Reprinted from DRUG BENEFIT NEWS, biweekly news, proven cost management strategies and unique data for health plans, PBMs, pharma companies and employers.
By Lauren Flynn Kelly, Editor
July 27, 2012 Volume 13 Issue 14
As members become more reliant on smartphones and other technology, health plans are taking steps to enhance online access to prescription drug price comparison tools and other key information pertaining to their pharmacy benefits. Moreover, as benefit designs get more complex, the need for such enhanced tools increases, suggest several industry experts.
“Medicare Part D did a lot to transform patients into health care consumers, and health insurance exchanges will be no different. With narrow networks coming into play, members have even more questions: ‘Which pharmacy can I go to?’ ‘How much is it going to cost?’” observes Jan Berger, M.D., chief medical officer at Silverlink Communications, a health care technology firm that specializes in consumer outreach. “Consumers are going to need engaging, easy-to-understand, easy-to-use and personalized communications as they take charge of their health care.”
Around the mid-2000s, PBMs worked to get basic information up on their websites, but it wasn’t really something health plans were focusing on, reflects Berger, who previously worked as chief clinical officer at CVS Caremark Corp., where she helped develop a price transparency tool. “The initial technology was a member could go in [to their PBM’s website], compare the prescription they were either taking or that their doctor had prescribed, see what the alternatives were, see what they were paying for it and view general information about the drug,” she tells DBN.
“Fast forward seven or eight years, and we’re seeing a number of health plans putting together programs like this, again in most cases where the member has to look in and has to be proactive,” explains Berger. Aetna Inc., Cigna Corp. and UnitedHealth Group have been active in this space with their launch of mobile phone applications that enable members to access prescription files, locate a network pharmacy, identify preferred and nonpreferred drugs on their formularies or even set up electronic refill reminders (DBN 5/27/11, p. 1).
Aetna has gone so far as to acquire Healthagen, the developer of the iTriage mobile app, and plans to market an open-data platform called CarePass to other insurance carriers that will allow patients to share data across multiple applications. The insurer also has partnered with CastLight Health to offer price transparency tools for everything from prescription drugs to medical procedures.
Such tools are a key component of this technology, whether they pertain to prescription drug prices or health care costs on the whole. And the prices given should be as accurate as possible — not just “estimates of estimates,” asserts Berger.
“Price transparency is a fundamental tenet in the development of the tools and features we implement for our members,” echoes Richard Swartz, vice president of marketing and business development at OptumRx, the PBM subsidiary of UnitedHealth Group. “We strive to provide our members with as much relevant information around how to both live healthier and save money as they manage their prescription benefits.”
OptumRx has partnered with technology vendor Exact Target to help build and act as the fulfillment component of My Medication Reminders, a Web-based service that enables members to set up automated text message alerts that will remind them to take a medication, order a refill or transfer a prescription online, in addition to other solutions. Exact Target also provides email campaign fulfillment services, says Swartz. Meanwhile, OptumRx internally developed My Medicine Cabinet, an online feature that lets members view their prescription profiles, and refill and check on the status of their mail-order prescriptions. Both services are also available through the PBM’s mobile-friendly website, which was launched in 2010.
Smaller Plans Are Slower to Go Mobile
Regional health plans that may not have the resources to develop mobile apps are partnering with technology vendors to offer Web-based member portals with information specific to their plan. SelectHealth, for instance, implemented RxEOB’s MyDrug Benefit about five years ago to help patients understand their pharmacy benefit options by including comparative pricing and personal health management tools, and has just upgraded to version 3.0. SelectHealth is a not-for-profit health plan serving approximately 550,000 members in Utah and Idaho that handles most PBM functions in-house.
“Members have access to all of their prescription histories, and anything they’re looking up is specific to their benefits, so if they have a coinsurance, then the pricing that they’re looking at is specific to that benefit,” explains Eric Cannon, Pharm.D., chief of pharmacy for SelectHealth. “They can also look at alternative medications, and see the actual cost of the medication and their portion of that cost.”
Cannon says the organization felt it was particularly important to implement such a tool for employees of Intermountain Healthcare, the hospital system that owns SelectHealth, because of their complex pharmacy benefit design. For the 65,000 members served by that plan, SelectHealth last year implemented a tiered coinsurance system with a $5 copay for generic medications on the first tier, a 25% coinsurance for tier 2 drugs and a 50% coinsurance for tier 3 drugs. But tier 2 has a minimum copay of $30 and a maximum copay of $60, so depending on the cost of the drug, there’s some variance. And on tier 3, there’s a minimum of $60 and a max of $120, he explains.
“With that complicated of a benefit, there’s no way to help members understand what they’re going to pay unless you’ve got some tool that really calculates out those prices for them and is specific to them and their benefits,” contends Cannon.
SelectHealth’s MyDrug Benefit is computer-based with the possibility of going mobile at some point. “We’ve had lots of discussions about mobile and just haven’t had the resources to prioritize it up higher. It’s something we continue to look at,” he adds.
Physicians Plus Insurance Corp., another hospital-owned health plan that manages its own pharmacy benefits, also has partnered with RxEOB to develop a Web portal for members that it calls Rx Manager. Both members and physicians can access the site to view the formulary, benefit design and other features of the program.
“The product itself not only has the member’s drug profile in it, but you can actually click to therapeutic alternatives within a drug class and see the pricing of some of these products. We encourage our members to print it off and take that sheet in when they see their physician and ask if there’s a less expensive alternative for the therapy,” explains Bill Raey, Pharm.D., chief pharmacy officer and senior director at Physicians Plus, which serves more than 105,000 members in south central Wisconsin.
Physicians Plus is now getting ready to launch a mobile version of the product. “We’ve been working on it the last several months. It’ll have some of the same features as the Web-based product, and we’re excited to get that off the ground,” says Raey.
To improve members’ understanding of their drug benefit, UPMC Health Plan has also made several pharmacy-specific revisions to its website under the Member Education portal. “Pharmacy-related links have been added to many areas of the member portal to create more efficient navigating, often with deep links or call-outs to enable users to go directly to a specific page or capability,” explains Chronis Manolis, vice president of pharmacy for the Western Pennsylvania health plan.
Moreover, the plan has provided enhanced capability on drug pricing — including generic/therapeutic alternatives and channel costs (retail and mail) that include opportunities for savings — redesigned its formulary search tool with enhanced icons to make the tool easier to understand and incorporated pharmacy-specific information into its mobile app.
While MyDrug Benefit could conceivably generate more generic substitutions by improving member awareness of lower-cost options, Cannon says that wasn’t SelectHealth’s primary goal in implementing the tool. “I think we’ve always anticipated that there’d be cost savings from doing this. Right now, our generic penetration is at about 83%, so I don’t think we anticipate getting huge increases based on the tool,” he asserts.
“At this point, I don’t know that we’re so worried about the cost savings as we are worried about providing accurate information to our members and helping them to make informed decisions, and in my mind, that’s kind of the standard that ought to be out there,” concludes Cannon.
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