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The Ripple Effects of Trend Management

The Ripple Effects of Trend Management

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The Ripple Effects of Trend Management

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  1. The Ripple Effects of Trend Management Ed Weisbart, MD, CPE, FAAFP Express Scripts

  2. The Ripple Effects of Trend Management With thanks to:

  3. Beyond Trend Management

  4. Beyond Trend Management

  5. Beyond Trend Management

  6. Beyond Trend Management

  7. Two Years Ago We Said… 65% 50% LDL Reducing Potency Simvastatin: 30 – 47% 25% 0%

  8. Two Years Ago We Said… 65% Crestor: 45 – 63% Lipitor: 39 – 60% Vytorin: 45 – 60% 50% LDL Reducing Potency Simvastatin: 30 – 47% Lovastatin: 21 – 42% 25% 0% Low High 2006 AWP

  9. Two Years Ago We Said… Did Switchers Compromise Their Health? 65% Crestor: 45 – 63% Lipitor: 39 – 60% Vytorin: 45 – 60% 50% ? LDL Reducing Potency Simvastatin: 30 – 47% Lovastatin: 21 – 42% 25% Over 80% of Lipitor used in low dosages. 0% Low High 2006 AWP

  10. Two Years Ago We Said… Did Switchers Compromise Their Health? 65% Crestor: 45 – 63% Lipitor: 39 – 60% Vytorin: 45 – 60% 50% ? LDL Reducing Potency Simvastatin: 30 – 47% Lovastatin: 21 – 42% 25% Over 80% of Lipitor used in low dosages. 0% Low High 2006 AWP

  11. Potency Was Generally Preserved

  12. Potency Was Generally Preserved

  13. Potency Was Generally Preserved

  14. Potency Was Generally Preserved

  15. Potency Was Generally Preserved

  16. Potency Was Generally Preserved

  17. Potency Was Generally Preserved

  18. Key Findings

  19. Beyond Trend Management

  20. Same drug Same dose How Does AdherenceImpact HTN Prescribing? Same drug Higher dose Drug A prescribed Second drug added

  21. Same drug Same dose 80 - 100% How Does AdherenceImpact HTN Prescribing? 60 - 80% Same drug Higher dose Drug A prescribed 40 - 60% 20 - 40% Second drug added 0 - 20%

  22. Non-Adherence Adds More Drugs Odds of escalation event

  23. Non-Adherence Adds More Drugs Odds of escalation event

  24. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Medication Possession Ratio

  25. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Medication Possession Ratio

  26. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Medication Possession Ratio

  27. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Waste Medication Possession Ratio

  28. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

  29. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

  30. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

  31. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

  32. Key Findings

  33. Beyond Trend Management

  34. CDHP Ripple Effects

  35. CDHP Ripple Effects

  36. A Common Benefit Design

  37. A Common Benefit Design

  38. A Common Benefit Design

  39. A Common Benefit Design

  40. A Common Benefit Design

  41. They Attract Different Groups CDHP Traditional All significant at p<0.05

  42. CDHP Ripple Effects

  43. CDHP Ripple Effects

  44. CDHP Ripple Effects

  45. Traditional Plan 2005-2006: 14% Increase in PMPY Claims PMPY Claims Adults only; CDS Matched; **p<.01

  46. Traditional Plan 2005-2006: Generics Up, Brands Flat PMPY Claims Adults only; CDS Matched; **p<.01

  47. CDHP 2005-2006: Slight Drop in Total Claims PMPY Claims Adults only; CDS Matched; **p<.01

  48. CDHP 2005-2006: Generics Up, Brands Down PMPY Claims Adults only; CDS Matched; **p<.01

  49. CDHP Ripple Effects

  50. CDHP Ripple Effects