One Experience With Motivating Pharmacists

Yesterday, a client was asking me about using incentives to motivate pharmacists to take action on behalf of the patient. I had done a pilot with a government client that had a concentration of lives in a small geography and had the majority of their prescriptions filled at one regional pharmacy chain. It seemed like the right scenario to try a program.

I wrote up a mini-case study last night which I thought I might share.

Summary:

The client decided to implement five new step therapy (i.e., the patient is required to use a lower cost generic drug prior to being able to get a higher cost brand drug) programs to go live simultaneously. We were asked to look at innovative solutions to manage the member “disruption”.

We approached the regional chain about a pilot program to reimburse pharmacists for helping patients resolve step therapy rejects at the point-of-sale. We designed a fax form for each of the five therapy classes which outlined the first-line alternatives. The objective was for each pharmacist to fax the prescribing physician using one of the five fax forms upon receiving a reject.

We agreed to pay the pharmacy/pharmacist $10 per fax sent. [Legally, we did not believe we could pay for results but simply for taking action.] We ran the pilot for 6 months and subsequently compared the amount of claims filled within the therapy class (aka GPI) after the rejects at the participating chain versus the amount of claims filled within the class at other chains for the client. We also looked at the number of prior authorizations and percentage of first line agents filled for patients that hit a step therapy reject.

Results:

At the conclusion of the pilot, we found no statistical difference between results from the participating chain versus other chains that did not participate in the pilot. In this time period, I believe we paid out approximately $20,000 for the program and concluded that this was not a solution for influencing physician behavior around plan design.

Lessons Learned:

Because of other priorities, we did not do a thorough analysis of the reasons for this not being successful (e.g., interviews with participating pharmacists), but we had numerous hypotheses about the pilot program.

1. The incentive did not actually get to the retail pharmacist from corporate and therefore the incentive was null.
2. $10 per fax was not enough, given the volume of rejects, to make a financial difference to a pharmacist making over $100K per year.
3. Pharmacists were already doing everything possible to help the patients and the incentive was simply additional cost for a task already being done.
4. Sending faxes to the physician needed to be followed up by the patient and/or pharmacist to make sure the physician acted on the request.
5. There needed to be more education from the corporate office of the retailer.
6. Patients were concerned about the follow-up. Our research had already shown that 50% of people who hit a step therapy reject don’t fill a claim, but that 90% of those that don’t fill a claim either get a sample, purchase an OTC, or pay cash for the rejected drug. (i.e., only 5% of those that hit the reject get nothing)
   

If I were to do it again, there were several things I would do differently. Trying to drive behavior at the pharmacy is a question of aligning incentives and pushing information to them through channels like the Point-of-Sale (POS) system and reject messaging. But, changing behavior has to involve physicians, consumers, and the pharmacist.