMatters
Baseline (2005)
Retail: $10/$20/$50
Mail: $20/$60/$100
Traditional
Deductibles:
•$50 Ind./$100 Family
CDHP
Not offered
Year 1 (2006)
No change
Retail: Generics 10% ($5
min)
Brands 25% ($20 min)
Deductibles:
•$2,500 ind./$5,000 family
Out-of-pocket maximum:
•$3,500 individual
•$7,000 family
HSA: 100% match ($500
ind./$1000 family)
Year 2 (2007)
No change
No change
Added
ChoiceMatters
ChoiceMatters
Preparation
Advice
• Enrollment
packets
• Newsletters
• Postcards
• Express
Savings
Alerts
• Prescription
Outreach
• Express
Savings
Statements
Protection
• Adherence
• Retro DUR
ChoiceMatters
2007: ChoiceMatters
Boosted Persistence
Reference group: CDHP with ChoiceMatters
Bars to the
green area on the left:
Choice Matters did better.
Adjusted Odds Ratio
* = p<0.05
2007: ChoiceMatters
Boosted Persistence
Reference group: CDHP with ChoiceMatters
Bars to the
green area on the left:
Choice Matters did better.
Bars to the
red area on the right:
Choice Matters did worse.
Adjusted Odds Ratio
* = p<0.05
2007: ChoiceMatters
Boosted Persistence
ChoiceMatters
worse
ChoiceMatters
better
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
2007: ChoiceMatters
Boosted Persistence
ChoiceMatters
worse
ChoiceMatters
better
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
2007: ChoiceMatters
Boosted Persistence
*
Adjusted Odds Ratio
* = p<0.05
ChoiceMatters
worse
ChoiceMatters
better
Reference group: CDHP with ChoiceMatters
ChoiceMatters Increased Switching
ChoiceMatters
worse
ChoiceMatters
better
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
ChoiceMatters Increased Switching
Reference group: CDHP with ChoiceMatters
*
*
*
*
Adjusted Odds Ratio
* = p<0.05
*
ChoiceMatters
worse
ChoiceMatters
better
*
*
Take-homes:
Formularies can be safely managed
Adherence is more important than ever
Communication is vital to CDHP
The Ripple Effects of
Trend Management
With thanks to:
Andy Behm
Emily Cox
Mark Eatherly
Amit Kulkarni
Yakov Svirnovskiy
Doug Mager
Rebecca Sedjo