I have said it in meetings, in emails and on Twitter: Wal Mart can revolutionize healthcare in this country. They have the power to change the way patients get and pay for their medications. Already, Wal Mart has changed the pharmacy industry by introducing their $4 generic drug program in the fall of 2006. This program made every pharmacy, from Target and CVS to Farmer Joe and Hannafords, also offer $4 generics to compete.
This program has saved Wal Mart customers $1 BILLION already. THAT is impressive.
One of the programs for aiding the US healthcare system and helping patients become healthier is employer /health plan sponsored lower co-pays and free medication for chronic diseases. This is not my original idea, as several companies have offered these services to their employees, but one that I fully support and believe will make a difference in medication non-adherence. As we know, forgetfulness is the #1 reason, with drug prices, side effects and drug education being the other factors that contribute to this pandemic.
Wal Mart and Caterpillar are taking this idea a step further by offering no co-pays for employees taking Tier-1 generics.
"Caterpillar Inc. and Wal-Mart Stores Inc. have embarked on a pilot drug program that could revolutionize the prescription drug industry, officials from both companies said Monday.
Select salaried and management employees of Caterpillar as well as its retirees and surviving spouses can get Tier-1 generic drugs filled for no co-payment at all Wal-Mart, Sam's Clubs and Neighborhood Market stores now through Dec. 31, 2009, as part of the program that began earlier this month.
The co-payment for the generic drugs is $5 at other pharmacies.
While about 70,000 Caterpillar employees are affected now, that could expand to include union-represented employees who opt into the company's HMO plan beginning Jan. 1, 2009, said spokeswoman Rachel Potts. Open enrollment begins in November."
I think this is another fantastic program and shows the real power Wal Mart has to influence the US Healthcare industry.
"The goal of the pilot program, on which Caterpillar and Wal-Mart negotiated for several months, was to remove unnecessary costs from the health care equation, said Todd Bisping, Caterpillar's pharmacy benefits manager.
It does that by eliminating the middle man, so to speak, in the pharmaceutical management process. Most companies contract with an outside pharmacy benefits manager to set rates on prescription drugs, rates co-payments are designed to cover to defray the company's costs.
Caterpillar negotiated directly with Wal-Mart on the rates, saving it money and enabling Caterpillar to then waive the co-payment for its employees and retirees, Bisping said."
You can read the full story from the Peoria Journal Star.
Showing posts with label Co-pays. Show all posts
Showing posts with label Co-pays. Show all posts
Tuesday, September 30, 2008
Thursday, January 31, 2008
Dr. Nash's Blog
A few months back, I met with Dr. David Nash, The Dr. Raymond C. and Doris N. Grandon Professor and Chairman of the Department of Health Policy at Jefferson Medical College of Thomas Jefferson University in Philadelphia. He is one of the KOLs in Health Policy and had done a significant amount of research in medication non-compliance/adherence. In his latest Health Policy Newsletter, there is a mention of his blog. I checked it our today and found this presentation. It is on medication non-adherence and how reduced co-pays save employers money in the long run and improve healthcare outcomes, specifically with chronic diseases.
I have posted a link to his blog in my blogroll.
Enjoy the presentation.
I have posted a link to his blog in my blogroll.
Enjoy the presentation.
Wednesday, January 9, 2008
Study Proves Lower Co-pays Equal Better Medication Adherence
Here is a piece about a study that I read yesterday in a bunch of places, but this has the most information from ScienceDaily's website and adapted from materials provided by University of Michigan Health System. It is so concise that I really cannot comment on it, save a few things which are at the end of this post.
ScienceDaily (Jan. 8, 2008) — As 2008 begins, millions of Americans are having to dig deeper into their own pockets every time they refill a prescription or see a doctor.The reason? Higher co-payments that took effect January 1, as employers try to deal with the rising cost of health insurance by making employees and retirees pay more.
But a new study finds that instead of going up, co-pays should go down -- at least for some people taking some drugs. Just by cutting a few dollars off the co-pay, the study suggests, employers could increase the chances that employees with chronic illnesses will take certain preventive medicines. And that could pay off in the long run, in the form of fewer hospitalizations or emergency room visits for employees with diabetes, high blood pressure, asthma and other conditions.
