the ripple effects of trend management
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The Ripple Effects of Trend Management. Ed Weisbart, MD, CPE, FAAFP Express Scripts. The Ripple Effects of Trend Management. With thanks to:. Beyond Trend Management. Beyond Trend Management. Beyond Trend Management. Beyond Trend Management. Two Years Ago We Said…. 65%. 50%. LDL - PowerPoint PPT PresentationTRANSCRIPT
The Ripple Effects of Trend Management
Ed Weisbart, MD, CPE, FAAFPExpress Scripts
The Ripple Effects of Trend Management
With thanks to:
Andy Behm Emily Cox Mark Eatherly
Amit Kulkarni Doug Mager
Rebecca Sedjo
Yakov Svirnovskiy
2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
3
2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
4
2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
5
2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
6
2008 Express Scripts, Inc. All Rights Reserved.
LDLReducing Potency
Two Years Ago We Said…
50%
65%
25%
0%
Simvastatin:
30 – 47%
Simvastatin:
30 – 47%
2008 Express Scripts, Inc. All Rights Reserved.
LDLReducing Potency
2006 AWP
Two Years Ago We Said…
Low High
50%
65%
25%
0%
Crestor:45 – 63%Crestor:45 – 63%
Lipitor:Lipitor:39 – 60%39 – 60%Lipitor:Lipitor:
39 – 60%39 – 60%Vytorin:45 – 60%Vytorin:45 – 60%
Simvastatin:
30 – 47%
Simvastatin:
30 – 47%Lovastati
n: 21 – 42%
Lovastatin: 21 – 42%
2008 Express Scripts, Inc. All Rights Reserved.
LDLReducing Potency
2006 AWP
Two Years Ago We Said…
Low High
50%
65%
25%
0%
Crestor:45 – 63%Crestor:45 – 63%
Lipitor:Lipitor:39 – 60%39 – 60%Lipitor:Lipitor:
39 – 60%39 – 60%Vytorin:45 – 60%Vytorin:45 – 60%
Simvastatin:
30 – 47%
Simvastatin:
30 – 47%
Over 80% of Lipitor used
in low dosages.
Over 80% of Lipitor used
in low dosages.
Lovastatin: 21 – 42%
Lovastatin: 21 – 42%
Did Switchers Compromise Their Health?
??
2008 Express Scripts, Inc. All Rights Reserved.
LDLReducing Potency
2006 AWP
Two Years Ago We Said…
Low High
50%
65%
25%
0%
Lipitor:Lipitor:39 – 60%39 – 60%Lipitor:Lipitor:
39 – 60%39 – 60%
Did Switchers Compromise Their Health?
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
2008 Express Scripts, Inc. All Rights Reserved.
Key Findings
2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
19
How Does AdherenceImpact HTN Prescribing?
Drug A prescrib
ed
Same drugSame dose
Same drug Higher dose
Second drug
added
How Does AdherenceImpact HTN Prescribing?
Drug A prescrib
ed
Same drugSame dose
Same drug Higher dose
Second drug
added
80 - 100%
20 - 40%
60 - 80%
40 - 60%
0 - 20%
2008 Express Scripts, Inc. All Rights Reserved.
Non-Adherence Adds More Drugs
2008 Express Scripts, Inc. All Rights Reserved.
Non-Adherence Adds More Drugs
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Scenario 1
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Scenario 1
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Scenario 1
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Waste
Scenario 1
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Scenario 2
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Scenario 2
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Scenario 2
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Waste
Scenario 2
2008 Express Scripts, Inc. All Rights Reserved.
Key Findings
2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
33
CDHP Ripple Effects
CDHP Ripple Effects
2008 Express Scripts, Inc. All Rights Reserved.
A Common Benefit Design
2008 Express Scripts, Inc. All Rights Reserved.
A Common Benefit Design
2008 Express Scripts, Inc. All Rights Reserved.
A Common Benefit Design
2008 Express Scripts, Inc. All Rights Reserved.
A Common Benefit Design
2008 Express Scripts, Inc. All Rights Reserved.
A Common Benefit Design
2008 Express Scripts, Inc. All Rights Reserved.
They Attract Different Groups
All significant at p<0.05
Traditional CDHP
CDHP Ripple Effects
CDHP Ripple Effects
CDHP Ripple Effects
2008 Express Scripts, Inc. All Rights Reserved.
Adults only; CDS Matched; **p<.01
PM
PY C
laim
sTraditional Plan 2005-2006: 14% Increase in PMPY Claims
2008 Express Scripts, Inc. All Rights Reserved.
Adults only; CDS Matched; **p<.01
PM
PY C
laim
sTraditional Plan 2005-2006:
Generics Up, Brands Flat
2008 Express Scripts, Inc. All Rights Reserved.
Adults only; CDS Matched; **p<.01
PM
PY C
laim
sCDHP 2005-2006:
Slight Drop in Total Claims
2008 Express Scripts, Inc. All Rights Reserved.
Adults only; CDS Matched; **p<.01
PM
PY C
laim
sCDHP 2005-2006:
Generics Up, Brands Down
CDHP Ripple Effects
CDHP Ripple Effects
CDHP Ripple Effects
2008 Express Scripts, Inc. All Rights Reserved.
2006: We Were Concerned
52
*p<.05
Q1 2006 persistence rates
2008 Express Scripts, Inc. All Rights Reserved.
2007: ChoiceMatters
2008 Express Scripts, Inc. All Rights Reserved.
ChoiceMatters
54
2008 Express Scripts, Inc. All Rights Reserved.
ChoiceMatters
55
2008 Express Scripts, Inc. All Rights Reserved.
2007: ChoiceMatters Boosted Persistence
56
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Bars to the green area on the left:
Choice Matters did better.
2008 Express Scripts, Inc. All Rights Reserved.
2007: ChoiceMatters Boosted Persistence
57
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Bars to the red area on the right:
Choice Matters did worse.
Bars to the green area on the left:
Choice Matters did better.
2008 Express Scripts, Inc. All Rights Reserved.
2007: ChoiceMatters Boosted Persistence
58
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Ch
oice
Matte
rs w
orse
2008 Express Scripts, Inc. All Rights Reserved.
2007: ChoiceMatters Boosted Persistence
59
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Ch
oice
Matte
rs w
orse
2008 Express Scripts, Inc. All Rights Reserved.
2007: ChoiceMatters Boosted Persistence
60
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
*
* = p<0.05
Ch
oice
Matte
rs w
orse
2008 Express Scripts, Inc. All Rights Reserved.
ChoiceMatters Increased Switching
61
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Ch
oice
Matte
rs w
orse
2008 Express Scripts, Inc. All Rights Reserved.
ChoiceMatters Increased Switching
62
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
*
* = p<0.05
*
**
*
*
*
Ch
oice
Matte
rs w
orse
2008 Express Scripts, Inc. All Rights Reserved.
Take-homes:
63
The Ripple Effects of Trend Management
With thanks to:
Andy Behm Emily Cox Mark Eatherly
Amit Kulkarni Doug Mager
Rebecca Sedjo
Yakov Svirnovskiy