Concept of wellness can yield greater savings

Sep 14 2009

According to a new survey released today, 90 percent of plan sponsors believe that minimal attention to personal health and increased incidence of chronic illness such as diabetes and heart disease are at the root of rising health care costs. When asked what influences will have the greatest impact on controlling these escalating costs, nearly 60 percent of respondents say embracing the concept of wellness will yield the most savings, citing the need to control preventable and self-inflicted diseases often linked to obesity and smoking.

The survey, a national peer study of prescription benefit management, was conducted on behalf of Medco by the Healthcare Division of Haldy McIntosh and Associates and polled 300 plan sponsors with between 500 and 50,000+ employees in the first quarter of 2009. It included private and public sector employers and labor unions. The results are reported in the third annual edition of 9 Leading Trends in Rx Plan Management.

"This survey shows that plan sponsors recognize that prevention is key to reducing costs and are looking for approaches that will help employees embrace the concept of wellness, adopt healthier habits, and follow doctors orders when it comes to taking essential medications," said Tim Wentworth, Group President of Medco's Employer Accounts. "A large percentage of our health care dollars are being spent on treatments for diabetes, cholesterol and hypertension - conditions that in many cases could be better controlled, and even prevented, by changing behaviors."

According to a study just published in the journal Health Affairs, obesity-related conditions cost the U.S. $147 billion in direct medical spending in 2008. The study cites the rising rate of obesity as the single greatest contributor to the country's diabetes epidemic.

In addressing the growing problem of chronic disease, plan sponsors are increasingly looking to integrate pharmacy and medical data to help improve health and financial outcomes. In fact, 80 percent of organizations plan to integrate drug and medical data, while 73 percent intend to add clinical management programs to their pharmacy benefit to help increase patient safety and control plan costs.

"Integrating both medical and prescription claims data is a key strategy in helping to control costs related to chronic and complex conditions," said Mike Romanzo, R.Ph., President of Medco's Systemed Group. "It facilitates identifying medication adherence and safety issues. Pharmacists can then counsel patients to reduce the chances of more serious health problems and additional costs."

Additional survey highlights include:

• Specialty SOS - For the second year in a row, specialty medications are seen as the leading driver of prescription drug costs, and 83 percent of plan sponsors support quick legislative action to bring generic versions of specialty drugs to market. More than 75 percent of plan sponsors have found some relief through reduced prices by billing these drugs under the pharmacy benefit instead of the medical benefit.
• Mail order improves adherence - Seventy percent of plan sponsors believe that mail-order pharmacies help members stick to essential drug therapies and nearly half believe that mail-order pharmacists do a better job at identifying adherence problems. Increased medication adherence results in better health outcomes and lower overall healthcare costs. For example, a recent Medco study found that annual healthcare costs for hypertensive patients using mail order saw a $700 per-patient reduction due to increased adherence to prescribed drug therapy.
• Low-cost retail generics programs fall short - While there is unanimous agreement that generics provide significant cost savings, 62 percent of respondents believe that the much-publicized $4 generics programs at retail pharmacies are merely designed to increase foot traffic, and represent only a limited number of available generic drugs.
• Pharmacogenomics goes mainstream - More than 60 percent of plan sponsors believe that genetic testing should become a routine part of health care, with larger companies leading the trend in covering these tests - nearly half provide coverage while only 14 percent of smaller companies do.

Source: http://www.medco.com