Insurers urge medical compliance

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Blue Care Network of Michigan came to an alarming realization last year that its members suffering from asthma were not as compliant as they should be in taking their prescribed medications.

A key driver for the lack of compliance, the insurer discovered, was that asthma controller inhalers designed for daily use were available only as high-priced brand products, said Kim Tonkavich, the director of pharmacy health centers for BCN of Michigan, the health maintenance organization subsidiary of Blue Cross Blue Shield of Michigan. In fact, internal pharmacy data pointed to a tendency for asthma sufferers to purchase rescue inhalers rather than controller inhalers because the rescue drugs had lower copayments, he said.

In response, the company launched an initiative this year to alleviate the copay burden for its members with the hope that this would spur increased medication compliance, Mr. Tonkavich said.

BCN of Michigan is one of several health insurers stepping up their efforts to improve member compliance with prescribed drug therapies, creating targeted programs to address specific disease classes or offering financial incentives to motivate patients to properly take their medications.

In January, the Detroit-based insurer launched generic copayments for all asthma drugs. In April, the company began allowing members to purchase 90-day supplies of asthma medications at retail pharmacies but pay only two copayments instead of the usual three copayments.

By utilizing both programs, members can save more than $300 annually in out-of-pocket prescription drug costs, Mr. Tonkavich said. "It's just an incentive to members to try to improve compliance with drug therapies," he said.

Other insurers have launched their own medication compliance programs.

Bloomfield, Conn.-based CIGNA Pharmacy Management implemented a nationwide diabetes compliance program last year after a pilot program demonstrated that members who adhered to prescribed drug regimens had more successful health outcomes. The pilot program participants who took their medications appropriately lowered their blood sugar levels, had 13% fewer emergency room visits and 18% fewer hospitalizations than in the six months prior to their participation in the program. Members who reached their recommended blood sugar goals also saw a 24% reduction in their medical costs.

A key feature of the CIGNA program is improved communication with physicians. The program identifies members taking drugs to treat the condition, examines their medical information and checks pharmacy claims data to see if they are taking their daily medications. If members are not adhering to the regimen or not achieving desired health target levels, the company forwards this information to the prescribing physician in a graph format, laying out the patient's prescription usage, hospitalization information and laboratory results.

"It makes a clear correlation for the prescribing physician," said Thom Stambaugh, chief pharmacy officer for CIGNA Healthcare.

This is important because doctors do not always know if their patients actually fill their prescriptions, he said. When doctors are informed of the lack of compliance, they can talk to the patient about why they are not complying with the prescribed drug therapies and make adjustments if necessary, he said.

Targeted communication with both physicians and the members themselves on the importance of medication compliance is another approach for health insurers.

A study conducted by United Behavioral Health, a unit of Minnetonka, Minn.-based UnitedHealth Group Inc., tested the value of mailing educational materials to members being treated for depression and their physicians. The materials emphasized that antidepressant medications should not be discontinued without consulting a doctor, that the best treatment for depression included medications combined with psychotherapy visits and that ending treatment early increases the chance of relapse by 50%.

According to the study, members who were sent the materials received more psychotherapy services, more medications and had fewer days/lapses between treatments than those who did not receive the materials, which showed that members will change their treatment plans if insurers invest in sending them educational materials, said Archelle Georgiou, executive vp of strategic relations with Specialized Care Services, the specialty health and well-being division of UnitedHealth.

She stressed, though, that the materials must be specifically targeted to the member's condition and must have detailed information about the repercussions of noncompliance with prescribed medications and treatment. "Otherwise, you could be wasting time and resources," she said.

While insurers are sharpening their compliance efforts with regard to maintenance drugs treating conditions such as asthma and diabetes, they have been focusing on compliance with specialty drug regimens for many years because of their high cost, said John Malley, eastern region pharmacy benefit consulting practice leader for Watson Wyatt Worldwide based in New York.

Specialty drugs are used to treat a variety of conditions that include hemophilia and hepatitis C.

Compliance with specialty drugs is problematic because many have major side effects that cause patients to stop taking them, he said. "Clearly, the focus is much more on big-ticket items, but it's the same type of philosophy," Mr. Malley said. "It's more prevalent in specialty drug management."

Insurers say they are interested in expanding these programs to target more disease classes. CIGNA has already implemented similar programs aimed at asthma and cholesterol.

BCN of Michigan's program could be expanded to focus on diabetes and hypertension if the asthma program is successful, Mr. Tonkavich said. The insurer plans to review its claims data from the first half of the year and compare it to last year's data to see if there has been any increase in the ratio of controller inhalers to rescue inhalers, he said. The company hopes that increased use of control medications will also result in decreased ER visits and costs, Mr. Tonkavich said.

"Our goal is to look at the utilization patterns and see if we're having some impact on changing behaviors," he said.