Thursday, March 19, 2009

Look back, look forward offers an interesting look back and look forward on the second anniversary of the mega merger between the CVS pharmacy chain and the Caremark, prescription benefit management company.

At the FEHBP carrier conference, OPM encouraged plans to use benefit designs that drive members toward effective, quality care. In my opinion, that's easier said than done because medicine remains as much an art as a science.

I am aware that step therapy is one such approach. Step therapy is "the practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary. The approach aims are to control costs and minimize risks." Business Insurance reported today on a study published in the American Journal of Managed Care finding that "benefit plan members subject to step therapy incurred $99 more in quarterly health care expenditures than a comparable group. Moreover, plan members in step therapy programs also had more inpatient admissions and emergency room visits, the study found."

It turns out that the underlying problem may be poor communication with doctors and patients about the step therapy. In any event, the study tends to support my opinion. Of course, that's no reason not to try to improve quality with benefit design. I just wouldn't expect results over night.

Speaking of comparative effectiveness, HHS today named fifteen members to the new "Federal Coordinating Council for Comparative Effectiveness Research. Authorized by the American Recovery and Reinvestment Act (ARRA), the new council will help coordinate research and guide investments in comparative effectiveness research funded by the Recovery Act." The keynote speaker from the OPM carrier conference, Neera Tanden, HHS health reform counselor and a lawyer, is one of the members.

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