Home Delivery a Gateway for Better Health and Value
Billions in Savings at Stake
ST. LOUIS, Sept. 18 /PRNewswire-FirstCall/ -- Consumers are more likely
to take their medications as directed and choose a money-saving generic
drug when using a home delivery pharmacy instead of a retail pharmacy,
according to results of two new studies from pharmacy benefit manager
Express Scripts (Nasdaq: ESRX).
(Logo: http://www.newscom.com/cgi-bin/prnh/20080827/EXPRESSSCRIPTSLOGO)
In one study, compliance, or taking a medication as prescribed by your
doctor, was nearly eight percentage points higher for home delivery
pharmacy patients taking medications to treat high blood pressure. These
patients were 78.6 percent compliant, but those using a retail pharmacy
were 70.8 percent compliant.
"It has been estimated that roughly half of patients do not take their
medications as prescribed by their doctors. Understanding how to improve
compliance is an important concern for all health care providers,"
explained Emily Cox, Ph.D., a study author and leader of Express Scripts
research department.
Cox explained that in addition to cost savings, home delivery promotes
better medication compliance through patient communications such as refill
reminders by phone or email, renewal assistance, a convenient reorder
process, and less frequent re-ordering.
In the second study, a letter alerting patients to the availability of
a generic alternative, the likelihood of choosing generics in home delivery
was 34% greater compared to the impact in retail. The letters were sent
following the introduction of generic Ambien(R) (zolpidem) in 2007.
Express Scripts estimates that use of generic sleeping aids will
increase to 70 percent of all sleeping aid prescriptions in 2008. However,
even that increase will not capture the $1.5 billion in additional savings
available nationwide for commercial and government-paid plans from
realizing the category's full generic potential of 95 percent.
"Billions in savings are at stake when you account for a similar impact
in other therapy classes," pointed out Cox. She added that home delivery
customers responded at a higher level to a letter from Express Scripts
because it clearly identified potential savings from using a generic that
would provide the same therapeutic benefit. "The assistance and patient
advocacy available in the home delivery channel led consumers using that
channel to respond at a higher level," according to Cox.
"Financial incentives are important but not enough to realize the full
money-saving potential of therapeutically equivalent generics. Timely
communications -- in this case immediately after a drug goes generic --
need to be coupled with the right financial incentives to increase the
number of consumers choosing a generic," said Cox.
Earlier this year, Express Scripts announced the establishment of the
Center for Cost-Effective Consumerism to accelerate development of an
advanced understanding of the consumer and of what works -- and what
doesn't work -- when trying to change the way consumers use health care.
The Center was inspired by research showing that a targeted
communications program implemented around the 2006 introduction of generic
Zocor (simvastatin) was nearly two to three times more effective than
financial incentives alone. The greatest impact came among consumers using
the company's home delivery pharmacy. The campaign generated over a billion
dollars in savings for Express Scripts' pharmacy benefit plan sponsors and
consumers.
"Despite the predictions of classical economic theory, it's clear that
giving consumers price information alone is not enough. Instead,
communications and a more advanced understanding of the consumer are needed
to accelerate better health and value," said Robert Nease, PhD, the
company's chief scientist.
For more information on the Center for Cost-Effective Consumerism,
visit http://www.consumerology.org.
About the Studies
The medication compliance study used an intervention (home delivery)
and comparison (retail) research design. The intervention group included
members enrolled in a client with exclusive home delivery for maintenance
medications while the comparison group included members that did not
provide a home delivery option.
Both intervention and control clients had a three tier flat copay
design with similar generic and preferred brand copayments. Members in the
home delivery group were selected if their initial and final claims were
filled through home delivery. The retail group did not allow a 90 day
refill, however members could obtain more than a 30 day supply by paying
out of pocket. Less than 5 percent of claims in the retail study arm had a
supply greater than 30 days.
Compliance was measured using the medication possession ratio (MPR),
the proportion of days patients were taking prescribed medications to all
days after the first prescription was filled. Compliance was defined as an
MPR of 80 percent or greater. Three therapy classes were examined:
anti-diabetic, anti-hypertensive, and anti-cholesterol agents. Sample sizes
for the three classes were 37,000, 26,000 and 7,500 respectively.
Patients filling a medication in any one of these therapy classes in
the first quarter of 2007 were followed for 270 days from the first claim.
Medication possession ratios were averaged for those patients in the
diabetes and anti-hypertensive therapy classes taking more than one
medication class. To increase the comparability between the two groups, the
retail arm was required to have at least 90 days supply of medication
during the follow up period for any one of their medications.
The generics study used a treatment and comparison study design.
Members of clients who signed up to receive the zolpidem mailing and met
the criteria to receive a letter were compared to members of clients who
were not signed up to receive the zolpidem mailing, met the target criteria
but did not receive the mailing.
Members meeting the targeting criteria had at least one prescription
for a branded sleeping aid in a 120 day pre-period, were 18 years or older,
were continuously eligible for the entire study period, were enrolled in a
plan using the company's national formulary and a flat copay structure. Any
patients filling a prescription for zolpidem at any time prior to the
letter alert campaign were excluded.
The letter alerts went to consumers who had at least one brand hypnotic
prescription between the introduction of zolpidem on April 23, 2007 and
August 15, 2007. Members were followed for 180 days after the initial claim
to determine switching behavior. Over 20,000 consumers representing over
1,000 clients were included in the study.
Copies of both studies are available at:
http://www.express-scripts.com/industryresearch/outcomes/onlinepublications/
About Express Scripts
Express Scripts, Inc. is one of the largest pharmacy benefit management
(PBM) companies in North America, providing PBM services to millions of
consumers 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.
Media Contact: Steve Littlejohn
314.996-0981
slittlejohn@express-scripts.com
SOURCE Express Scripts, Inc.
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http://www.express-scripts.com
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CONTACT:
Steve Littlejohn of Express Scripts,
+1-314-996-0981, slittlejohn@express-scripts.com
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