Archive | August, 2011

Adherence Event In DC – September 22 – NEHI

Do you remember NEHI? They are the ones that prepared the often quoted report quantifying the cost of adherence at $290B per year.

Well, they’re at it again. They’re hosting an event in Washington DC on September 22nd to talk about adherence. And, from the participant list, it looks like everyone is signing up to be there. So, I called Tom Hubbard (Senior Program Director) and asked him some questions about the organization and the event. Here’s his responses:

  • Who is NEHI?
    • NEHI is a non-profit research organization, headquartered in Cambridge (Massachusetts). We were created to be a “think and do tank” that focuses primarily on questions of innovation in health care. Our particular modus operandi is to be very multi-stakeholder in how we approach things: our founders deliberately set out to create a think tank, supported by member organizations that spanned multiple sectors of the health care world, including patient groups, payers, providers, academic medicine and technology firms in pharma, biotech and medical devices.  
  • Why are you focused on adherence?
    • We started to focus on adherence because of very strong input from member organizations that adherence is one issue in health care that could prove to be one of those rare win-win propositions. At least in theory, better adherence will result in better health for patients, more effective health care that creates higher value and less waste, a bend in the cost curve, while increasing the appropriate use of drug therapies. Back when we started this work, almost three years ago, many of our member organizations felt that poor adherence was a neglected issue in health policy that cried out for greater attention and creativity from all stakeholders. (See their recent 2-page overview document.)
  • Describe the current project – history, objectives, participants?
    • Our current project in medication adherence is an attempt to create a “roadmap” for improved adherence. We’re not ambitious enough to suggest that we can produce the kind of roadmap that some industries are familiar with —- a roadmap that lays out specific benchmarks of progress at specific points in time. Health care doesn’t work that way, for better or worse.  The medication adherence roadmap we’re devising is one that will identify what we think are outstanding opportunities for making progress on medication management and patient adherence based on the multitude of trends and initiatives that are aligning to support these goals, or could align given time and attention from decision makers. So – for example – one major opportunity that a lot of people are seeing is in initiatives around the reduction of unwarranted hospital readmissions. Cutting readmissions will involve good medication management and faithful adherence among patients, and readmissions policy represents a significant driver of new medication management and adherence strategy.
  • What is the upcoming event about?
    • On September 22, we will hold a conference in Washington at the National Press Club to release our roadmap document and stage a discussion that will focus on how to make the roadmap a reality. We’re assembling a panel and an audience of thought leaders from a number of key sectors to explore where we can find common cause on these various opportunities to improve medication management and patient adherence throughout the health care system over the next few years.
    • Some of the panelists for the upcoming event are:
      • Joshua Benner, PharmD, Brookings Institution
      • Laura Cranston, Pharmacy Quality Alliance
      • Doug Hoey, National Community Pharmacists Association
      • Ken Majkowski, PharmD, Surescripts
      • Terry McInnis, MD, Blue Thorn Inc.
      • Michael Sherman, MD, Harvard Pilgrim Health Care
      • William Shrank, MD, Center for Medicare and Medicaid Innovation
      • Brian Sweet, AstraZeneca
      • Troy Trygstad, PharmD, PhD, Community CareNorth Carolina
      • Ira Wilson, MD, Brown University
  • What is the objective of the event and how does this build on the prior report?
    • Our primary objective with the roadmap and the September 22 event is to help build more understanding and support for action that will promote good medication management and adherence. There’s widespread recognition that more research is needed on effective adherence promotion, so there’s a lot left to learn about how to do this well. But the health care system cannot afford the luxury of waiting. The double whammy of increasing chronic disease cases and increasing health care spending is already compelling at least some organizations to reorganize and refocus on the effective use of medications. We want to shed more light on this and build more support.
  • What’s next for NEHI in this area?
    •  I mentioned that NEHI’s founders sought to build a “think and do tank,” so we’re interested in the “doing” part of adherence promotion. In the short ter,m this will mean working hard to disseminate the patient medication adherence roadmap among decision makers in both the public and private sectors. Longer term, we want to work with like-minded organizations to try and advance an adherence agenda that makes sense for patients and other stakeholders. Just exactly what this means in terms of our work after September 22 is something we’ll assess as we launch the roadmap.      

