Thomas Morrow, MD

Health plans can benefit when these therapeutic ATMs are used because of their ability to track dispensing data

Thomas Morrow, MD

Most technologies reviewed in this monthly column are expensive, are used for relatively rare conditions, and are patient-focused. This month’s Tomorrow’s Medicine will focus on a process-focused technology that promises to decrease costs and hassles to patients, physicians, and health plans and at the same time help meet many of the primary needs attached to an initial treatment for a variety of common medical conditions.

I entered medicine after a residency as a primary care physician during the explosive pharmaceutical development era of the 1980s and 1990s, where even the basic antihistamines and blood pressure medications were brand-name medicines. Because of this, I am extremely familiar with the physician sample closet.

I relished the ability to pull out a sample pack of a drug and hand it to the patient as a trial to see if it would solve the problem we faced. Despite some of the office problems it caused, it was considered a significant resource for physicians then and now, and remains a mainstay of pharmaceutical marketing.

Back then there were few complaints from health plans because most of the medications had no generic competition and the sample closet actually saved health plans the cost of the initial trial medication.

Sample closet still in use

Fast forward 30 years. Now most of that remarkable pharmaceutical technology is available as a generic, and for many diseases generic drugs can be the mainstay of therapy. But, the physician sample closet is still used. Why? Because there is a therapeutic advantage to handing the actual medication to the patient during the office visit where therapeutic decisions are being made.

First, you can be assured that patients actually have access to the drug. Second, patients can see and touch the medication without having to drive to a pharmacy, get out of their car, hand over the written prescription and wait … and wonder what the medication will cost, or even in some cases, whether the pharmacy can actually fill it. In fact, many people never fill a written prescription. This is not a problem for a self-limited disease, but is certainly a problem for any number of chronic diseases where the disease remains untreated. Finally, patients enjoyed the free samples and actually asked for them.

Why health plans care

Health plans are not very fond of the fact that virtually 100 percent of samples handed out in physician offices are brand name products. Managed care organizations realize that this initial start is likely to be followed by a written prescription for that very same branded product. Plans have not been secretive about their desire to have a generic used in cases where a generic offers a valuable alternative, primarily because of the cost savings to the plan and ultimately to the consumer and employer.

From a plan’s perspective and, to some extent, from the patient and physician’s perspective, the ability to hand out a sample of a generic would offer many of the same advantages as the sample-closet approach. But no company provides samples of generics — that is, until recently.

MedVantx has been attempting to solve this problem and has established a beachhead that may just become a trend. It has developed a machine for use in physician offices that acts like an automated teller machine (ATM) or a high-tech snack machine. The machine contains slots for up to 50 different drug samples that can be given to the patient for the most common conditions a primary care physician might encounter: hypertension, diabetes, depression, bacterial infections, hyperlipidemia, ulcer disease, and even dermatologic conditions. Some of the medications are available in several dosage forms.

The cabinets are customized to the payer’s needs and can even be customized further with the individual physician’s favorite generics if desired.

The drugs are enclosed in a locked, electronically-controlled cabinet that records pertinent information and even transmits the NDC level data to the sponsoring plan. The products are still free to the patient, contain a course of therapy or a one-month supply (whichever is shorter), and is meant to supplement or eliminate the uncontrolled and loosely managed drug closet found in most physicians’ offices. Inventory levels are continuously monitored via a web link and the cabinets resupplied as necessary.

MedVantx offers this service to physicians for free. The leading health plan in the market usually sponsors the machine. The company claims that for a small fee for each sampled drug, the plan will obtain higher formulary compliance, a higher generic fill rate, a happier patient, and a satisfied physician. The company even allows the physician to give the samples to nonmembers for free while the plan absorbs the cost.

Medication management

An additional component is a medication management program. Each bottle has a toll-free number that the patient can call to talk to a pharmacist about the medication as well as to enroll in a disease management program. MedVantx can also fill future prescriptions through its mail order pharmacy or route refill requests to the preferred mail order pharmacy if the sponsoring plan so desires. The company discourages the physician from refilling the second month via the machine; it instructs them to use the mail-order pharmacy or give the patient a written prescription.

The company feels that this approach rewards all participants — the plan, the patient, and the physician — and maintains the data transmission that plans need for regulatory and HEDIS purposes that may be lost when a written prescription is filled at a chain or retail pharmacy through one of the $4 per month programs.

Published articles suggest a significant return on the minimal investment made by the sponsoring plan. The plan sees higher generic dispensing rates as well as savings on the alternative branded products. Actual return-on-investment figures from an early adopter, Highmark in Pittsburgh, are 4 :1.

The study was published in the January/February issue of the Journal of Managed Care Pharmacy.


Information. That is one item that plans are clamoring for. This machine provides this, at least for the initial sample therapy. It also has been proven to increase the generic fill rate. It assures that the patient has the needed medication, and gives patients the opportunity to start a medication immediately without the time and effort needed to fill a written prescription.

MedVantx is working on further enhancements that will provide even more value, such as e-prescribing integration, access to patient assistance-programs, and an enhanced EMR interface.

Thomas Morrow, MD, is the immediate past president of the National Association of Managed Care Physicians. He has 24 years of managed care experience at the payer or health plan level. Contact him at
The author is a director in the value-based health department at Genentech Inc. Before taking the Genentech position, he received honoraria or other financial benefits from: Amgen, Amylin Pharmaceuticals, AstraZeneca, Biogen Idec, Centocor, Galderma, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Novo Nordisk, Pfizer, Procter & Gamble, Q-Med, Sanofi-Aventis, Teva Pharmaceuticals Industries, UCB, and Wyeth. The views expressed in Tomorrow’s Medicine are the author’s alone.

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.