Specifically, the study showed that a major private employer significantly increased the use of important preventive medicines among its employees by automatically making some medications free, and slashing co-pays for other drugs by 50 percent. Meanwhile, another employer that kept its co-pays the same didn't experience the same increase in use of preventive medicines.
The difference in medication use between chronically ill employees at the two companies was sizable -- even though all the employees in the study were also enrolled in special programs designed to help them take control of their diseases.
The study is published in the January/February issue of the journal Health Affairs by a team led by University of Michigan and Harvard University researchers. It is the first rigorous, controlled trial of a concept called "value based insurance design."
That concept, introduced in the late 1990s by members of the research team, is based on the idea that there should be few barriers standing between a chronically ill person and the medications that can keep them well enough to work and to avoid health crises and complications related to their disease. Even a barrier of a few dollars is enough to keep people from using the medicines they need the most.
"All research to this point has shown that individuals will not buy important medical services even if there's a small financial barrier: $5 or even $2," says senior author Mark Fendrick, M.D., of the U-M Medical School and School of Public Health. "This study showed that when you remove those barriers, people started using these high-value services significantly more. These results bolster the idea that health insurance benefits should be designed in ways that produce the most health per dollar spent."
Fendrick and first author Michael Chernew, Ph.D., of the Harvard Medical School, co-founded the Center for Value-Based Insurance Design, based at U-M. They conducted the study with co-authors from ActiveHealth Management, which had been retained by both companies in the study to provide voluntary disease-management programs for employees and dependents with 32 medical conditions.
Members of GlaxoSmithKline's Health Management Innovations division also took part in the study, which was supported by unrestricted funds from both GSK and Pfizer, Inc. The employers involved in the study have asked to remain anonymous. During the study period, ActiveHealth Management was acquired by Aetna, a major insurer, but there was no impact on the study.
The study involved more than 35,000 employees and dependents at the company where co-pays were reduced (Company A), and more than 70,000 employees and dependents at the other (Company B). All had regular phone contact with nurses in their disease management programs, who offered help based on each person's test results, medication use, doctor visits and other health information.
The researchers looked at use of five classes of drugs: heart-protecting ACE inhibitors and angiotensin-receptor blockers; blood-pressure-reducing beta blockers; diabetes medicines including blood sugar-reducing drugs and insulin; cholesterol-reducing statins; and asthma-calming inhaled steroids.
In the study period, co-pays at Company A went from $5 to $0 for generic drugs, from $25 to $12.50 for name-brand drugs on the company's preferred drug list, and from $45 to $22.50 for non-preferred name-brand drugs. Co-pays at Company B stayed around $29 for brand-name drugs and $16 for generics.
As part of the disease management program at both companies, people who weren't already taking preventive medications related to their conditions were contacted automatically to let them know about the importance of those specific medications. At Company A, they were also informed of the reduced co-pays. For all Company A employees, the co-pay reductions were made automatically at the pharmacy.
In just one year, the appropriate use of the preventive medicines at Company A increased significantly in four of the five drug classes, with inhaled steroids for asthma being the exception. The increase in use of statins was more modest than the increases in use of ACEs/ARBs, beta blockers and diabetes drugs.
And, the results show that "nonadherence" -- a term used to describe a situation when someone should be taking a medicine but isn't -- decreased between 7 percent and 14 percent, depending on drug class.
Chernew notes that the study was not designed to assess whether increased adherence to preventive drugs had a measurable impact on employees' and dependents' health, or their use of costly services such as hospitalization and emergency care.
"While future studies need to be done to actually quantify this specifically, there is considerable evidence that use of the classes of medication in this study will reduce the frequency of adverse clinical events and associated hospitalizations and ER visits," he says. "We believe that tailoring co-pays to the individual patient can improve the efficiency of health care spending when applied to this type of high-value health service."
The new data provide the first rigorous, controlled analysis of the impact of a "clinically sensitive" health benefit design. Previously, employers such as office-equipment maker Pitney Bowes and the city of Asheville, NC have reported increased adherence and decreased use of health services among chronically ill employees who had their co-pays reduced.
