Aetna debuts co-pay program for high-risk self-funded members

HARTFORD, Conn. Aetna recently unveiled the Aetna Healthy ActionsSM Rx-Savings, a new incentive program under which co-pays for individuals enrolled in self-funded benefits plans who have high risk clinical profiles and are taking medications for chronic health conditions including asthma, diabetes, high cholesterol, high blood pressure and heart disease are paid in whole or in part by their employer.

The program allows self-funded employers to offer a drug class co-pay discount to employees based on a member’s clinical risk profile and relevant evidence-based standards. Eligible members are identified through ActiveHealth Management’s CareEngine System technology, which can proactively identify at-risk individuals who currently use a drug covered in the program, as well as those who could benefit from use of a drug covered in the program.

Once identified, an outreach mailing is sent to members to notify them if they are eligible for co-pay discounts.  If a member is not currently using a drug covered in the program, an outreach mailing is sent to both the member and his or her physician.

“The use of evidence-based medicine in combination with pharmacy benefit design may significantly help to improve the overall quality of care for members with the targeted chronic health conditions by reducing the cost barrier to patient compliance with recommended drug therapies and treatments,” said Ed Pezalla, national medical director of Aetna Pharmacy Management.