CVS Caremark (NYSE: CVS) is presenting data at the Academy of Managed Care Pharmacy (AMCP) 2010 Educational Conference illustrating how innovative approaches to traditional plan designs can help clients reduce drug spend, improve generic dispensing rates (GDR) and minimize member disruption. The company is sharing results from three different client experiences that demonstrate how by adapting traditional plan design approaches such as step therapy and 90-day prescription mail pricing, plan sponsors see improved results while members experience minimal disruption.
"PBMs 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," said Per Lofberg, head of CVS Caremark's pharmacy benefit management 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."
One of the CVS Caremark studies reviewed a new approach to driving a generics-first strategy focused on Proton Pump Inhibitors (PPIs). 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 which provided them with a 20 percent discount on FSA-eligible store brands to help manage the costs of OTC 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 decreased potential member disruption significantly, with 56 percent of eligible members converting from a non-preferred 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 percent reduction in PPI spend and the client's GDR in the PPI class of drugs increased from 53.7 percent (one month prior to implementation) to 75.6 percent in the first month and remained steady in the five subsequent months.
A second study examined the impact of a unique 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 non-preferred drugs. Prior to implementation, three phases of proactive communication and outreach were conducted: 1) the plan sponsor sent notification letters about the upcoming plan design change to members and physicians 60 and 30 days prior to implementation; 2) a dedicated call center handled questions and prior authorization requests and; 3) 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 percent and the GDR rose from 57.5 percent to 72.8 percent after one year of the program. Furthermore, no escalated member complaints were reported by the client.
A third study highlighted the reduction in overall drug spend that can be achieved by implementing Maintenance Choice, an innovative 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 which 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 percent in average gross cost per day with eighty-two percent 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 percent to 68 percent as the result of combining Maintenance Choice with other plan design changes to drive generic utilization.
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