Meanwhile, other employers have launched their own such programs without waiting for a controlled study to convince them of the potential benefits. In fact, the University of Michigan is currently offering free or reduced-price medications and tests to more than 2,000 of its employees and their dependents who have diabetes.
That project, called MHealthy: Focus on Diabetes, is being managed by the Center for Healthcare Quality and Transformation and may produce its first data this year.
"When I told my mother about this study, she turned to me and said 'I can't believe you had to spend all that money to show that if you make people pay more for something they'll buy less of it,'" says Fendrick. "But we needed to show with a carefully done study that if we did lower barriers that people would utilize these essential medical services more. And as always, my mother was right."
In addition to Fendrick and Chernew, the study's authors are Mayur Shah, Arnold Wegh, Stephen Rosenberg, and Iver Juster of ActiveHealth; Allison Rosen of U-M Medical School and School of Public Health, who is leading the analysis of the University of Michigan diabetes project; and Michael Sokol and Kristina Yu-Isenberg of GSK.
COMMENTS
As it has been proven in the past, lower co-pays = betters adherence. The question is, who is going to pay? Pitney Bowes is picking up the tab for their employees, but they have one of the best employer healthcare programs and they see the value. Since insurance companies are always trying to make more of a profit, with they cover more prescription costs and realize it will pay off in the future? See the Aetna post of last month
My own experience with copays almost affected my adherence, but I know better. When we switched over to a HSA program my co-pays went up by a ridiculous amount - almost 500%. My wife and son were also on two medications plus my two, and we were spending about $400 a month! Luckily we switched over to a regular plan and they went back down to $20 a script. Point being, with any financial barriers, adherence suffers.
This study is almost like a "Duh, of course", just like Dr. Fendrick's mother said, but it is important for insurers and employers to realize that cost is definitely a part of medication adherence.
Stay compliant! Remember to take your meds.
ScienceDaily (Jan. 8, 2008) — As 2008 begins, millions of Americans are having to dig deeper into their own pockets every time they refill a prescription or see a doctor.The reason? Higher co-payments that took effect January 1, as employers try to deal with the rising cost of health insurance by making employees and retirees pay more.
But a new study finds that instead of going up, co-pays should go down -- at least for some people taking some drugs. Just by cutting a few dollars off the co-pay, the study suggests, employers could increase the chances that employees with chronic illnesses will take certain preventive medicines. And that could pay off in the long run, in the form of fewer hospitalizations or emergency room visits for employees with diabetes, high blood pressure, asthma and other conditions.
Specifically, the study showed that a major private employer significantly increased the use of important preventive medicines among its employees by automatically making some medications free, and slashing co-pays for other drugs by 50 percent. Meanwhile, another employer that kept its co-pays the same didn't experience the same increase in use of preventive medicines.
The difference in medication use between chronically ill employees at the two companies was sizable -- even though all the employees in the study were also enrolled in special programs designed to help them take control of their diseases.
The study is published in the January/February issue of the journal Health Affairs by a team led by University of Michigan and Harvard University researchers. It is the first rigorous, controlled trial of a concept called "value based insurance design."
That concept, introduced in the late 1990s by members of the research team, is based on the idea that there should be few barriers standing between a chronically ill person and the medications that can keep them well enough to work and to avoid health crises and complications related to their disease. Even a barrier of a few dollars is enough to keep people from using the medicines they need the most.
"All research to this point has shown that individuals will not buy important medical services even if there's a small financial barrier: $5 or even $2," says senior author Mark Fendrick, M.D., of the U-M Medical School and School of Public Health. "This study showed that when you remove those barriers, people started using these high-value services significantly more. These results bolster the idea that health insurance benefits should be designed in ways that produce the most health per dollar spent."
Fendrick and first author Michael Chernew, Ph.D., of the Harvard Medical School, co-founded the Center for Value-Based Insurance Design, based at U-M. They conducted the study with co-authors from ActiveHealth Management, which had been retained by both companies in the study to provide voluntary disease-management programs for employees and dependents with 32 medical conditions.
Members of GlaxoSmithKline's Health Management Innovations division also took part in the study, which was supported by unrestricted funds from both GSK and Pfizer, Inc. The employers involved in the study have asked to remain anonymous. During the study period, ActiveHealth Management was acquired by Aetna, a major insurer, but there was no impact on the study.