 

Walgreens Quote From NACDS As “Community Pharmacy”

While many of us would consider Walgreens as one of the two models of chain pharmacy (with CVS), this quote from one of their executives from the NACDS conference in Boston right now makes it sound like they consider themselves more of a community pharmacy.

“There is no greater value in healthcare delivery than community pharmacy.  When I talk of value, I am not talking just about all that community pharmacists do everyday to help reduce drug spend.  Though that is important, pharmacy’s value goes so much deeper.  It is about community pharmacy – and the expertise of pharmacists – as a true partner in a comprehensive and collaborative approach to healthcare.  It is about improving patient health, while delivering part of the solution to driving down health costs across the spectrum by preventing more costly forms of care.”  Walgreen Co. Divisional Vice President, Government and Community Relations, and 2011 National Association of Chain Drug Stores (NACDS) Pharmacy & Technology Conference Chairman Debbie B. Garza, RPh

Maybe this has been their long-term positioning, but I also wonder if a few events haven’t pushed them from being a mediator in the middle of the industry to taking a more hardline approach:

  • CVS (their competition) buys Caremark changing their retail perspective
  • Walgreens jumping into the direct-to-employer model at Caterpillar with Walmart
  • CVS Caremark and Walgreens network dispute in 2010
  • Walgreens sells their PBM to CatalystRx
  • Walgreens and Express Scripts ongoing dispute

Given the traditional angst between the independents and the PBMs, will Walgreens harden their position to be closer to the independents and what will that mean for the overall industry?

Pharmacy Satisfaction Report

If you haven’t read through the Pharmacy Satisfaction Pulse Report, you’re missing some great information.  There’s not a lot out there about consumer level expectations for pharmacies but this is a good start.  (Full site with other data)

Here’s four charts I pulled out of the report to get you started…These should help you frame messaging around retail-to-mail, 90-day, and pharmacy adherence programs.

 

 

 

Summary Of Drug Trends (Prime’s Report’s Out)

Prime Therapeutics published their Drug Trend Report yesterday.  I haven’t had time to read it yet, but I pulled their total trend numbers and aggregated them into charts with the previously reported numbers from other PBMs.  (As always, you can see detailed summary’s from Adam Fein and I on most of the reports.)

Additionally, here’s a summary from last year.  AND, as always, don’t forget that these aren’t apples to apples.

(NOTE: Lower trend is better implying that the PBM is doing a better job at managing costs for their clients although as I’ve argued there may be some clinical reasons for trend going up that are good - e.g., improved adherence, identification of pre-diabetics, addressing primary adherence.)

 

 

Increasing Preferred Pharmacy Usage (3 of 3)

This is the third of three posts on new ideas for increasing usage:
  1. Driving preferred pharmacy usage from the employer site
  2. Using social media
  3. Borrowing from other industries

The idea in all of these was to look at new ways that builds on the standard approach that we work with many clients on today.  And, if you believe that the Express Scripts / Walgreens dispute won’t get resolved, we’re going to see a lot of people using limited or preferred networks very soon.  This is also something that Adam Fein talked about in highlighting some of the progress Wal-Mart is making in this area.

So what are some examples of things we could borrow from other industries?

Referral Program:  Why not offer incentives for people who refer their friends and family into the pharmacy? Wouldn’t this play into the social network or peer-to-peer trends out there?

Satisfaction Surveys:  Why isn’t there more monitoring of the customer satisfaction to look for improvement opportunities?  [Note: I know there is some, but I think it's under-utilized as a tool.]

Tiered Service Levels:  Frequent travelers get different levels of customer service.  Why don’t high utilizers with lots of co-morbidities and Rxs get a better level of service?

Points:  Why aren’t there more incentive systems and “points” that are used to reward consumers based on share-of-wallet or other metrics?  [I think there may be some legal issues here.]

Online Order Tracking:  Why can’t I watch my prescription being filled and track it around the system online?

