Aetna's Healthy Actions Rx-Savings

There is a signifacant correlation between the cost of a drug and one's adherence to the drug. eg. Drug X costs me $125 a month and after two months, I don't really see any results. I will stop taking that drug. Now my employer tells me they will pay for drug X, so I go back on it and stay the course until I see a change. That is if I remember to take my drug and the side effects are not too bad!

Marriott is doing a great service for their employees considering the majority of them most likely earn above minimum wage and are supporting a family with their healthcare benefits. They also will see the benefit with lower absenteeism, and higher productivity. Kudos to Aetna for their CareEngine System and offering so many programs to lower costs to their members.

This is straight off the BusinessWire press release:

HARTFORD, Conn.--(BUSINESS WIRE)--Aetna (NYSE:AET) today announced the launch of Aetna Healthy ActionsSM Rx-Savings, an incentive program under which co-pays for individuals enrolled in self-funded benefit plans who have high risk clinical profiles and are taking medications for chronic health conditions including asthma, diabetes, high cholesterol, high blood pressure, and heart disease are paid in whole or in part by their employer. The program is designed to encourage member compliance with medications shown to be essential, according to the evidence base, to the effective management of these conditions for high risk members.

“The use of evidence-based medicine in combination with pharmacy benefit design may significantly help to improve the overall quality of care for members with the targeted chronic health conditions by reducing the cost barrier to patient compliance with recommended drug therapies and treatments,” said Ed Pezalla, M.D., National Medical Director, Aetna Pharmacy Management. “This program is one of several value-based plan design initiatives we are deploying to our member population to help promote better health outcomes, reduce costs, increase satisfaction and over time, lower cost trend for the employer.”

Aetna Healthy ActionsSM Rx-Savings allows self-funded employers to offer a drug class co-pay discount to employees based on a member’s clinical risk profile and relevant evidence-based standards. Eligible members are identified through ActiveHealth Management’s CareEngine® System technology which can proactively identify at-risk individuals who currently use a drug covered in the program, as well as those who could benefit from use of a drug covered in the program. Once identified, an outreach mailing is sent to the member to notify them they are eligible for co-pay discounts. If the member is not currently using a drug covered in the program, an outreach mailing is conducted to both the member and his or her physician.

Marriott International, Inc. is a pilot customer for the program.

“Reduced co-pays resulted in increased adherence rates, which we believe may lower the number of costly medical emergencies and hospitalizations in our workforce, and ultimately help alleviate our health care costs over time," said Jill Berger, vice-president, Health & Welfare for Marriott International, Inc.

The drug classes and conditions applicable in this program include: anti-diabetic medications, inhaled steroids for asthma, beta blockers for cardioprotection, ACEI/ARBs when needed for cardiorenal protection and statins for those who have high-risk conditions such as diabetes and CAD; with a recommended discount of up to 100 percent off the co-pay for generics and up to 50 percent off the co-pay for preferred brands. This program has been piloted with certain self-funded employers and will be available more broadly to all self-funded customers January 1, 2008.

Clinical studies have shown that co-payments and deductibles can impact patients' compliance with medications and treatment plans. One example is a 2004 study tracking patients with high cholesterol that found patients who paid lower co-pays for statins were more compliant with their treatment regimen.1

In October, Aetna launched a groundbreaking study in partnership with Brigham and Women’s Hospital to follow drug compliance in members who have had a heart attack and who are on maintenance drugs such as beta blockers. In the study group, individuals’ co-payments, co-insurance or deductibles for certain drugs proven effective in managing their condition will be paid for by Aetna or the employer (depending on the nature of the coverage) rather than the member. The study is the first of its kind to test the impact of variable or no co-payments on the outcomes of certain chronic diseases.

Aetna has a unique combination of consumer-directed experience, member information and technology that can help provide better understanding of patient decision-making and potentially encourage them to better manage their condition with incentive-based offerings. With a number of programs in place including Save-a-Copay, available first-dollar coverage of preventive medications within its Health Savings Account-compatible high-deductible health plans, and pilot programs with its largest customers, the company is committed to building, evaluating and deploying value-based plan design initiatives.

"Lower costs have been shown to help improve medication adherence and we believe this will lead to improved care and reduce costs," said Pezalla. "Health insurers and self-insured employers partially offset their costs of insurance by requiring co-payments, coinsurance or deductibles; however, they incur the costs of illness if a patient suffers further complications from chronic illness. This program offers real opportunities for promoting better care and reduced waste while promoting consumerism. As we gain a deeper understanding of the effect of reduced out-of-pocket costs on member adherence to prescribed therapies, Aetna will apply these insights to future benefit design efforts.”