What is a Mail Order Pharmacy (Home Delivery Pharmacy)?

My most popular post ever is “What is a PBM?” which made me think that this is probably a relevant post for the average healthcare consumer.  And, given the historical push to mail combined with the current economy, you can expect mail order pharmacy (or home delivery pharmacy) along with 90-day retail pharmacy to be [...]

Are Involved Patients More Compliant?

This is a study from a few years ago from Harris Interactive and BCG that I found on the BioPlus website.  If I am interpreting it right, it would imply that those that are most involved in their healthcare are most likely to be non-compliant.  It doesn’t seem logical, but perhaps those are the people [...]

Why Can’t I Go To Any Physician?

In pharmacy, there is a rarely used benefit structure called Therapeutic MAC (Maximum Allowable Cost).  What this does is say that in any class of drugs (e.g., cholesterol lowering drugs) there is a maximum amount of money that will be paid by the plan.  But the individual can get any drug.
That can be controversial since [...]

Would You Pay $100 To Be Told To Take Your Rx?

We know adherence is a serious issue that drives healthcare costs.  And, as I have talked about a little here and a lot with many of our pharmacy clients, it’s not a simple issue.  People aren’t adherent for a variety of reasons - cost, side effects, health literacy, or simply just forgetting (among others).
There are [...]

Tier Zero

Frank Koronkiewicz, the Director of Pharmacy, at Blue Cross of Northeastern Pennsylvania (BCNEPA) just launched a new plan where people can get 65 different generics focused on chronic diseases at no copay AND without any premium.  It’s called Tier Zero.

Frank has always been a progressive Director of Pharmacy.  We worked on several programs together at [...]

Brand Prices Up; Generics Down

For those of you who are interested in this type of stuff, I think the AARP Watchdog reports (Brand Report, Generic Report) which track prescription drug prices over time are pretty interesting.  (Note: This is for drugs most commonly used by Medicare recipients, but I think you’ll get the point.)

Why People Choose Mail Order Pharmacy?

I was looking for something else in the Express Scripts Drug Trend Report 2005 when I came across this study referenced on page 209. I should have remembered since I wrote this section (yes I was a contributor see page 332). This is a Morgan Stanley study which talks about why people choose [...]

Sell Your Captive PBM - Why?

I was a little surprised by the quote from Lisa Gill from JPMorgan Chase about why health plans should sell their in-house PBMs (Pharmacy Benefit Management):
“I think it makes a lot of sense for PBMs [pharmacy benefit managers] to be sold or spun off as a stand-alone business. The only time it will make sense [...]

Express Scripts Jumps Into Worker’s Compensation

Express Scripts has been in the Worker’s Compensation space for years now.  As I suggested several months ago (see #2), buying a worker’s compensation PBM makes some sense.  The margins are good, but it does require a different service model.
That being said, they jumped in last week with the announcement to buy the worker’s compensation [...]

George Paz (Express Scripts) on Adherence

Paul Levy who is the CEO of a hospital has a blog called Running A Hospital.  He posted a summary the other day of a presentation by George Paz who is the CEO of Express Scripts.  It has some good facts and there are several good comments on there about defining the terms in this [...]

More On Silverlink’s Think Different Event

I am now up in Minneapolis at our 4th Think Different event on how to engage the healthcare consumer.  I talked about the first few speakers the other day, and I finally had a chance to hear the other speakers present.  This week, I had the chance to listen to  James Taylor (of Smart (enough) [...]

NCPA Survey on Adherence

I have been talking a lot about adherence lately (or lack of). A friend sent me the results of a survey of 1,000 adults by NCPA (National Community Pharmacy Association) from October 2006. This is now the 3rd study I have read this week with different results. Of course, they all used [...]

PBM Satisfaction Survey

It should be out soon, and it will be interesting to see the data. The WilsonRx PBM Satisfaction Survey is the only (I think) independent survey done of the industry. [Although I never remember paying attention to it at Express Scripts.] From what I know, they seem to get a good sample [...]

You Only Have To Be Compliant For 10-Days…What Happened?

On the topic of non-compliance, I found this a pretty pathetic statistic:
56% of children on a 10-day course of penicillin for streptococcal infections were no longer receiving the drug by day three. (The Merck Manual of Diagnosis and Therapy)
I guess I expect it with maintenance drugs, but this is for your sick kids where you [...]

Our First Think Different Event

Today was our first Think Different event in Boston. This is a road show we are doing around our new positioning and how health care companies need to get outside the box to improve the effectiveness of their communications. It has four external speakers plus our CEO.
[Spoiler Alert: If you are attending an [...]

