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AIS's Health Business Daily
Featured Story July 8, 2008 PBMs, Specialty Pharmacy Vendors Focus on High-Touch Rx Management StrategiesReprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies. By Neal Learner, Managing Editor (nlearner@aispub.com) Health plans and other pharmaceutical payers increasingly say they want a "higher touch" approach to managing their members' drug therapies, according to pharmacy benefit managers (PBMs) and other vendors that have launched programs recently to meet the growing demand. Some of the biggest PBMs are rolling out new medication therapy management (MTM) initiatives that aim to improve health outcomes and save money by avoiding more costly interventions down the road. Meanwhile, some smaller specialty pharmacy and disease management firms are forecasting increasing demand for their services as health plans struggle with an "unmet need" for better MTM programs. The latest movement is driven in part by the wave of expensive, personalized therapies now hitting the market, one specialty pharmacy executive says. "The drugs that are going to be coming out…are more focused on the genetic makeup of a patient, rather than the type of disease," says Atheer Kaddis, Pharm.D., vice president of managed markets at Diplomat Specialty Pharmacy, which provides Rx management programs for patients with serious and chronic conditions. "The pharmacies that…make that more of their business model, in the long run, are going to be very successful and will have a lot of demand by managed care organizations and other payers," he tells DBN. Some of the largest industry players also are laying the groundwork for more intensive MTM offerings. Late last month, Medco Health Solutions, Inc. and its partner Healthways, Inc., a disease management firm, opened a center formed around the concept of "health action teams." Each team includes pharmacists and health specialists, such as nurses, health coaches and benefit specialists, who provide management of chronic diseases and coaching on lifestyle and wellness issues, such as weight loss and smoking cessation. "The [teams] have shared accountability for improving the health and care and therapy management for the population of the client we're charged with," says Glen Stettin, M.D., senior vice president and general manager of Medco's clinical and therapeutic solutions group. Services at the center, which are available to all of Medco's clients, have demonstrated a worthwhile return on investment, he tells DBN. The center grew out of payers' increasing dissatisfaction with the results of existing MTM programs, Stettin says. Their concerns centered on the fact that too few people joined therapy management programs, or that people would not engage in them quickly enough, Stettin explains. "It is difficult to engage people in these types of programs after they have lived with their chronic condition for months or years," he adds. Medco addresses this issue by identifying potential participants early on through real-time electronic claims data. "We know seconds after a prescription has been processed whether someone is being treated for diabetes or heart disease for the very first time," he says. The PBM also engages potential members who call Medco's mail-order pharmacy. "We're catching them at a point in time when they're interested in their medications, and interested in their health," Stettin adds. Express Scripts Examines Consumer Behavior Express Scripts, Inc. also recently launched a center that aims to boost health and financial outcomes by improving communications with consumers, including around Rx compliance and generic drugs. Its Center for Cost-Effective Consumerism is conducting research that should let the PBM design more effective therapy management programs, among other things, says a company executive. The impetus for the center grew out of lessons learned from the launch of generic Zocor (simvastatin) in mid-2006. At that time, the PBM saw that financial incentives alone had a limited effect in changing consumer behavior, says Robert Nease, Ph.D., chief scientist at Express Scripts. "For every unit of behavior change that you get from financial incentives, you get one to two units by adding on sound, scientifically based messaging that resonates with the members," he tells DBN. For example, Express Scripts experienced only a 16% switch rate to generic simvastatin when it simply took brand Zocor off the formulary but did not enroll members in a behavior-changing campaign. That rate rose to 28% with "behavioral-based, framed messaging" through the retail channel, and to about 45% through home-delivery, mail-order pharmacy, Nease explains. The U.S. spends an additional $40 billion each year on drugs by relying on financial incentives alone to change behavior, Nease says of the lost opportunities to switch members to generics. Financial incentives also play only a partial role in boosting Rx adherence, he says. The center is conducting a pilot research program, including randomized trials, on other factors that could improve adherence, including what types of "reminder messaging" are most effective for individual members. "We're looking to see if who it is doing the reminding makes a difference, the wording makes a difference, the timing makes a difference, etc.," Nease says. Meanwhile, others say health plans increasing want a high-touch, high-management approach to specialty pharmacy patients. Plans simply are not getting the kinds of results they expect, Diplomat's Kaddis says of a widely shared sentiment expressed by executives at the National Managed Care Roundtable in Dallas (NMCRT) last month. A high-touch, high-management approach to specialty pharmacy, he explains, would include interacting directly with patients to monitor side effects; ensuring that they have access to the drug; ensuring they tolerate and stay on their therapies; and making sure that physicians understand what barriers may be blocking optimal care. However, many health plans today are having their specialty pharmacy members serviced through mail-order pharmacies, which do not provide such a high-touch approach to specialty Rx, contends Phil Hagerman, president and CEO of Diplomat. "When you're talking about biotech therapies that are thousands of dollars, and the complexities of the diseases are greater, I think the mail-order model just doesn't fit," he says. One therapy management firm also is seeking new ways to help patients stay on their medications. Drug compliance "is the nut that people have not been able to crack for many years," says Minalkumar (Jay) Patel, M.D., CEO of Care Management International, Inc., a firm that provides MTM through its clinical and non-clinical staff in both the U.S. and in India. "We're around 50% on chronic disease on refill rate," he tells DBN. "There have been a lot of different interventions that have been tried in the past." One new approach
that Care Management International offers its health plan clients is
the ability to do outbound reminder phone calls when a refill is due,
Patel explains. The company's non-clinical staff in India can survey
health plan members who are known to be noncompliant. The staff also
uses scripts that allow them to talk through some of the issues that
are resulting in poor compliance, Patel says. |
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