New Studies Find Home Delivery Pharmacy Customers More Likely to Take Their Medicine and Choose Money-Saving Generic Drugs, According to Express Scripts
Home Delivery a Gateway for Better Health and Value Billions in Savings at Stake
ST. LOUIS, Sept 18, 2008 /PRNewswire-FirstCall via COMTEX/ -- 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 (ESRX:Express Scripts ESRX 72.01, -0.99, -1.4%).
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.