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CVS Caremark study finds PBM design optimizes generic utilization

10/13/2009

WOONSOCKET, R.I. CVS Caremark presented data at the Academy of Managed Care Pharmacy's annual educational conference, which illustrated how innovative pharmacy benefit plan design can impact generic utilization. The study further underscored how pharmacy benefit managers can work with plan sponsors to manage costs and improve health outcomes by working to change plan participant behavior through increased engagement.

The study was designed to evaluate the results of plan design changes, including implementation of a $0 copay for generic medications, on the generic dispensing rate, plan participant cost and impact of plan participant behavior changes on health outcomes. During the study period, participants were allowed to fill prescriptions for generic medications at a preferred retail pharmacy network at a $0 copay. The study included 15,000 plan participants covered by a self-funded employer group who were continuously enrolled under the benefit for the duration of the study period (Dec. 1, 2007, through July 31, 2009).

The study found that implementing a $0 copay structure for generic medications can be an effective strategy to increase generic dispensing, with the generic dispensing rate increasing to 60.8% (a 4.2% increase) during the study period.

In addition to an improvement in GDR during the study period, the analysis found that the average participant cost share for generic medications decreased 9.4%. In addition, the average plan cost per 30 days of therapy also exhibited a slight decline, despite the reduction in generic copayment rates. Prevalence of use in three key preventative drug classes also increased significantly (participants on cholesterol lowering therapy increased 13%, on antihypertensive therapy increased 7% and on diabetic therapy increased 9%) as a proportion of eligible patients.

"Our 2009 Benefit Planning Survey found that clients are more interested in identifying opportunities to change plan participant behavior, rather than shift costs," said CVS Caremark EVP Jack Bruner. "The data presented at AMCP illustrates an example of how we can work with our plan sponsors to change and optimize participant behavior in order to achieve increased generic utilization. These types of partnerships enable us to effectively reduce costs for both our client and their plan participants without compromising quality or access.

"While some plan designs work to drive generic utilization by increasing brand medication copayments, this study demonstrates that lowering the generic copayment can also be an effective strategy to increase GDR," Bruner added. "In addition, the data indicates that lowering the generic copayment may also be associated with an increase in participants taking key preventative drugs, which could positively impact adherence and overall health outcomes."

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