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CVS Caremark Research Highlights How Innovative Plan Designs Help Clients Reduce Drug Spend and Improve Generic Dispensing Rates
Date:10/14/2010

d to a higher tier or the member cost-share would be increased, the client opted to provide members with first-line access to generic options and a preferred brand which was due to become available as a generic (Lansoprazole) within six months of implementation. In addition, members received the CVS Caremark ExtraCare Health Card, a pharmacy discount card which provided them with a 20 percent discount on FSA-eligible store brands to help manage the costs of OTC alternatives. Members and their prescribing physicians also received proactive communications about the new plan design three months prior to implementation.  

Results showed that the proactive communications outreach decreased potential member disruption significantly, with 56 percent of eligible members converting from a non-preferred brand to an alternative therapy in the first four months of the program before experiencing a rejected claim. In addition, one year after program implementation, the client experienced a 20 percent reduction in PPI spend and the client's GDR in the PPI class of drugs increased from 53.7 percent (one month prior to implementation) to 75.6 percent in the first month and remained steady in the five subsequent months.  

A second study examined the impact of a unique step therapy program designed to address concerns about potential member disruption, which is common when implementing step therapy where members are required to use preferred brand or generic drugs before non-preferred drugs.  Prior to implementation, three phases of proactive communication and outreach were conducted: 1) the plan sponsor sent notification letters about the upcoming plan design change to members and physicians 60 and 30 days prior to implementation; 2) a dedicated call center handled questions and prior authorization requests and; 3) physicians were able to proactively request prior authorization through the call center prior to implementation of the new plan design. After
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SOURCE CVS Caremark
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