the ripple effects of trend management
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The Ripple Effects of Trend Management. Ed Weisbart, MD, CPE, FAAFP Express Scripts. The Ripple Effects of Trend Management. With thanks to:. Beyond Trend Management. Beyond Trend Management. Beyond Trend Management. Beyond Trend Management. Two Years Ago We Said…. 65%. 50%. LDL - PowerPoint PPT PresentationTRANSCRIPT
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The Ripple Effects of Trend Management
Ed Weisbart, MD, CPE, FAAFPExpress Scripts
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The Ripple Effects of Trend Management
With thanks to:
Andy Behm Emily Cox Mark Eatherly
Amit Kulkarni Doug Mager
Rebecca Sedjo
Yakov Svirnovskiy
![Page 3: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/3.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
3
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2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
4
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2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
5
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2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
6
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2008 Express Scripts, Inc. All Rights Reserved.
LDLReducing Potency
Two Years Ago We Said…
50%
65%
25%
0%
Simvastatin:
30 – 47%
Simvastatin:
30 – 47%
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LDLReducing Potency
2006 AWP
Two Years Ago We Said…
Low High
50%
65%
25%
0%
Crestor:45 – 63%Crestor:45 – 63%
Lipitor:Lipitor:39 – 60%39 – 60%Lipitor:Lipitor:
39 – 60%39 – 60%Vytorin:45 – 60%Vytorin:45 – 60%
Simvastatin:
30 – 47%
Simvastatin:
30 – 47%Lovastati
n: 21 – 42%
Lovastatin: 21 – 42%
![Page 9: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/9.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
LDLReducing Potency
2006 AWP
Two Years Ago We Said…
Low High
50%
65%
25%
0%
Crestor:45 – 63%Crestor:45 – 63%
Lipitor:Lipitor:39 – 60%39 – 60%Lipitor:Lipitor:
39 – 60%39 – 60%Vytorin:45 – 60%Vytorin:45 – 60%
Simvastatin:
30 – 47%
Simvastatin:
30 – 47%
Over 80% of Lipitor used
in low dosages.
Over 80% of Lipitor used
in low dosages.
Lovastatin: 21 – 42%
Lovastatin: 21 – 42%
Did Switchers Compromise Their Health?
??
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2008 Express Scripts, Inc. All Rights Reserved.
LDLReducing Potency
2006 AWP
Two Years Ago We Said…
Low High
50%
65%
25%
0%
Lipitor:Lipitor:39 – 60%39 – 60%Lipitor:Lipitor:
39 – 60%39 – 60%
Did Switchers Compromise Their Health?
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Potency Was Generally Preserved
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Potency Was Generally Preserved
![Page 13: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/13.jpg)
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Potency Was Generally Preserved
![Page 14: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/14.jpg)
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Potency Was Generally Preserved
![Page 15: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/15.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Potency Was Generally Preserved
![Page 16: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/16.jpg)
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Potency Was Generally Preserved
![Page 17: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/17.jpg)
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Potency Was Generally Preserved
![Page 18: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/18.jpg)
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Key Findings
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Beyond Trend Management
19
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How Does AdherenceImpact HTN Prescribing?
Drug A prescrib
ed
Same drugSame dose
Same drug Higher dose
Second drug
added
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How Does AdherenceImpact HTN Prescribing?
Drug A prescrib
ed
Same drugSame dose
Same drug Higher dose
Second drug
added
80 - 100%
20 - 40%
60 - 80%
40 - 60%
0 - 20%
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Non-Adherence Adds More Drugs
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Non-Adherence Adds More Drugs
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Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Scenario 1
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2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Scenario 1
![Page 26: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/26.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Scenario 1
![Page 27: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/27.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $32•Escalated Rx: $30
What happens when…
•Initial Rx: $32•Escalated Rx: $30
Medication Possession Ratio
Waste
Scenario 1
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2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Scenario 2
![Page 29: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/29.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Scenario 2
![Page 30: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/30.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Scenario 2
![Page 31: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/31.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Escalation Contributes to Trend
What happens when…
•Initial Rx: $24•Escalated Rx: $101
What happens when…
•Initial Rx: $24•Escalated Rx: $101
Medication Possession Ratio
Waste
Scenario 2
![Page 32: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/32.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
Key Findings
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2008 Express Scripts, Inc. All Rights Reserved.
Beyond Trend Management
33
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CDHP Ripple Effects
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CDHP Ripple Effects
![Page 36: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/36.jpg)
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A Common Benefit Design
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A Common Benefit Design
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A Common Benefit Design
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A Common Benefit Design
![Page 40: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/40.jpg)
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A Common Benefit Design
![Page 41: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/41.jpg)
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They Attract Different Groups
All significant at p<0.05
Traditional CDHP
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CDHP Ripple Effects
![Page 43: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/43.jpg)
CDHP Ripple Effects
![Page 44: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/44.jpg)
CDHP Ripple Effects
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Adults only; CDS Matched; **p<.01
PM
PY C
laim
sTraditional Plan 2005-2006: 14% Increase in PMPY Claims
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Adults only; CDS Matched; **p<.01
PM
PY C
laim
sTraditional Plan 2005-2006:
Generics Up, Brands Flat
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2008 Express Scripts, Inc. All Rights Reserved.
Adults only; CDS Matched; **p<.01
PM
PY C
laim
sCDHP 2005-2006:
Slight Drop in Total Claims
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2008 Express Scripts, Inc. All Rights Reserved.
Adults only; CDS Matched; **p<.01
PM
PY C
laim
sCDHP 2005-2006:
Generics Up, Brands Down
![Page 49: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/49.jpg)
CDHP Ripple Effects
![Page 50: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/50.jpg)
CDHP Ripple Effects
![Page 51: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/51.jpg)
CDHP Ripple Effects
![Page 52: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/52.jpg)
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2006: We Were Concerned
52
*p<.05
Q1 2006 persistence rates
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2007: ChoiceMatters
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ChoiceMatters
54
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ChoiceMatters
55
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2007: ChoiceMatters Boosted Persistence
56
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Bars to the green area on the left:
Choice Matters did better.
![Page 57: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/57.jpg)
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2007: ChoiceMatters Boosted Persistence
57
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Bars to the red area on the right:
Choice Matters did worse.
Bars to the green area on the left:
Choice Matters did better.
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2007: ChoiceMatters Boosted Persistence
58
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Ch
oice
Matte
rs w
orse
![Page 59: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/59.jpg)
2008 Express Scripts, Inc. All Rights Reserved.
2007: ChoiceMatters Boosted Persistence
59
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Ch
oice
Matte
rs w
orse
![Page 60: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/60.jpg)
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2007: ChoiceMatters Boosted Persistence
60
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
*
* = p<0.05
Ch
oice
Matte
rs w
orse
![Page 61: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/61.jpg)
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ChoiceMatters Increased Switching
61
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
* = p<0.05
Ch
oice
Matte
rs w
orse
![Page 62: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/62.jpg)
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ChoiceMatters Increased Switching
62
Reference group: CDHP with ChoiceMatters
Adjusted Odds Ratio
*
* = p<0.05
*
**
*
*
*
Ch
oice
Matte
rs w
orse
![Page 63: The Ripple Effects of Trend Management](https://reader035.vdocument.in/reader035/viewer/2022062806/56814f45550346895dbce6e6/html5/thumbnails/63.jpg)
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Take-homes:
63
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The Ripple Effects of Trend Management
With thanks to:
Andy Behm Emily Cox Mark Eatherly
Amit Kulkarni Doug Mager
Rebecca Sedjo
Yakov Svirnovskiy