Replacing the “Plan Design Bigot”

In my whitepaper, I talked about the fact that plan design as a tool for managing trend is “dying”. There isn’t room to shift more cost to the consumer. PBMs and plans have to actually activate consumers and get them to take preventative action and cost saving actions.

There are still plenty of people out there that I will call “plan design bigots”. They believe that the only way to drive behavior is to implement plan design – limit the formulary, change copays, put in utilization management programs, implement POS edits. Those things work…don’t get me wrong. But, if that was all there was to it, this would be easy. It isn’t.

You have to find ways to engage the consumer, get them to care, and get them to take action.

I would layout 3 challenges:

  1. Cutting through the “noise” or “communication clutter” that people have in their lives.
  2. Delivering personalized information (right message, right time, right channel).
  3. Getting them to act (AND sustaining that action over time).

Just look at adherence. Reducing copays to $0 improves adherence, but only about 5-10%.

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