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Targeted Patient Education Effective in Switching Patients to Therapeutically Equivalent Generic Alternatives: Significantly Greater Impact in Home Delivery (PDF file)
Patients are not always aware of newly available generic drugs after patents for brand drugs expire and potential cost savings often remain unrealized. After the patent for Ambien® expired in April 2007, a letter campaign targeted patients taking other branded hypnotics to educate them about the availability and cost-savings potential of the therapeutically equivalent drug. This study evaluated the success of the educational program and demonstrated that informing patients about lower-cost, equally effective alternatives significantly increased the likelihood of switching to the generic. The study also found a greater response among patients filling their medications through home delivery pharmacies as compared to patients who used retail pharmacies.


Is Compliance Really Better in Home Delivery? Evidence Across Three Chronic Therapy Classes
(PDF file)
When compared to retail pharmacy, the convenience and savings of the home delivery channel is of great value to many patients. In addition to cost savings and convenience, another potential benefit for patients and plan sponsors is increased compliance with chronic medications. However, comparing compliance of home delivery users to those using retail is often complicated by channel bias — patients who opt into home delivery are more likely to have intentions of remaining on therapy; and therefore, the result is higher compliance rates. This potential bias has been difficult to control for statistically since individual intentions are not easily measured using pharmacy-claims data. This study attempts to reduce these biases by evaluating compliance between retail and home delivery using two plan sponsors with exclusive channel arrangements — retail only and home delivery only — for medications in three therapy classes: antihyperlipidemics, antihypertensives and antidiabetics.

After adjusting for channel bias introduced through patients’ choice of delivery channel and controlling for patient demographics and utilization, members receiving their medications through home delivery had significantly higher compliance rates compared to their retail-pharmacy counterparts. This finding was consistent across all three chronic therapy classes evaluated.


Geographic Variation Trends in Prescription Use: 2000 to 2006 (PDF file)
This study examines trends in prevalence and intensity of prescription use by state from 2000 through 2006 for seven major therapy classes: antihyperlipidemics, antidiabetics, antihypertensives, gastrointestinal (GI) medications, antidepressants, analgesics/anti-inflammatories and estrogen. This study also estimates the change in pharmaceutical spending within the commercially insured U.S. market associated with changes in utilization. Results suggest dramatic changes in prescription-use prevalence from 2000 to 2006 with prevalence and intensity more than doubling for antihyperlipidemics, and increasing by more than 80% for antidiabetics and antihypertensives. The South had both higher prevalence rates and trends in use — particularly for antihyperlipidemics, antidiabetics, antihypertensives, and GI medications. In 2006, increased utilization of antihyperlipidemics, antidiabetics, antihypertensives, antidepressants and GI medications was estimated to cost U.S. plan sponsors and their members more than $12 billion.


What Happens to Prescription-Drug Use After Consumer-Directed Health Plan Enrollment? Consumer Choices and the Need for Education (PDF file)
This study assessed changes in prescription-drug utilization from pre- to post-implementation of a Consumer-Directed Health Plan (CDHP) in two large employers in the financial services sector. A particular focus of the study was whether CDHP members took advantage of available cost-savings opportunities, such as converting from brand medications to generics and using Home Delivery. The study compared enrollees choosing a CDHP with those remaining in a traditional insurance plan. Findings suggest that CDHP enrollment alone does not automatically produce more cost-effective behaviors. Better education may positively affect enrollees’ choices.


Potential Savings of Biogenerics in the United States (PDF file)
This study calculated the potential savings to the U.S. healthcare system that could be realized if the Food and Drug Administration (FDA) were to develop a pathway for evaluation and approval of generic biologic medications, or “biogenerics.” Using data from Express Scripts 2005 Drug Trend Report and IMS, Express Scripts modeled the savings opportunity in four therapeutic categories of biologic medication use: interferons for multiple sclerosis, erythropoietin for anemia, growth hormone for growth failure, and insulin for diabetes. Total estimated savings over a 10-year period was approximately $71 billion. The unrealized savings are significant and warrant FDA consideration of a pathway for biogeneric evaluation and approval.


