Study Shows CDHP Financial Incentives Not Enough to Change Consumer Behavior

Consumer-Directed Health Plans (CDHP) require more than financial incentives to help consumers make smart choices about their health and prescription use, according to a new study by pharmacy benefit manager Express Scripts. CDHP participants were, in fact, less likely than traditional health plan enrollees to change behavior and take advantage of cost-saving generic drugs. The Express Scripts study found that CDHP participants simply curtailed brand-medication use instead of consistently substituting generic for brand medications. "CDHPs do not automatically produce more cost-effective behavior,” said Glen Moller, vice president of product development, Express Scripts. "Our research shows that consumers need more and better tools to make prescription drug choices that maximize both health and financial outcomes. At Express Scripts, we are leveraging our success with consumer engagement in traditional pharmacy benefits to promote utilization of the most clinically-effective and cost-effective medications by CDHP enrollees.” The Express Scripts study reviewed the results of two national employers that began offering a CDHP as a benefit option in January 2006 – without such consumer tools. The study, involving 19,500 enrollees of employer A and 14,600 enrollees of employer B, examined prescription claims during the first nine months of 2005 and 2006 respectively. At both employers, it compared CDHP and traditional pharmacy benefit plan experiences. A significant number of employees enrolled in the CDHP plans: 36 percent for employer A and 22 percent for employer B. While implementation of a CDHP produced considerable prescription-drug cost savings, the main source of savings came from cost-shifting as enrollees paid a greater proportion of their drug costs through high CDHP deductibles. Utilization decreases and higher enrollee payments associated with the CDHPs led to net-plan cost reductions of 62 percent and 24 percent for Employers A and B, respectively. Although CDHP enrollees at both companies reduced their use of brand medications by about 13-14 percent following enrollment, those reductions were not offset by increases in generic-medication use. Meanwhile, enrollees in traditional pharmacy benefit plans increased their use of lower-cost generic drugs, while their use of brand drugs remained unchanged from 2005 to 2006, resulting in net utilization increases. On a per-enrollee basis, growth in generic claims for Employer A’s traditional plan more than doubled that of the CDHP, 18.6 percent vs. 7.5 percent. At Employer B, the per-enrollee growth in generic claims for the traditional plan was 17 percent but only 13 percent for the CDHP. According to the study, which is available at http://www.express-scripts.com/ourcompany/news/outcomesresearch/ onlinepublications, the findings suggest a role for better education of CDHP enrollees. (Due to its length, this URL may need to be copied/pasted into your Internet browser's address field. Remove the extra space if one exists.) Within traditional pharmacy benefit plans in 2006, Express Scripts saved plan sponsors and patients $126 million just through greater use of generic cholesterol-lowering drugs. By the end of the year, 40 percent of all cholesterol-lowering prescriptions at Express Scripts were for generic simvastatin, lovastatin and pravastatin, up from 8 percent at the beginning of 2006. Contributing significantly to this success was a comprehensive, multi-faceted consumer behavior change program that encouraged patients to ask their physician about low-cost generic medication options available to treat high cholesterol. The programs included tailored communications and decision assistance timed for greatest relevance and ease of use. Express Scripts now offers plan sponsors a similar education program for use with CDHP enrollees. Included in the program are broad-based enrollee communications, such as a web-based tool for checking drug prices and savings opportunities. In addition, targeted patient-specific communications inform enrollees using high-cost medications about savings available from generics. Enrollees using home delivery also get an outbound call before a high-cost medication is dispensed. To ensure chronically ill enrollees continue taking their medications, letters are sent to both enrollees and their physicians when a gap in claims activity is detected. "The pharmacy benefit is ripe for consumerism and offers a great opportunity for members to take a more active role in managing their healthcare decisions, but it takes advice from a trusted expert” said Moller. "The pharmacy benefit is typically a patient’s first encounter with the health benefit in a given year; it happens primarily in a non-emergency situation; there many available alternatives to treat most conditions; and when the plan member is not satisfied with his/her decision, it is relatively easy to make a different decision the next month. Through better communications and tools, we are able to take advantage of these teachable moments to help members raise their ‘Pharmacy IQ.’” Express Scripts also supports CDHPs by providing seamless data integration with plan sponsors’ medical carriers. This allows medical and pharmacy claims data to be shared at any frequency, up to and including real time, to manage and track combined CDHP accumulators like deductibles and out-of-pocket maximums. Express Scripts currently integrates data for CDHPs with more than 50 national, regional and local carriers, health plans and third-party administrators. Express Scripts, Inc. (Nasdaq: ESRX) is one of the largest pharmacy benefit management (PBM) companies in North America, providing PBM services to more than 50 million patients through facilities in 13 states and Canada. Express Scripts serves thousands of client groups, including managed-care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at http://www.express-scripts.com.