Groups And Microsegments

When I was listening to Kinney Zalesne (Microtrends author) present this morning at our Think Different event, there were several things that crossed my mind:

Which micro-trends am I part of?

How much micro-targeting is too much?

Will consumers self-identify into groups?

Without going back to the whole book, I can think of several micro-trends with which I associate:

Marathoning
Stay-at-home [...]

Express Scripts Settlement on Statin Switches

I don’t know the insider details, but I am certainly familiar with the original program in 2005/2006 which targeted users of 3rd tier branded cholesterol (statin) drugs to get them to move to a lower cost agent which could either be a brand or generic drug on formulary (obviously wanting it to be the generic).
Apparently [...]

Missing The First Step

When I saw Forrester’s data around Personal Health Records (PHRs), it reminded me of one of the facts we struggled with around increasing mail order utilization…most people didn’t know what it was or whether they had it as a benefit.  (From their Q2 - 2007 Social Technographics Online Healthcare Survey)

So, given all the buzz about [...]

Additional Blog Site

I got asked to contribute to the Drug Safety Hub Blog and just posted my first entry there on patient’s awareness of technology solutions around pharmacy.

Book Review: Health Care Reform Now!

Health Care Reform Now! A Prescription For Change is the latest book by George Halvorson (CEO of Kaiser Permanente). I have been talking about it and using quotes from it for a few months. I finished the book a few weeks ago and figured that I better carve out the time to capture [...]

Medco’s Trend Report

Medco’s Trend Report recently came out for 2008 (which looks back at 2007). Here are some of the graphs and information from it.
“Generic drugs have been a tremendous asset in controlling runaway health care costs,” Medco Chairman and CEO David B. Snow Jr. said. “Generic cholesterol medications have helped contain our drug trend to [...]

Literacy and Consumer Empowerment

A few of the highlights from external speakers at the Spring client event for Medco included:
Helen Osborne talking about the “Prescription for Savings: Using Health Literacy Principles in Your Communications.”

Finding the right words for the best reasons
Not about dumbing down but about smartening up
Health literacy is a shared responsibility between patients and providers and each [...]

Most Medicated Generation

Well, we have finally broke the 50% mark of people using maintenance (or chronic) medications. It shouldn’t be a big surprise. Sit around the table with your friends and ask who takes a medication (without asking what for). Why do so many people take medications:

We are in worse health…think obesity.
There are better medications.
Doctors are more [...]

The Brand Only PBM

A few years ago, I would have argued that PBMs could one day simply cover generic drugs and not cover brand drugs.  With most therapy classes (excluding specialty) having multiple generic options, this seemed possible.  Already, some companies have generic fill rates which are above 70% (meaning that 70% of all prescriptions filled are filled [...]

Pharmacy Satisfaction Did You Knows

PharmacySatisfaction.com puts out a weekly factoid. They are very interesting and make some great points. I have talked about it before, but here is an updated list with the new factoids from 2008.

Independent drug stores continue to score highest in customer satisfaction, followed by food stores, clinics, and chain and mass merchandise pharmacies, [...]

Are You Doing Enough To Drive Generics?

From the Express Scripts Outcomes event a few weeks ago, here is an estimate of all the money left on the table by not increasing your generic fill rate in certain key categories.  Are you doing enough?

Utilization management programs - step therapy, prior authorization, quantity level limits?
Formulary coverage?
Plan design incentives?
Pharmacy incentives?
eRx messaging?
Web tools?
Patient communications?
Patient incentives?
Driving [...]

Incentives and Communications

Everybody looking at the healthcare system understands that incentives and alignment of goals is a critical component for successful change.

Providers need to be motivated to focus on wellness and prevention.
Individuals need to be motivated to care about the cost of care and to act in a healthy manner.
Pharmacists need to be motivated to take the [...]

Addressing Medicine Adherence

There are numerous studies on this, but they all point to the same issue…compliance.
The National Council on Patient Information and Education (NCPIE) released a report last year that I just came across titled “Enhancing Prescription Medicine Adherence: A National Action Plan“. With only 50% of patients using medication as prescribed, the systemic costs are [...]

Home Delivery Versus Mail

Do you care what it’s called? Some people really dislike Mail Order Pharmacy and go with Home Delivery. I made that change when I was responsible for the product at Express Scripts.
It becomes a little bit more meaningful when you talk about Mandatory Mail which is a benefit design where you are required [...]

Drugs Down. Gas Up. Food Up.

With most of our good going up.  According to CNN, I heard them say this morning that gas is up $0.60 per gallon in the past year and earlier this week, they said that food is up 35% in the past year.  (Neither of these are scientific, but they make the point.)
That makes me wonder [...]