Zero Dollar Generic Copayment Program — 2006 Evaluation (PDF file)
This study evaluated the impact of enhancements to Express Scripts’ Zero Dollar Generic Copayment program. The program, designed to move members from brand to generic drugs, waives copayments on generics in targeted therapy classes for three to six months. Express Scripts recommends the program run for six months. Members of a large state employer plan who met criteria were divided into “case” and “control” groups. A letter informed the case group they would receive the generic drug at no cost for up to four fills. As a result, a significantly greater number of members in the case group switched to generics in five of the seven targeted therapy classes. This finding suggests that member communications, when coupled with an attractive financial incentive, can play an important role in motivating members to try generic drugs.


Factors Predicting Patient Compliance to Specialty Drug Therapy Regimens for Multiple Sclerosis, Inflammatory Conditions and Hepatitis C (PDF file)
Patients taking specialty medications may be at particular risk for noncompliance because their medical conditions are almost always complex, as are the drugs. This study evaluates compliance rates for patients being treated for multiple sclerosis, inflammatory conditions and hepatitis C. It also examines how cost-sharing arrangements (copayments), patient demographics and distribution channels (specialty, retail or home-delivery pharmacies) affect compliance with specialty medications. The findings suggest that patients taking specialty medications are less price-sensitive, only showing a significant drop in compliance when copayments reached the highest levels. Patients using CuraScript, Express Scripts specialty pharmacy, were considerably more compliant than patients using retail pharmacies or other specialty pharmacies, suggesting that the higher-touch model of care provided by CuraScript may positively affect compliance.


CuraScript’s Human Touch in the Treatment of Rheumatoid Arthritis (PDF file)
The Express Scripts research team surveyed rheumatoid arthritis (RA) patients, comparing the "human-touch" services provided by CuraScript — Express Scripts specialty-pharmacy provider — with retail-pharmacy services. The sample included 200 CuraScript and 200 retail patients, all of whom had taken specialty RA medications for a full year prior to June 2006. Responses showed that CuraScript patients were more likely than retail patients to be completely satisfied with services and perceive staff as extremely skillful. Patients enrolled in CuraScript were also better prepared to manage their disease and had a better understanding of how to take their specialty medications.


2005 Generic Drug Usage Report (PDF file)
This study estimates the generic opportunity based upon therapeutic and chemically equivalent generic substitution across six therapy classes, in addition to documenting variations in generic drug utilization among states. Further, the study estimates the potential savings nationally, by state and by therapy class if these targets are reached within a commercially insured population. The estimated annual savings opportunity among commercially insured members across the 48 states and six therapy classes evaluated was $21.3 billion in 2005. The study also provides a national estimate of savings for 2006 of $24.7 billion.


2002-2005 Trends in the Prevalence of Antidiabetic Drug Therapy in Children Age 5 Years to 19 Years (PDF file)
Express Scripts analyzed the prevalence of anti-diabetic prescription use among children enrolled with Express Scripts, Inc., through commercial health plans. The study reviewed the prescription records of at least 3.7 million U.S. children each year. The study revealed a four-year doubling in those taking medication typically used to treat or prevent Type 2 diabetes – a rise from about 0.3 to 0.6 per thousand from 2002 to 2005. The study also identified a 25.9% increase in Type 1 diabetes prescription use, and a 37.9% increase in total prevalence of diabetes medication use for either Type 1 or Type 2 diabetes.


Optimizing the Copayment Differential: Impact on Generic-Fill Rate (PDF file)
Express Scripts studied the relationship between copayment differentials and patients’ choice of generics. The findings indicate appropriately designed copayment structures, such as those using tiered copayments that establish different costs for generics, preferred brands and non-preferred brands can incent members to purchase lower-cost options of their prescription medications such as generics. Every 1 percentage point increase in the generic fill rate can translate into a 1 percentage point reduction in drug costs without shifting costs to members.

