Prescription benefit manager Express Scripts issued a report titled, Super Spending: U.S. Trends in High-Cost Medication Use. The report
examines prescription drug use among patients with exceedingly high annual medication costs under the pharmacy benefit. The number of U.S. patients estimated to have annual medication costs greater than $50,000 jumped 63 percent between 2013 and 2014, from 352,000 to 576,000 Americans. The population of patients estimated to be taking at least $100,000 worth of medication nearly tripled in the same time period, from 47,000 to 139,000 Americans.
And of course, the drugs at issue are specialty drugs and insurers covered virtually all of the costs. This is a trend that needs to be curbed quickly as the ACA’s high cost coverage excise tax kicks in about 30 months from now (2018). Express Scripts offers some strategies and tactics.
OPM and the rest of the federal government has been promoting cessation of tobacco use. The other major PBM CVS Health reported on a tobacco cessation study conducted on 2500 of their own employees.
The researchers randomly assigned approximately 2,500 CVS Health colleagues and their family and friends to one of four incentive-based smoking cessation programs or to usual care, which consisted of informational resources and free access to a behavioral-modification program and nicotine-replacement therapy. Across all of the incentive-based programs, participants were eligible for up to $800 for successfully quitting smoking but the programs differed in how incentives were accrued and disbursed. Two of the programs required participants to pay an upfront deposit of $150, which was reimbursed if participants successfully quit smoking. Overall, study participants who enrolled in any of the four incentive-based programs were nearly three times more likely to quit smoking than those who received usual care alone. In addition, although participants assigned to the groups requiring an upfront deposit were more likely to decline participation than those in the pure incentive-based programs, deposit programs led to nearly twice the rate of abstinence from smoking at six months among people who would have accepted either type of program.
The study appears to confirm human nature. OPM, however, does not allow FEHB carriers this level of flexibility in crafting their smoking cessation programs.
The Health Care Cost Institute which is a consortium of health insurers released a report on the cost of diabetes care in the U.S.
The report, Per Capita Health Care Spending on Diabetes: 2009-2013, is one of the first of its kind to examine health care spending for adults and children with diabetes relative to those without diabetes, both in terms of total per capita health care spending and out-of-pocket costs. It is based on the health care claims of more than 40 million Americans younger than 65 covered by ESI from 2009 to 2013. HCCI identified 5.3% of the ESI population as having diagnosed diabetes (type 1 or type 2) in 2013, up from 4.7% in 2009.
“The number of people with diabetes continues to grow, as does the health care spending for these individuals,” said HCCI Executive Director David Newman. “We, and others, need to better understand the relationship between spending and actual health outcomes for people with diabetes, particularly children.”
Good luck with that effort. HCCI does good work.