Pharmacy Ratings:  Why isn’t there a consumer and business system that ranks pharmacies based on wait time, friendliness of staff, error rates, generic fill rates, overall satisfaction, or other metrics that can then be pushed to the consumers?

Incentives / Coupons: Certainly these have been tried and there are limits here especially in government funded benefits, but it’s still few and far between.

MD Programs: Physicians can certainly influence this decision.  Why isn’t there more effort to differentiate a pharmacy (mail, retail, specialty) by building relationships with high prescribers?

Check-in / Preferences: Why don’t the forms in the physician’s office (or applications) have you select a preferred pharmacy or have a pop-up with a preferred pharmacy in it to drive you there?

Credit: For some people, it’s an issue to front the money for the 90-day supply.  Why haven’t the mail order pharmacies partnered with a credit card company to allow for installment payment?

If you’re going to “win” at this game, you have to think differently.  You have to test and learn.  You have to capture insights from your customers and translate them into product offerings.  It’s not easy.

Infographic: MD-Pt Communication Link To Non-Adherence

Within the payer / pharmacy / PBM world, we tend to think of adherence as something that can be addressed by us. What if the problem is more systemic than that? I’m not talking about clinical issues like side effects or even cultural biases.

I’m talking about process related issues that stem from physician and patient interactions. If the patient doesn’t believe the drug will help them and doesn’t understand their condition and their medication, they’re set up to fail.

With that in mind, I appreciated the infographic that Stephen Wilkins (@HealthyMessaging) sent to me earlier today (see below):

Increasing Preferred Pharmacy Usage (2 of 3)

This is the second of three posts on new ideas for increasing usage:
  1. Driving preferred pharmacy usage from the employer site
  2. Using social media
  3. Borrowing from other industries
A lot of companies have YouTube channels (for example):
But, why hasn’t anyone focused on how to leverage patient or consumer stories as testimonials about their pharmacy experience to drive new customer acquisition?  This is certainly used in other industries.  We’ve all seen promotions where companies ask people to submit video stories about how they use their product.  What a great way to get people talking about their experience.  I haven’t seen anyone do that in pharmacy.
Given that we know storytelling works for patients, why don’t people try this.  We know peer pressure messaging works to address weight loss or smoking or even energy usage so why not pharmacy selection.
We’re all probably familiar with the famous “What Would You Do For A Klondike Bar” campaigns.

Or what about the Foursquare concept of location based check-in?  Would this drive traffic?  Could you cross-sell using Foursquare – OTCs, non-Rx purchases, DME?  Maybe we could ask Walgreens

Here’s a description from Foursquare on their merchant page:

“Whether you’re a national chain, a mom-and-pop shop, or anywhere in between, you can attract new customers or reward your most loyal ones by offering foursquare Specials – mobile coupons, prizes or discounts – which are presented to users when they check in at or near your venue.  Specials create extra enticement to get customers to stop by – think 20% off a meal, a free dessert, or even a reserved parking spot for your most loyal customers.  Specials can be tailored to fit your needs, whether it’s a unique discount for first-time customers or rewards for the 10th visit (see our full menu of available Specials below).”

 

Increasing Preferred Pharmacy Usage (1 of 3)

For my purposes, I’m going to define a preferred pharmacy as one of the following:

