Industry Research

Program Evaluation

Published in 2004

Delate T, Fairman KA, Carey SM, Motheral BR. Randomized Controlled Trial of a Dose Consolidation program. Journal of Managed Care Pharmacy. 2004;10(5):396-403.

The purpose of this study was to evaluate the effectiveness and financial impact of a drug dose consolidation program using a letter intervention. Using a randomized controlled research design, three study arms were evaluated: a member/physician letter-based interventions, a physicians only letter-based intervention and a control group with no intervention to member or physician. The letters were personalized to member and/or physician and contained information about the inefficient regimens and suggested does consolidation options. A review of pharmacy claims data was performed monthly for 3 consecutive months to identify inefficient regimens for any one of 68 dosage strengths of 37 single-source maintenance drugs with once-daily dosing recommendations. Study results show the rate of consolidation to a suggested dosing was higher for both intervention groups compared to the control group, however the rate was higher for the physician/ member intervention group compared to the physician only group. Financial modeling indicated that a dose consolidation intervention could save $0.03 to $0.07 per member per month (PMPM) in 2003 dollars with full medication compliance, but only $0.02 to $0.03 PMPM when savings were calculated with realistic, partial compliance rates indicating that a letter-based dose consolidation program did not appreciably decrease pharmacy expenditures.

Cox ER, Henderson R, Motheral BR. Health plan member experience with point-of-service prescription step therapy. Journal of Managed Care Pharmacy. 2004;10(4):291-298.

The purpose of this study was to better understand the member experience with point-of-service prescription step-therapy edits and the outcomes associated with these edits in terms of drug received. Self-administered surveys were mailed to members who experienced a step-therapy edit for proton pump inhibitors and nonsteroidal anti-inflammatory drugs. Based on the results of the mailed survey, a telephone survey was conducted on separate group of members who experienced a step-therapy edit and did not receive a subsequent claim. Results of this study suggest that a majority of members receive a medication covered by their health plan subsequent to a step-therapy edit. However, opportunities exist for better member and provider communication designed to increase the use of first-line drugs and reduce the number of members paying out-of-pocket or receiving no medication.

Motheral BR, Henderson R, Cox ER. Plan-sponsor savings and member experience with point-of-service prescription step therapy. American Journal of Managed Care. 2004;10:457-464.

The study examines the effect of prescription step-therapy programs on plan-sponsor saving and member experience at the point-of-service. A quasi-experimental, case-control study design was used to measure plan-sponsor saving. Member experience with step-therapy was measured by using a self-administrated mailed survey. Results of this study show a decrease of $0.83 in the net cost after implementing step therapy in the intervention group, while the comparison group had an increase in $0.10 PMPM for these therapy classes., Members who did not receive a medication were less likely to be satisfied with their pharmacy benefit compared with those who received first-line therapy or those who paid out of pocket for the brand medication. The study shows that step therapy can have significant drug savings, however there is opportunity to further member’s and providers’ understanding of there programs.

Published in 2000

Fairman KA, Murphy C. Using informed decision counseling to promote cost-effective care. Drug Benefit Trends 2000;12(4):44-55.

Informed decision counseling (IDC) is the provision of medical information by clinicians to consumers via telephone. IDC addresses two major problems affecting the health care system, unnecessary ambulatory service use and inadequate patient/provider communication. IDC's underlying principle is that members will make appropriate utilization decisions if accurately informed. This article reviews the benefits, purposes and operational requirements of IDC. IDC programs can yield tangible benefits such as cost savings through avoidance of unnecessary utilization, as well as intangible benefits such as better health education and increased member satisfaction.

Published in 1998

Motheral BR. Fairman KA. Patient education programs and continuance with estrogen replacement therapy: Evaluation of the Women's Health Exchange. Menopause 1998;5(1):35-41.

 

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