The Ripple Effects of Trend Management

1. The Ripple Effects of Trend Management Ed Weisbart, MD, CPE, FAAFP Express Scripts

2. The Ripple Effects of Trend Management With thanks to:

3. Beyond Trend Management

4. Beyond Trend Management

5. Beyond Trend Management

6. Beyond Trend Management

7. Two Years Ago We Said… 65% 50% LDL Reducing Potency Simvastatin: 30 – 47% 25% 0%

8. Two Years Ago We Said… 65% Crestor: 45 – 63% Lipitor: 39 – 60% Vytorin: 45 – 60% 50% LDL Reducing Potency Simvastatin: 30 – 47% Lovastatin: 21 – 42% 25% 0% Low High 2006 AWP

9. Two Years Ago We Said… Did Switchers Compromise Their Health? 65% Crestor: 45 – 63% Lipitor: 39 – 60% Vytorin: 45 – 60% 50% ? LDL Reducing Potency Simvastatin: 30 – 47% Lovastatin: 21 – 42% 25% Over 80% of Lipitor used in low dosages. 0% Low High 2006 AWP

10. Two Years Ago We Said… Did Switchers Compromise Their Health? 65% Crestor: 45 – 63% Lipitor: 39 – 60% Vytorin: 45 – 60% 50% ? LDL Reducing Potency Simvastatin: 30 – 47% Lovastatin: 21 – 42% 25% Over 80% of Lipitor used in low dosages. 0% Low High 2006 AWP

11. Potency Was Generally Preserved

12. Potency Was Generally Preserved

13. Potency Was Generally Preserved

14. Potency Was Generally Preserved

15. Potency Was Generally Preserved

16. Potency Was Generally Preserved

17. Potency Was Generally Preserved

18. Key Findings

19. Beyond Trend Management

20. Same drug Same dose How Does AdherenceImpact HTN Prescribing? Same drug Higher dose Drug A prescribed Second drug added

21. Same drug Same dose 80 - 100% How Does AdherenceImpact HTN Prescribing? 60 - 80% Same drug Higher dose Drug A prescribed 40 - 60% 20 - 40% Second drug added 0 - 20%

22. Non-Adherence Adds More Drugs Odds of escalation event

23. Non-Adherence Adds More Drugs Odds of escalation event

24. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Medication Possession Ratio

25. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Medication Possession Ratio

26. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Medication Possession Ratio

27. Escalation Contributes to Trend Scenario 1 Average monthly Rx cost • What happens when… • Initial Rx: $32 • Escalated Rx: $30 Waste Medication Possession Ratio

28. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

29. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

30. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

31. Escalation Contributes to Trend Scenario 2 Average monthly Rx cost • What happens when… • Initial Rx: $24 • Escalated Rx: $101 Waste Medication Possession Ratio

32. Key Findings

33. Beyond Trend Management

34. CDHP Ripple Effects

35. CDHP Ripple Effects

36. A Common Benefit Design

37. A Common Benefit Design

38. A Common Benefit Design

39. A Common Benefit Design

40. A Common Benefit Design

41. They Attract Different Groups CDHP Traditional All significant at p<0.05

42. CDHP Ripple Effects

43. CDHP Ripple Effects

44. CDHP Ripple Effects

45. Traditional Plan 2005-2006: 14% Increase in PMPY Claims PMPY Claims Adults only; CDS Matched; **p<.01

46. Traditional Plan 2005-2006: Generics Up, Brands Flat PMPY Claims Adults only; CDS Matched; **p<.01

47. CDHP 2005-2006: Slight Drop in Total Claims PMPY Claims Adults only; CDS Matched; **p<.01

48. CDHP 2005-2006: Generics Up, Brands Down PMPY Claims Adults only; CDS Matched; **p<.01

49. CDHP Ripple Effects

50. CDHP Ripple Effects