This is the first of three posts on new ideas for increasing usage:
  1. Driving preferred pharmacy usage from the employer site
  2. Using social media
  3. Borrowing from other industries
For today’s post, I’m going to focus on how a PBM (or retailer) could work with an employer to drive use of a preferred pharmacy.  There are the obvious ways:
  1. Plan design
  2. Incentives
  3. Interventions (letters, calls)
  4. Reminders on the intranet
But, let’s look at a little history of what’s been tried first outside the obvious:
  1. On-site collection boxes
  2. Kiosks
  3. On-site pharmacy
It’s my understanding that Medco used to (or maybe still does) have “drop boxes” at their large employer sites in the HR department for people to drop off prescriptions for mail order.  The employee would drop them off and then they would be FedEx’d to Medco each night.  It’s a nice convenience feature and if promoted probably serves as a good constant reminder.
Another attempt was made by Duane Reade in NY to put kiosks at employer sites and hospitals to capture new prescriptions and allow them to be couriered over to the consumer from their central fill.  It was a good idea, but it didn’t scale well and had limited upside outside NY.
I spent about a year looking at how to blend the Duane Reade model with Redbox to allow for kiosks that could leverage telemedicine and dispense the top 100 SKUs.  A few models of that concept have continued to grow (although slowly).  Instymeds now has 200 deployments (after almost a decade).  I’ve heard about a few others continuing to try also.
You then began to see a spike in on-site clinics where you could see a physician or another medical professional and get a prescription filled.  Again, this works like some of these others in high density areas where there is a population using lots of chronic medications and with the same PBM/insurer.
Now, with technology, is there an easier way?
Why not have a QR Code posted in your HR department or in the physician’s office or on the back of your ID card or some other place.  When the patient gets their new Rx, they can scan in the code and it can do any of the following:
  • Show them a message about considering mail order
  • Trigger an SMS asking someone to call them
  • Send an e-mail requesting a call back about the closest preferred pharmacy
  • Send them a map of the closest in-network pharmacy
  • Link them to a YouTube video on getting started with mail order
  • Or, in the Worker’s Compensation area, it could create a virtual card for the network
We all know that mobile apps in the pharmacy space are “all the rage” although adoption is surely in the 5-10% range (best case).  So, will this make a difference?  Perhaps not today, but it’s a low-cost way of learning about how consumers (especially those working in large, high-tech environments) might engage.  Right now, most companies are in a learning mode.

Why Do We Have Shortages Of Drugs?

The fact that more and more drugs (180 so far in 2011) are out-of-stock or have limited supply should seem crazy to most of us.  We all feel like we pay so much for healthcare and medication and the system is so intelligent that it should be able to estimate supply in a profitable way.

Obviously, something is broken.  (Here’s a good NYTimes article on the situation.)  And, if you need to be more offended yet capitalistically intrigued, you can read about people price gouging on these drugs when they do find them.  (You only hope that people didn’t buy up large supplies to create false shortages to then create high prices.)

While 1/2 the problems are from issues found during the inspection process, the other 1/2 appear to be from business model problems where there isn’t interest (read money) in producing the drug or not enough supply is produced (perhaps due to constant changing of suppliers or the race to the bottom in generics).

So, what will happen?

  • Will the government step in and do something?  [probably]
  • Will the government stockpile drugs?  [maybe]
  • Will the government require early notification of shortages?  [probably]
  • Will anyone address the business model problem?  [maybe but unlikely]
This isn’t different than some of the issues around vaccines.  As it became ultra-competitive and demand was unpredictable, it wasn’t worth being in the business.  (See 2002 report from the Manhattan Institute.)
To understand some of the regulatory reasons for the shortages, I think Alex Tabarrok does a good job here. Separately, you can read the FDA’s perspective on drug shortages here.  Another link is to ASHP where they track the current shortages.
It would be one thing if the shortages were happening around traditional drugs for chronic medications like high cholesterol where it’s easier to find an alternative, but a lot of the shortages are around oncology drugs which are harder to substitute.  And, at least one article I read on the topic talked about people finding difficulty getting the alternative covered.  IMHO – There should be a process by which an override occurs when a drug hits some national list for shortage so people can take an alternative and only have to worry about clinical outcomes or side effects not coverage issues also.

The Effects Of Sleep On Health (Infographic)

My regular readers know I am fascinated by the correlation of sleep and health.  I found this infographic the other day.

Another Tip For Sleeping – A Cooling Cap

Here’s a new one.  People can sleep better when their head is cold.

So, how do you get your head cold…wear a cooling cap.  I’m not sure where you get them (although a Google search reveals several places), but it seems like an interesting alternative for people with sleep challenges who don’t want to talk sleeping pills.  (more on the topic)

According to data from a few years ago, about a quarter of people were using sleeping pills.  And, while I believe many of these pills were originally seen as acute, 2/3rds of patients have been taking them for an average of 5 years. 