The findings of this study indicate that the larger the copayment differential, the greater the impact on Generic Fill Rate (GFR). For every $10 incremental difference in generic and preferred-brand copayments, clients may expect an increase in GFR of up to 3 to 4 percentage points.


Generic Drug Usage Report (PDF file)
In addition to documenting variations in generic drug utilization among states, this study estimates the generic opportunity based upon therapeutic and chemically equivalent generic substitution across six therapy classes. Further, the study estimates the potential savings nationally, by state and by therapy class if these targets are reached within a commercially insured population. The estimated annual savings opportunity among commercially insured members across the 48 states and six therapy classes evaluated was more than $20 billion.


Geographic Variation in Generic Fill Rate (PDF file)
Express Scripts found significant variations in the use of generic medications across states, even greater variation than that seen previously for overall prevalence of prescription use. These findings suggest that among states with lower generic fill rates, opportunities exist to achieve greater savings through adoption of programs designed to increase generic use.


Prevalence of Antidepressant Use in Children: 2003 - 2004 (PDF file)
In an effort to continue to monitor the prescribing of antidepressants in children, Express Scripts evaluated antidepressant prescription claims data for 2003 and the first half of 2004 for a sample of over 5 million commercially insured children 0 to 19 years of age. Our results indicate that the prevalence of antidepressant use in children continued to rise through the first half of 2004. The overall rate of antidepressant use in children grew from 1.47% in the first quarter of 2003 to 1.61% in first quarter 2004, a 9.4% increase in the prevalence of use. This increase in the prevalence of use moderated through the second quarter of 2004, slowing from 9.4% in the first quarter to just under 3% in the second quarter.


Financial Impact of Benefit Design Choice for Non-Sedating Antihistamines
All forms and strengths of Claritin — a prescription (Rx) non-sedating antihistamine (NSA) — became available for sale over the counter (OTC) in December 2002. With these products going OTC, other Rx NSAs still on the market, and no generic Rx Claritin products being offered, health plans had a number of trend management options available for OTC Claritin and the other Rx NSA products. This study presents an evaluation of the financial impact on health plans of their choice of Rx NSA benefit design.


Changes in the Use of Hormone Replacement Therapy (HRT) Combination Products, Estrogens and Other Agents
In July 2002, the Journal of the American Medical Association published two studies questioning the relative safety of combination estrogen/progestin hormone replacement therapy (HRT) products. To assess physician and member reaction to these studies, Express Scripts researchers analyzed the use of combination HRT products before and after the issuance of the HERS II and WHI information. More specifically, Express Scripts addressed the extent to which the use of the HRT combination products Prempro and Premphase, estrogens, and other agents (such as Evista®, Fosamax® and Actonel®) that are used to treat osteoporosis changed after these highly publicized studies were released in July.


Prescription Drug Atlas
Read the first comprehensive, state-by-state study of prescription drug use.


Sex Differences in Prescription Medication Use and Costs in a Large, National Commercial Sample, 1999 (PDF file)
For researchers and policy makers, study results can serve as benchmarks in a number of ways. Examples of this usage include examinations of trends over time and comparisons of prescription drug use in different countries. Plan sponsors may use these findings to anticipate the number and type of members that will be affected when adopting new clinical and administrative programs.


Copayment Increase: Effects of Employee Salary And Chronic Disease (PDF file)
Does a family's income affect its response to prescription copayment changes? This study measures prescription expenditures in a commercially insured HMO population before and after the implementation of a new copayment structure. Using prescription claims analysis and employee survey data, the study finds that responses to a copayment change are influenced both by the magnitude of the change and by income.


Prescription Use Among a Commercially Insured Senior Population, 1998 (PDF file)
Find detailed information on prescription use among the senior population, including gender and age group differences in use across various therapy categories, and total costs paid by the member across different types of cost-sharing methods.

 

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