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AIS's Health Business Daily
Featured Story July 15, 2008 Demand Grows for Value-Based Rx Plans; As Insurers Expand Offerings, ROI Is ElusiveReprinted 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) Pharmaceutical payers are expressing increased interest in adopting value-based insurance designs, according to health plans and other stakeholders involved in the VBID concept. As insurers roll out new VBID offerings to meet the growing demand, some pharmacy executives acknowledge that hard data demonstrating a return on investment (ROI) remain elusive. So far, however, that hasn't dampened interest in VBID - a concept in which financial barriers to "high-value" drugs are lowered in hopes of raising Rx compliance and avoiding more expensive medical costs later on. Among the recent developments, Humana Inc. last month launched "RxPlus" to its administrative services only (ASO) customers. The program has three components: (1) lower copays for diabetes and asthma medications; (2) opportunities to add services, such as nurse-based clinical management of the two conditions; and (3) incentives and rewards, such as gift cards, for individuals who meet specific behavioral targets and guidelines. It's still too early in the selling season to know how many clients will sign on to the new program, says Troy Koch, Pharm.D., director of pharmacy sales at Humana. But many clients are inquiring about this and other VBID programs, he tells DBN. "Many groups are in the learning mode as to what is the potential impact, what are the savings versus the costs," he explains. On these issues, Koch says that VBID, first of all, improves drug adherence. "And adherence will lead eventually to a level of improvement on the medical side," he adds. Humana expects soon to have more data on the ROI question based on several ongoing RxPlus pilot programs with its ASO customers, he says. Meanwhile, Aetna Inc., which offers two separate VBID programs, is seeing a "groundswell of interest" in the concept from its customers, says Mark Rubino, chief pharmacy officer at the insurer. Much of the interest comes from large national accounts, but those interested also include the midsized market of 1,000 to 2,000 covered lives, he tells DBN. Under Aetna's VBID programs, plan sponsors can reduce copays to whatever levels they choose, says Rubino, who couldn't say exactly how many sponsors have signed up for the programs. He notes that Aetna also is trying to get a clearer view of the programs' ROI. As such, it is conducting a multi-year prospective study that looks at a group of heart attack patients who have zero copays on their cardiac drugs versus a control group that has normal copays. The study, which has several years to go, will examine copay effects on such things as compliance and the incidence of second heart attacks, he says. Most recently, Independence Blue Cross on June 19 said it would waive copays and coinsurance on 75 generic drugs used to treat common chronic conditions. Among other things, the program aims to improve Rx adherence. Some questions about the financial value of VBID also could be answered in a study soon to wrap up at the University of Michigan (UM) in Ann Arbor. The university in June will conclude its "focus on diabetes" program, a two-year research study that examines the link between lower drug copays and increased adherence and compliance among diabetic patients, says Keith Bruhnsen, who manages the university's prescription drug program. UM has about 2,500 diabetics in its health insurance plans, he tells DBN. UM selected a half dozen "essential medications" for lower copays: Generics had 100% copay relief, preferred brand drugs had a 50% copay reduction, and non-preferred brands had a 25% reduction. The program costs UM roughly half a million dollars annually in lost copays, Bruhnsen says. Members with diabetes from Blue Care Network of Michigan — the parent of which acquired the UM health plan in January 2008 — served as the control group. Results of the study are expected by October, Bruhnsen says. "We're on a timeline to make a decision about whether we're going to adopt this as a standard benefit here at the university, or whether the evidence does not show there is an improvement in adherence and compliance or utilization," he says. "In that case, we'd make some decision about modifying or ending that program." He declined to discuss any preliminary findings. Bruhnsen says the industry's challenge is to develop research and data supporting the concept that lowering copays for essential services actually removes barriers to their use. "Personally, I believe the reasons people take prescription medications are quite complex," he says. "There are a lot of motivations and issues in that, and copays may not, in and of themselves, be enough to change adherence and compliance." Demand for VBID Said to Remain Strong Still, VBID continues to remain a popular insurance concept, finds a survey of pharmacy benefit stakeholders. According to a Pharmacy Benefit Management Institute (PBMI) survey of Rx benefit payers, consultants, PBMs, pharmaceutical companies and others, "many multinational corporations are embracing value-based benefit design to meet business objectives while working to improve the health of the workforce." The challenges of VBID include quantifying clinical and economic ROI, as well as implementing the program, gathering data and measuring outcomes, according to PBMI. Tim Watson, Pharm.D., principal of consulting firm Pharmaceutical Strategies Group, says employers continue to invest in health and wellness initiatives, but in a fragmented fashion that makes measurement of outcomes difficult, if not impossible, to achieve. "The main interest in VBID is to try to use benefit design tools that will result in improvements in pharmaceutical care, that will extrapolate to all other areas of health care," he tells DBN. Watson says employers are looking for a broader outcomes measurement approach than strictly measuring improvements in medical outcomes. Cyndy Nayer, president of the Center for Health Value Innovation (CHVI), says her organization, formed in 2007, helps employers develop "business-based evidence" that can demonstrate the value of VBID. She says both large and midsized employers are "incredibly interested" in the concept. "They want to jump in," Nayer tells DBN. "They need to be able to see an early ROI, what we define as somewhere around 15 to 18 months. We've got to help them get that information." To this end, CHVI
has developed ways to document the "business ROI," including
reductions in excess drug utilization, rescue treatments and disability
days. Nayer acknowledges that costs and utilization of drugs under a
VBID program go up. "That's the investment," she says. "The
return on the investment is more workdays, more work production, less
rescue treatments. Those are the reductions in costs, and those take
time." |
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