Another study I find interesting is trying to map sleeping style to personality (see here).  Here’s the six positions that they categorized.

TV Can Kill You

A recent JAMA meta-analysis leads to some interesting data.  Not surprisingly, watching more TV increases your probability of chronic conditions.  This should remind you of some of the Blue Zones work about how to live longer.

The correlation between sedentary activities like watching TV and health risks has long been known, but according to the JAMA study, more than two hours a day of TV increases the risk of diabetes and cardiovascular disease by a troubling 20 percent and 15 percent respectively. More than three hours a day raises the risk of premature death for all other conditions by 13 percent. “Beyond altering energy expenditure by displacing time spent on physical activities, TV viewing is associated with unhealthy eating (e.g., higher intake of fried foods, processed meat, and sugar-sweetened beverages and lower intake of fruits, vegetables, and whole grains) in both children and adults,” write authors Frank Hu and Anders Grøntved, who studied all relevant medical literature from 1970 to March 2011.

25% of MDs Tell Un-vaccinated Kids To “Get Lost”

Unfortunately, the issue of kids not getting vaccinated is not going away.  While only 1% of infants don’t get any vaccines, there are still 30% of kids who don’t get all the recommended vaccines.

So, what should a pediatrician do about families that don’t get their vaccines?  Should they continue to treat them?  The number that say it’s time to find a new provider has jumped to 25% in 2011 (compared to 18% in 2005) according to research reported in a Time Magazine article.  I’d bet that number might jump further as physicians bear risk or have more money tied up in performance bonuses.

It begs the question of what adults do…For example, with flu shots, do adults get them?  Based on a Consumer Reports study, it’s only about 50% of adults that do.

I have a few older posts on this general topic.  It’s also a very interesting topic in the pharmacy world as retailers focus on vaccinations both as a revenue source and a value-added service.

I also found this infographic on the topic which I thought I would share.

Medical Coding Career Guide
Created by: Medical Coding Career Guide

Engaging The Un-Engaged

 

One of the hot topics in a lot of healthcare conversations these days is engagement.  There’s the “easy” engagement for the e-patients that are actively involved in their healthcare.  Then there’s the much harder engagement of those that aren’t engaged.  And, finally, there’s the issue of chronic engagement.  I can easily get someone to engage a few times with an incentive or some other “trick”, but how do I get them to stay engaged over time.  It’s not easy.

This is one of the topics that will be discussed at the upcoming Forum 11 in San Francisco.  If you’re coming, look me up.  I’m presenting on Friday.

Large Employer PBM Survey From Barclays Capital

One of the analysts that I follow is Larry Marsh and his team from Barclays Capital.  They put out a lot of great data and information on the industry.  One report that I was reading earlier today is on an employer survey they did of 55 employers representing 1.75M lives.  Medco and CVS Caremark were the largest PBMs in that market segment followed by Express Scripts, Catalyst, and OptumRx.

I was a little surprised that only 76% of the respondents were satisfied or very satisfied with their current PBM.  That’s lower than many studies show.

On the other hand, less than 50% see the proposed Express Scripts / Medco acquisition as driving lower costs (which I generally agree with).

Also, not surprisingly, employer’s specialty trend has been high and 35% of them anticipate it will be higher in 2011.

And, finally, to beat a drum I often talk about…movement to plan designs that support mail or 90-day retail and more use of step therapy are the big changes being made and planned.

How To Use A Robot For Patient Support

While it’s unlikely that we’re going to get much empathy from robots in the near future, VGo Communications is definitely making the idea of tele-presence more believable.  What intrigued me when I first saw this was the ability for remote caregivers to participate in events.  For example, I could imagine my parents going to a physician’s visit in Detroit.  If I was able to log-in and join them using a VGo robot, it would be great.  It’s unlikely I would fly from St. Louis to Detroit to join them.

Now, cost would be an issue here, but I’m guessing someone can come up with a model that allows providers or hospitals to buy multiple robots and allow a remote, web-based log-in process.  (After some training by the user on controlling the robot.)

