The Official Medtipster Blog

Medtipster Source: www.pharmalive.com; www.vitality.net; www.att.com

Don’t forget to take your meds! The costs of non-adherence are staggering.

Jason A. Klein, Medtipster President

Life is expensive. You work for a living. Your employer offers health insurance. You’re a diabetic. Your doctor prescribes Glucophage (Metformin Hydrochloride). The average monthy cost is roughly $97.00 (or $8.99 for the generic at Rite Aid….Thanks Medtipster.com!).

Now, what happens if you forget to take or refill your medication? That’s easy. Blue Cross & Blue Shield likely saves $97.00. WRONG. The correct answer is: You get sick and the non-adherence to your medication costs on average 100 times more. According to a study published in August by the New England Healthcare Institute, non-adherence costs the U.S. $290 billion in added medical spending each year. Mortality rates are twice as high among diabetes and heart disease patients who don’t take their pills properly, it said.

A Cambridge, Mass.-based startup called Vitality Inc. took note of the New England Healthcare Institute study and is gearing up to offer an extremely innovative solution. Not only that, but they have brought along AT&T, one of the nations largest communications providers, along for the ride. Their solution: A pill bottle cap that keeps track of when and how often it is opened. If not opened according to the pre-programmed clinical specifications, you will be notified via the AT&T network. The cap can also be programmed to notify your spouse, parents, or children. You can run, but you can’t hide! We, at Medtipster, love this innovation. See full press release below:

Medtipster Source: CVS Caremark (NYSE: CVS), 10/13/2009, http://info.cvscaremark.com/newsroom

This is an old release from November 2009, BUT I really liked it and have been meaning to post it for some time now.  The message of the CVS Caremark release and the study is: We as an industry need to advise benefit payors to focus on changing consumer utilization behavior rather than  shifting cost. This study took 15,000 people, gave them a $0.00 copay on generic medications. What happened? Overall plan costs decreased due to a GDR (generic dispensing rate) increase and therapy compliance/adherence increased in key classes (antihyperlipidemics, antihypertensives, antidiabetics). WOW…who would have thought that by giving away the cow, you could pay for the milk…

WOONSOCKET, R.I., Oct. 13 /PRNewswire/ — CVS Caremark (NYSE: CVS) presented data at the Academy of Managed Care Pharmacy (AMCP) Annual Educational Conference, which illustrates how innovative pharmacy benefit plan design can impact generic utilization. The study further underscores how pharmacy benefit managers (PBMs) can work with plan sponsors to manage costs and improve health outcomes by working to change plan participant behavior through increased engagement. The study found that implementing a $0 copay structure for generic medications can be an effective strategy to increase generic dispensing, with the generic dispensing rate (GDR) increasing to 60.8 percent (a 4.2 percent increase) during the study period.

“Our 2009 Benefit Planning Survey found that clients are more interested in identifying opportunities to change plan participant behavior, rather than shift costs,” said Jack Bruner, Executive Vice President, CVS Caremark. “The data presented at AMCP illustrates an example of how we can work with our plan sponsors to change and optimize participant behavior in order to achieve increased generic utilization. These types of partnerships enable us to effectively reduce costs for both our client and their plan participants without compromising quality or access.”

In addition to an improvement in GDR during the study period, the analysis found that the average participant cost share for generic medications decreased almost 10 percent (9.4 percent decrease). In addition, the average plan cost per 30 days of therapy also exhibited a slight decline, despite the reduction in generic copayment rates. Prevalence of use in three key preventative drug classes also increased significantly (participants on cholesterol lowering therapy increased 13 percent, on antihypertensive therapy increased seven percent and on diabetic therapy increased nine percent) as a proportion of eligible patients.

“While some plan designs work to drive generic utilization by increasing brand medication copayments, this study demonstrates that lowering the generic copayment can also be an effective strategy to increase GDR,” said Mr. Bruner. “In addition, the data indicates that lowering the generic copayment may also be associated with an increase in participants taking key preventative drugs, which could positively impact adherence and overall health outcomes.”

