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PBMI Expands Content of 16th Annual Drug Benefit Design Survey

SCOTTSDALE, Ariz. – (March 18, 2010 ) – The Pharmacy Benefit Management Institute (PBMI) is expanding the scope of its benefits research on prescription drug costs and plan design to understand more about specialty pharmacy and personalized medicine. PBMI wants all sponsors of drug benefit programs, including employers, union groups and associations, to participate in the online survey now underway.

PBMI’s 16th Prescription Drug Benefit Cost and Plan Design Survey will continue to document decisions organizations are making about their drug benefit plans to control costs and improve clinical outcomes. In addition to cost sharing and pharmacy reimbursement trends, the study provides insights on dispensing channels (retail, mail, specialty), per member per month utilization metrics, and clinical management tools including academic detailing, face-to-face consults, and step therapy.

“Employer participation in our survey enables PBMI to provide valued benefits benchmarking resources to all of the professionals involved in designing and managing drug benefit programs,” says Dana H. Felthouse, MBA, president of PBMI. “We are offering incentives to encourage participation from plan sponsors offering the drug benefit.”

Plan sponsors (employers, unions and associations) who have not received a survey invitation should contact PBMI at 480-730-9814 or info@pbmi.com. Survey deadline is April 30.

PBMI gratefully acknowledges the support of Takeda Pharmaceuticals North America (TPNA), Inc. for the provision of a grant to cover costs incurred in the production of print and online versions of the report. TPNA has no access to the individual responses or raw data gathered, nor do any other third parties. This protects the confidentiality of the survey respondents and ensures the independence and objectivity of this report.

The Pharmacy Benefit Management Institute provides research and education to help health care benefit executives work effectively with pharmacy benefit managers to improve the design and management of drug benefit programs. Learn more at www.pbmi.com. To view this release and other PBMI news, visit www.pbmi.com/news-releases.asp

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PBMI Recognizes Innovation in Drug Benefit Industry

SCOTTSDALE, Ariz, February 18, 2010 - The Pharmacy Benefit Management Institute (PBMI) has awarded four 2010 Rx Benefit Innovation Awards to the 1199SEIU Benefit Funds, Blue Cross and Blue Shield of North Carolina, Manatee County (Florida) Government Employee Health Benefits, and Unity Health Plans Insurance Corporation with the Wisconsin Pharmacy Quality Collaborative. The awards were announced today at PBMI’s 15^th anniversary Drug Benefit Conference in Phoenix.

The 1199SEIU Benefit Funds are being recognized for a cost containment program offering members the most clinically effective medications at no out-of-pocket cost, while achieving a -1% drug trend. Blue Cross and Blue Shield of North Carolina (BCBSNC) is being recognized for a program that increased medication adherence in its chronic disease population by minimizing barriers to adherence. Manatee County Employee Health Benefits is being recognized for an integrated health management program resulting in a -3.8% drug trend and measurable improvements in employee health. Unity Health Plans Insurance Corporation and the Wisconsin Pharmacy Quality Collaborative are being recognized jointly for a novel provider-payer partnership that compensates community pharmacists for quality-based, value-added services.

"Our 2010 award recipients have demonstrated creative thinking in their solutions to ongoing cost and quality issues,” says Dana H. Felthouse, MBA, president of PBMI. "They have challenged industry norms to improve the value of the drug benefit. The importance of investing in effective plan design, health improvement and medication management is a common theme.”

Cost Savings Without Cost Shifting
In an era of increased cost shifting to participants, the 1199SEIU Benefit Funds provide 420,000 members with access to a range of generic and brand-name drugs at no cost, provided members follow the plan. The Funds’ aggressive management strategies include mandatory generics, mandatory mail-order for maintenance drugs, and a preferred list. If members make choices outside these parameters, they pay out-of-pocket. The approach has engaged members in using their benefits wisely and saved more than $200 million in drug costs since 2005.

Increased Medication Adherence
BCBSNC implemented member and provider strategies to increase medication adherence in a 100,000-member population with hypertension, high cholesterol, diabetes or congestive heart failure. The plan offered free generics and reduced copayments for certain brand-name drugs. Members received refill reminders and physicians received ePrescribe™ messages about patient adherence. Pharmaceutical representatives delivered program information to physicians during office calls. In 19 months, medication possession ratio (MPR) for the target population increased from 70.7% to 74.14%.

Controlling Trend With Value-based Benefit Culture 
Manatee County’sYour Choice Employee Benefits Plan is a model for controlling drug and medical costs and improving employee health by investing in a fully integrated health management program. Through financial incentives, a rich array of onsite clinical resources, and collaboration across health care silos, the County has built a value-based benefit culture that delivers a return on investment. A total of 93 percent of members are engaged in preventive screenings and programs for targeted health improvement. The County’s combined medical and pharmacy costs are currently at 2006 levels.

Quality-based Pharmacy Reimbursement
The WPQC developed a pharmacy pay-for-performance program that features a quality-based pharmacy credentialing process and professional services reimbursement schedule. Participating pharmacies must implement changes at their practice sites to meet 12 quality-based requirements to be eligible for payer reimbursement for value-based services. As the first payer participant, Unity Health played a key role in advancing the project. Unity estimates a 2.5 to 1 return on investment in the value-added pharmacy services.

PBMI provides research and continuing education to help health care purchasers work effectively with pharmacy benefit managers and other industry professionals to improve pharmacy benefit programs and control costs. Read case studies on award winners at www.pbmi.com. To view this release and other PBMI news, please visit www.pbmi.com/news-releases.asp

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