If we look at studies like the one presented by Kaiser years ago (see below), we know that there’s a huge gap between what the physician says and should say.  For example, this shows that only 34% of the time did the physician tell the patient the duration of therapy.  This play into what I’ve talked about before which is the gap between what the physician says and the patient hears and the questions that come up after the fact versus what questions come to mind during the office encounter.  Could a tele-presence by a third-party help that?  It’s an interesting concept.

Tagxedo Word Cloud For Blog

I love the way Tagxedo takes your blog, tweets, or something else and turns it into word art.  Here’s one from my blog.

I also created them for a few of my favorite blogs…

Drug Channels

KevinMD

WSJ Health Blog

Great Video! Placebo Effect Summarized In Video

A great summary of lots of the placebo research.  A must watch.  (remember if you get this e-mailed to you that you might have to come to the website to see it.)

The Wrong Time To Go To The Hospital

The people at RNCentral sent me this infographic.  It makes you think twice.  Maybe something for clinics to think about in terms of their hours.

New Running Challenge Coming To St. Louis – RunRuckus

For those of you that like running challenges but are tired of the treadmill or your typical neighborhood run, this might be just the challenge.  This is part of the new extreme sports trend, but on a manageable scale for people like you and I.  A good friend of mine is working with the company that is sponsoring Run Ruckus in St. Louis and several other places (Columbus, Boston, Kansas City, Pittsburgh, and more in 2012).

While I’ll admit that I’m a little nervous since my training has been slack here, a good race is always a motivator to step it up.  And, 4 miles in obstacles should be interesting.  Want to join me?  I may have a 2 free passes to the first people that reach out to join me.  Let me know.

In the meantime, take a look and consider signing up.

Penn And Teller On Vaccinations

This is a video that everyone should share.  It’s a funny, short, and blunt video on why to get your kid vaccinated.

There was a recent article in USA Today about vaccines which said:

Vaccines are widely available across the country, doctors say, and poor children can get them for free. The biggest impediment to vaccinating kids today is not cost, but fear, says William Schaffner, a spokesman for the Infectious Disease Society of America and professor at Vanderbilt University School of Medicine in Nashville. Around the world, millions of parents began skipping or delaying vaccines because of an infamous (and since retracted) 1998 study in the British medical journal The Lancet. The study’s author theorized that a combined measles-mumps-rubella shot caused autism.

It became one of the greatest myths in modern medicine, says Offit, author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. He points to nearly two dozen studies showing no link between vaccines and autism. Last year, The Lancet issued the retraction after learning that information had been falsified. British health officials also stripped the study’s author of his ability to practice medicine in England because of professional misconduct.

NY Bill Continues To Stir The Pot – NCPA, FTC

The bill to restrict mail order utilization for pharmacy is not the first attempt, and it won’t be the last attempt by the independents to try to even the playing field with the PBMs through legislation (see comments about KS bill).  If limiting networks (retail, specialty, mail) can lower prices and save consumers and payers money, why shouldn’t they exist?  The payers should have this option in their toolkit.

Here’s the actual text from the bill:

SHALL PERMIT  EACH PARTICIPANT TO FILL ANY MAIL ORDER COVERED PRESCRIPTION, AT  HIS OR HER OPTION, AT ANY MAIL ORDER PHARMACY OR  NETWORK  PARTICIPATING  NON-MAIL  ORDER  RETAIL  PHARMACY  IF THE NETWORK PARTICIPATING NON-MAIL  ORDER RETAIL PHARMACY OFFERS TO ACCEPT A PRICE  THAT  IS  COMPARABLE  TO  THAT  OF THE MAIL ORDER PHARMACY. ANY POLICY WHICH PROVIDES COVERAGE FOR  PRESCRIPTION DRUGS SHALL NOT IMPOSE A CO-PAYMENT FEE OR OTHER  CONDITION  ON ANY INSURED WHO ELECTS TO PURCHASE DRUGS FROM A NETWORK PARTICIPATING  NON-MAIL  ORDER  RETAIL  PHARMACY  WHICH IS NOT ALSO IMPOSED ON INSUREDS ELECTING TO PURCHASE  DRUGS  FROM  A  DESIGNATED  MAIL  ORDER  PHARMACY

