Managed care decision makers have a powerful tool that affects patient compliance with antihypertensive medications — the copayment level. This setting has associated clinical and economic consequences for the health plan. Researchers at the Hawaii Medical Service Association found that copayment level, independent of other determinants, was a strong predictor of compliance with antihypertensive medications, with greater compliance observed in patients filing pharmacy claims for drugs that required lower copayments, according to an article published in the American Journal of Managed Care.

Overall compliance for these agents was 66.8 percent in tier 1, 66.1 percent in tier 2, and 54.6 percent in tier 3. Angiotensin receptor blockers had the highest rate, whereas thiazide diuretics had the lowest. Groups that may need to be targeted because of low compliance include members under age 40, (42.5 percent compliance), Filipinos (58.7 percent), and HMO members (59.7 percent).

The researchers concede that observing a study population drawn from a single health plan in Hawaii means that conclusions may not be applicable to other populations. Medication compliance was determined indirectly from pharmacy claims.

The researchers recommend that patients be informed of their full range of options and of the copayment levels associated with each so that they can make cost-effective decisions that may lead to improved compliance and health outcomes.

As copayment goes up, compliance goes down

Percent compliant

N/A indicates that the tier is unavailable for the therapeutic class

Source: Taira, DA, et al. Copayment level and compliance with antihypertensive medication: analysis and policy implications for managed care. Am J Manag Care. 2006;12:678–683

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.