The study was designed to evaluate the results of plan design changes, including implementation of a $0 copay for generic medications, on the GDR, plan participant cost and impact of plan participant behavior changes on health outcomes. During the study period, participants were allowed to fill prescriptions for generic medications at a preferred retail pharmacy network at a zero dollar copay. The study included 15,000 plan participants covered by a self-funded employer group who were continuously enrolled under the benefit for the duration of the study period (12/1/2007 through 7/31/2009). 

Nádia - your personal pharmacy cost adviser

The report, “Retail Clinics: Update and Implications,” suggests that consumer adoption of retail medicine is strong and growing. Additionally, the report suggests that the industry’s potential to expand its revenue opportunities will support its long-term sustainability. The four factors that will likely contribute to the sector’s growth include:

•Increased use and satisfaction by consumers
•Increased use and acceptance by commercial health plans and large employers
•Increased services provided through the retail medicine model
•Increased demand for preventive and primary health care services as a result of health reform and consumer demand

“The growth and evolution of retail clinics reflect opportunities for disruptive innovation and an improved value proposition of price, quality and service for the U.S. health care system,” said Paul Keckley, Ph.D. and executive director, Deloitte Center for Health Solutions. “While the current economic downturn has incited a period of contraction, the retail clinic industry will emerge with a more refined business model to drive a second, albeit slower, wave of growth in the next three years.”

Key findings highlighted in the report include:

•Patient Volume Remains Strong: According to the report and Deloitte’s 2009 Survey of Health Care Consumers, 33 percent of consumers indicate they are willing to use a retail clinic, especially younger and middle-aged working adults. Moreover, 30 percent of respondents are likely to use a retail clinic if it would cost them 50 percent less than seeing their physician.

“Retail clinics represent a new channel that can deliver primary care services more conveniently and at lower cost to consumers,” added Keckley. “Clinic services are typically safe and effective, due in large measure to medical management programs that are evidence-based and supported by electronic medical records. Additionally, health insurance plans are increasingly offering coverage of retail clinic visits in their benefits packages for individuals and employers — ‘covered lives’ is a key to growth.”

•Existing Locations: Most retail clinics operate in retail pharmacy settings (82 percent), or as a department or wholly-owned subsidiary of the host organization, such as a grocery store (12 percent) or big-box discount store (6 percent). Notably, 2009 has seen increased activity by acute care organizations entering retail medicine via contractual arrangements with drug store and grocery chains.

•Potential Locations: The market potential for retail clinics remains strongest in retail pharmacies, as within 10,000 retail pharmacies, there are currently 801 clinic locations. However, big-box discount stores and grocery stores have expansion opportunities if these channels selectively leverage services, given:
•Within over 5,000 big-box discount stores, there are currently only 58 clinic locations
•Within over 5,000 grocery stores, there are currently only 115 clinic locations

•The Evolving Business Model: Core services at retail clinics typically include preventative health screenings, prescriptions and over the counter (OTC) therapeutics and uncomplicated primary care. The retail clinic business model is capable of supporting additional revenue streams (zones) unrelated to its core operations:
◦Zone Two: Core extenders including medication management, health coaching for chronic issues and employee wellness
◦Zone Three: New revenue programs including care management services for chronic issues; referral management services for acute, specialty or OTC issues; and health insurance for individuals or groups

•Challenges to Growth: The retail clinic industry faces a few challenges, including labor shortages, compensation inflation, price pressures from new entrants and regulatory pressures from state governments — all of which may slow growth or impede retail clinics from opening. In fact, in some states and localities, regulators are fearful that retail clinics represent a compromise to safe and effective care. Additionally, some local physicians have actively campaigned against retail clinic openings and advised patients to seek care elsewhere.

“As a new entrant to the health care industry, retail clinics represent a threat to many traditional health care stakeholders,” added Keckley. “However, to consumers, health plans and employers, retail clinics offer an important health care alternative with a strong value proposition. Therefore, we expect this new sector to mature while growing its scope of services, locations and impact on population-based health status.”

Find your nearest retail clinic by using medtipster.com