Let me make a few comments:

  1. Does this mean that Express Scripts has to let it’s members go to Caremark mail order if they meet their rates?
  2. What does “comparable” mean?  Why isn’t it the same?  Do the independents really want to go to mail order rates?
  3. No more copay differentials?  If this works, pharma should lobby for no more formularies.  (That might not be relevant today, but in the biologics or biosimilars world, they could say we’ll meet the price but you can’t have any copay differentials or utilization management restrictions…AND get it legislated!)

You can see some similar comments on this from Ed Silverman at Pharmalot and Adam Fein at Drug Channels.

As Adam points out, this may even be a leading indicator on how the FTC views the acquisition of Medco by Express Scripts (although the $MHS stock doesn’t reflect that right now).  Here’s what the FTC said in their letter:

FTC staff appreciate that A-5502-B seeks to enhance consumers’ ability to fill their prescriptions at the pharmacies of their choice. We are concerned, however, that the Bill impedes a fundamental prerequisite to consumer choice: healthy competition between retail and mail order pharmacies, which constrains costs and maximizes access to prescription drugs. We are concerned that, in the end, higher costs will lead to higher prices and fewer choices for New York health care consumers. For some consumers, increased costs may mean higher out-of-pocket prices for prescription drugs. For other consumers, it may mean that prescription drug benefits are curtailed or eliminated. Scaled-back drug benefits are likely to create pressing financial concerns for many consumers, and may even lead to additional health problems. As an article in ealth Affairs noted, “when costs are high, people who cannot afford something find substitutes or do without. The higher the cost of health insurance, the more people are uninsured. The higher the cost of pharmaceuticals, the more people skip doses or do not fill their prescriptions.”

As I mentioned in a Pharmacy Times article that I just wrote for their online version, this is a unique time for the independents to try to figure out what to do about consolidation in the industry.  If it’s not Express and Medco, it will be others.  This will look like the wholesaler market sooner rather than later.  It’s time to figure out how to make lemonade here and differentiate their pitch and value. 

In the end, I think you do yourself a long-term disservice to not allow for pricing differentiation within the network based on copays.  I would want to position myself as a higher service pharmacy with greater satisfaction, better medication possession ratio, better outcomes, and therefore become a preferred pharmacy within a limited retail network. 

Press Hits, Presentations, Writing YTD

I wanted to put together a quick summary of brand awareness so far in 2011.  It’s been a banner year already exceeding 2010 press hits (21).

  1. Drug Benefit News article in January around predictions for the industry
  2. Whitepaper on the future of the PBM/pharmacy industry
  3. Mention of my whitepaper in Adam Fein’s blog
  4. Barclays PBM Expert Call on 2/8/11
  5. Drug Benefit News article on Lipitor in February
  6. Managed Care Magazine on Lipitor
  7. Drug Benefit News article on coalition in February
  8. Drug Benefit News article on Walgreens PBM sale in March
  9. AIS Webinar on Copay Cards
  10. Drug Benefit News on Copay Cards
  11. Pharmacy Times on Mail Order
  12. Silverlink eBook we put out on healthcare communications
  13. AJPB July/August 2011 From the Editor
  14. Health Plan Weekly (8/1/11) on OptumRx moving away from Medco
  15. Pharmacy Technology Podcast in July
  16. Ten different appearances in the PCMA SmartBrief
  17. Five references on RxRoundtable.org
  18. A blog citation about extreme couponing
  19. Some discussion of my AIS webinar by David Williams
  20. A guest post on KevinMD about paying physicians for adherence
  21. Grand Rounds
  22. Drug Channels News Roundup
  23. A mention in DigiPharm
  24. HealthLeaders on Medco sale to Express Scripts
  25. HR Online about limited networks
  26. Drug Channels review of the Express Scripts Drug Trend Report

And, I have 5 things that I’ve actively provided comment and content to including my upcoming presentation at the Care Continuum Alliance on engaging the hard to engage with one of our clients – Aetna.

