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Blue Cross and Blue Shield of North Carolina
Medication Dedication Program
Problem Identification
Poor adherence to medication therapy is as dangerous and costly as many illnesses. Studies show non-adherence costs 125,000 lives a year to cardiovascular disease alone plus $100 billion annually in health care dollars.1 Yet only half of people with
chronic health conditions take medication as directed.2 Increasing medication adherence provides significant health benefits and decreases overall health care costs. A recently published study found that higher rates of medication adherence for congestive heart failure (CHF), diabetes, high blood pressure and high cholesterol were associated with significantly lower rates of hospitalizations.3
Factors contributing to non-adherence can be attributed to providers, patients and the health care system. Barriers include cost, forgetfulness, education, and drug side effects. Programs most successful at increasing adherence are multi-level and focus on several components of the issue.
Objectives
Blue Cross and Blue Shield of North Carolina (BCBSNC) established the Medication Dedication program to remove barriers, improve adherence as measured by Medication Possession Ratio (MPR), improve health outcomes, and lower overall health care costs.
Target Population
The program targeted 100,000 fully-insured group members being treated for high blood pressure, high cholesterol, diabetes, or CHF. Prescribing physicians were another key audience.
Solution
Removing Cost Barriers
Phase I addressed the cost barrier issue. BCBSNC waived the member copayment on generic drugs used to treat the targeted conditions and implemented drug tier changes to make certain brand-name medications more affordable. The plan leveraged office calls by pharmaceutical representatives to deliver information on the Medication Dedication program and affordable prescription alternatives to physicians. BCBSNC created Medication Dedication collateral materials for pharmaceutical companies to customize with drug -specific information about their products to share with prescribers.
Educating Members, Physicians
Phase II addressed education and forgetfulness. The member strategy included automated refill reminder calls, reminder letters promoting free generics, and convenient 90-day supply prescriptions. BCBSNC worked with pharmaceutical companies to provide copayment reduction coupons. The physician strategy included enhanced ePrescribe™ messaging with electronic reminders of patient adherence levels based on medication history. Physicians received report cards detailing patient-specific adherence levels and generic dispensing rate information. BCBSNC leveraged statewide network provider conferences and provider electronic communication links to promote its free generics and 90-day supply prescriptions for the targeted population.
Results
MPR for the targeted population of 100,000 improved by more than 3% from January 2008 through September 2009. The pre-program MPR was 70.7%. As of September 2009, MPR was 74.14%. Improvement in adherence (MPR) between 2008 and 2009 for members participating in the medication adherence program far exceeds improvement in adherence for nonparticipants. This holds true for all four targeted conditions. The targeted population is measured based on a rolling 12 months, allowing the plan to properly account for active members with fills prior to the beginning of the measurement period and prevent over-counting fills obtained at the end of the measurement period.
Other results that support increased adherence include:
- More than 10% increase in newly diagnosed members starting therapy with a generic in 2008 (70%) than in 2007 (59.8%). Early 2009 data show continued positive trend.
- Increase in generic dispensing rate for Medication Dedication drugs from 65.2% to 70.6%. BCBSNC data shows members switching from brands to generics are more adherent to therapy than members remaining on brand-name medications.
- Substantial increase in the percentage of members filling a condition-matching Rx within 90 days of diagnosis (41.6% to 45.1%) and decrease in number of days to initial fill following diagnosis (from 15 days to 11.2 days). These numbers are calculated by referencing medical claims to identify date of initial diagnosis and integrating with pharmacy data for initial fill date.
- 2% increase in prescriptions filled as 90-day vs. 30-day supply. Medication adherence is higher for members who purchase 90-day fills over those members who purchase 30-day fills.
BCBSNC is conducting additional analysis to identify changes in inpatient and emergency room utilization, as well as total health care costs.
1 Case Management Adherence Guidelines V2.2006. Available at http://www.cmsa/org/portals/0/pdf/CMAG2/pdf Accessed 2/24/07.
2 Rubin, Rita. (2007, March 28). Doctors baffled by patients not taking prescriptions. USA Today. Accessed March 30, 2007.
3 Sokol MC, et al. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Medical Care. 2005;43:521-530.
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