Targeted patient education increases formulary compliance in a 3-tier pharmacy benefit

Key Points

A study was conducted to determine whether users of nonformulary blood glucose meters would increase their formulary compliance if they were provided with targeted information and an offer for a free formulary meter.

ELIGIBILITY

All participants were plan members of Blue Cross and Blue Shield of Nebraska and were included in the intervention if they were continuously enrolled and had a claim for nonformulary diabetic glucose strips during a 6-month period prior to the mailing date of October 28, 2005.

Educational information was sent to all members utilizing nonformulary diabetic meters and strips, notifying them of the drug formulary and the co-pay advantage of changing to a formulary product. The materials also included a brochure that explained how to obtain a free formulary glucose meter of the member's choice.

Following the mailing, a retrospective analysis was performed to assess the effectiveness of the intervention.

The postmailing analysis period was November 1, 2005, to April 30, 2006.

RESULTS

A total of 2,057 letters were mailed to health plan members; 416 members were not continuously enrolled through the end of the postmailing analysis period and were eliminated; a total of 1,641 members met eligibility requirements.

Of the 1,641 eligible participants, 164 members switched from nonformulary to formulary products, representing a 10% conversion.

For members who switched to a formulary product, out-of-pocket expenses decreased by an average of $13.02 per prescription filled (Figure 3).

LIMITATIONS

The lack of a control group prevented the analysis of the intervention's influence on conversion versus other reasons for switching.

Costs were not adjusted for trend over the analysis period.

Rebates for this class are significant and were not factored into cost analysis. Since the plan returns 100% of rebates to groups, a net savings to employer groups and employees would have been demonstrated for those who switched.

CONCLUSIONS

Targeted education regarding formulary glucose meter products in addition to the offer of a free formulary glucose meter increased formulary compliance in a 3-tier pharmacy benefit design.

Increasing formulary compliance helped to lower out-of-pocket expenses paid by members. Members who continued to utilize nonformulary products continued to have higher out-of-pocket costs.

The results suggest that pharmacy management approaches need not be administratively costly or burdensome to elicit behavioral changes.

Dr Ryan is a staff pharmacist at Bergan Mercy Medical Center in Omaha, Neb. Dr Handke is vice president for wellness and clinical business for Blue Cross and Blue Shield of Nebraska, Omaha, Neb, and is an adjunct faculty member at the University of Nebraska Medical Center College of Pharmacy, Omaha, Neb. Dr Williams is the director of pharmacy for Blue Cross and Blue Shield of Nebraska and is an adjunct instructor at the University of Nebraska Medical Center College of Pharmacy. Dr Williams is also the education chair on the board of directors of the Omaha Association of Health Underwriters. Dr Karolski is a pharmacy resident for Blue Cross and Blue Shield of Nebraska and is an adjunct faculty member at the University of Nebraska Medical Center College of Pharmacy.

Disclosure Information: The authors report no financial disclosures as related to products discussed in this article.

Editors' Note:
This article is adapted from a poster originally presented at the Academy of Managed Care Pharmacy 2006 Educational Conference, Chicago, Ill, October 4–7, 2006.