The study involved more than 35,000 employees and dependents at the company where co-pays were reduced (Company A), and more than 70,000 employees and dependents at the other (Company B). All had regular phone contact with nurses in their disease management programs, who offered help based on each person's test results, medication use, doctor visits and other health information.
The researchers looked at use of five classes of drugs: heart-protecting ACE inhibitors and angiotensin-receptor blockers; blood-pressure-reducing beta blockers; diabetes medicines including blood sugar-reducing drugs and insulin; cholesterol-reducing statins; and asthma-calming inhaled steroids.
In the study period, co-pays at Company A went from $5 to $0 for generic drugs, from $25 to $12.50 for name-brand drugs on the company's preferred drug list, and from $45 to $22.50 for non-preferred name-brand drugs. Co-pays at Company B stayed around $29 for brand-name drugs and $16 for generics.
As part of the disease management program at both companies, people who weren't already taking preventive medications related to their conditions were contacted automatically to let them know about the importance of those specific medications. At Company A, they were also informed of the reduced co-pays. For all Company A employees, the co-pay reductions were made automatically at the pharmacy.
In just one year, the appropriate use of the preventive medicines at Company A increased significantly in four of the five drug classes, with inhaled steroids for asthma being the exception. The increase in use of statins was more modest than the increases in use of ACEs/ARBs, beta blockers and diabetes drugs.
And, the results show that "nonadherence" -- a term used to describe a situation when someone should be taking a medicine but isn't -- decreased between 7 percent and 14 percent, depending on drug class.
Chernew notes that the study was not designed to assess whether increased adherence to preventive drugs had a measurable impact on employees' and dependents' health, or their use of costly services such as hospitalization and emergency care.
"While future studies need to be done to actually quantify this specifically, there is considerable evidence that use of the classes of medication in this study will reduce the frequency of adverse clinical events and associated hospitalizations and ER visits," he says. "We believe that tailoring co-pays to the individual patient can improve the efficiency of health care spending when applied to this type of high-value health service."
The new data provide the first rigorous, controlled analysis of the impact of a "clinically sensitive" health benefit design. Previously, employers such as office-equipment maker Pitney Bowes and the city of Asheville, NC have reported increased adherence and decreased use of health services among chronically ill employees who had their co-pays reduced.
Meanwhile, other employers have launched their own such programs without waiting for a controlled study to convince them of the potential benefits. In fact, the University of Michigan is currently offering free or reduced-price medications and tests to more than 2,000 of its employees and their dependents who have diabetes.
That project, called MHealthy: Focus on Diabetes, is being managed by the Center for Healthcare Quality and Transformation and may produce its first data this year.
"When I told my mother about this study, she turned to me and said 'I can't believe you had to spend all that money to show that if you make people pay more for something they'll buy less of it,'" says Fendrick. "But we needed to show with a carefully done study that if we did lower barriers that people would utilize these essential medical services more. And as always, my mother was right."
In addition to Fendrick and Chernew, the study's authors are Mayur Shah, Arnold Wegh, Stephen Rosenberg, and Iver Juster of ActiveHealth; Allison Rosen of U-M Medical School and School of Public Health, who is leading the analysis of the University of Michigan diabetes project; and Michael Sokol and Kristina Yu-Isenberg of GSK.
COMMENTS
As it has been proven in the past, lower co-pays = betters adherence. The question is, who is going to pay? Pitney Bowes is picking up the tab for their employees, but they have one of the best employer healthcare programs and they see the value. Since insurance companies are always trying to make more of a profit, with they cover more prescription costs and realize it will pay off in the future? See the Aetna post of last month
My own experience with copays almost affected my adherence, but I know better. When we switched over to a HSA program my co-pays went up by a ridiculous amount - almost 500%. My wife and son were also on two medications plus my two, and we were spending about $400 a month! Luckily we switched over to a regular plan and they went back down to $20 a script. Point being, with any financial barriers, adherence suffers.
This study is almost like a "Duh, of course", just like Dr. Fendrick's mother said, but it is important for insurers and employers to realize that cost is definitely a part of medication adherence.
Stay compliant! Remember to take your meds.
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