Yellow Dot and HIPAA

I’m confused.  We spend so much time and money in this country worried about HIPAA and patient privacy and now people are putting all their healthcare data on a piece of paper in their glovebox and putting a sticker on their car letting people know that it’s there.  The program is called Yellow Dot.  (see USA Today article)

Don’t get me wrong…I think it’s a great, low-cost strategy to give data to rescue workers in an emergency.  (Not that there shouldn’t be a much easier strategy using technology.)  I’m just amazed that no one seems to worry about privacy here.  Maybe, privacy is only an issue when data can be stolen in mass quantities and sold not when someone can break into your car at the grocery store and take all your information.

Am I alone on this or do others find these things difficult to reconcile?

Storytelling Is A Part of P2P Healthcare

P2P (or peer-to-peer) is a popular topic in healthcare today.  It builds on both the social components of behavioral modification along with the social networking trends.

About one-third of Americans who go online to research their health currently use social networks to find fellow patients and discuss their conditions, and 36 percent of social network users evaluate and leverage other consumers’ knowledge before making health care decisions. Social networks hold considerable potential value for health care organizations because they can be used to reach stakeholders, aggregate information and leverage collaboration.  (from Deloitte study)

One of the biggest researchers out there in this space is Susannah Fox from the Pew Research Center.

Peer-to-peer healthcare acknowledges that patients and caregivers know things — about themselves, about each other, about treatments — and they want to share what they know to help other people. Technology helps to surface and organize that knowledge to make it useful for as many people as possible.  (from recent presentation from NIH – “Medicine: Mind the Gap”)

With that in mind, I found this study from a few months ago about storytelling very interesting.  Imagine the power of capturing stories in some form – DVD, YouTube, written – and sharing them with newly diagnosed patients across an expanded social network.  Imagine helping patients plug into a social network (ala – PatientsLikeMe).

Conclusion:  The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension.

What has really surprised me is that I haven’t seen the large institutional healthcare organizations promoting the use of the social networks.  Maybe I’ve missed it, but I would think they would partner up with a few of these to encourage consumers to use them.  I understand on the one hand that that is “handing off” a patient to a different company, but rather than trying to build their own social networking application, I think they’re better served to leverage what exists.

Newly Diagnosed Diabetics

I was giving a presentation today on diabetes and used this quote from the American Diabetes Association.  I thought I would share it.  To me, this is why it’s so important for pharmacies, PBMs, MDs, payers, employers, etc. to focus on the consumer experience and help address what consumers are feeling when they’re newly diagnosed with diabetes, cancer, or some other condition.

Pharmacy Costs As A Percentage Of Total Medical Spend

If you look at AIS, they track total annual pharmacy costs for leading health plans.  I pulled a few payers out from the table in the July 22, 2011 Drug Benefit News here to share.  If you exclude two very clear outliers on the low end, they ranged from a low of 9.70% to a high of 21.86%.

Here’s a sample:

A New Life For Lipitor – OTC?

Are you surprised that Pfizer might have found a way to extend Lipitor?  You shouldn’t be.

As I talked about before, Lipitor is scheduled to go generic later this year.  Now, there are stories that Pfizer may try to take Lipitor over-the-counter (OTC).  As Ed Silverman (Pharmalot) points out, this has been tried before with Mevacor.  Has anything really changed since then?  I don’t know much about any outcomes from the UK’s allowance of Mevacor to be sold BTC (behind-the-counter), but it would be a good point of information.

The prior questions about consumer behavior with an OTC statin all still apply:

  • Will the right people use them?
  • Will there be over-use?
  • Will this create unnecessary risks?
  • Will people monitor themselves appropriately?

Since statins certainly have side effects, this is a real question.

IMHO – I would think an OTC strategy is a low likelihood unless there is some new data.

On the other hand, with home monitoring of cholesterol tests, there have been some changes.  This might be another source of data.  Who’s using these?  Have they impacted their use of medication?

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