Caterpillar, Inc.
Zero Dollar Drug Copay
Description | Challenge | Solution | Outcomes | Additional Info | Time Commitment | Lessons Learned | Future Changes
Description
Statins, cholesterol lowering drugs, rank #1 by both volume and cost at Caterpillar. In many clinical situations, generic statins are equally effective and safe as the more costly brand statins. Evidence-based plan design changes instituted in 2007 and 2008 increased generic statin utilization from 36% (2006) to 81% (2008) while lowering costs for both the consumer and the enterprise and increasing the utilization of this very beneficial class of drugs.
Challenge
Non-value added costs of some brands of drugs leads to excess costs (waste) for the payer, increased cost-sharing for the consumer (higher premiums and copays) and decreased adherence (utilization) of important drug classes used in the treatment of chronic diseases or conditions.
Solution
Caterpillar’s Clinical Pharmacy Team recommended drug plan design changes that led to the implementation of zero dollar copays for all generic statins plus step-therapy for brand statin dosages that had generic equivalent cholesterol lowering alternatives.
Educational letters including the evidence behind the changes and conversion charts were mailed prior to implementation to all affected prescribing physicians and Caterpillar people.
Outcomes
Statin scripts per thousand covered lives (utilization) increased 4.5% while the overall statin costs for both employees and the enterprise fell (employees decreased 14.2% and Caterpillar’s cost decreased 29.8%). Additionally, new statin users’ six month generic adherence rates increased from 70% to 82% while brand adherence rates remained flat at about 50%.
Additional Information
Generic step-therapy applied to all covered lives (both bargained and non bargained employees, retirees and dependents). The zero dollar copay tier was added for only the nonbargained covered lives since it could not be unilaterally added for those insured by a negotiated contract.
Caterpillar’s US pharmacy benefit plans covers approximately 150,000 lives equally divided between bargained (those covered by a negotiated contract) and non-bargained individuals. Approximately 20,000 individuals were filling statin prescriptions at the time of implementation (2007).
Time Commitment
Planning Cycle: Six Sigma Project most of 2006
Implementation time: First phase Feb 2007; second phase August 2008
Lessons Learned
- Zero dollar copay does lead to improved adherence of maintenance medications
- Zero dollar copay by itself is not enough of an incentive to achieve the desired changes
- Although all at Caterpillar benefited from the plan design change, the workload and hassle for prescribing physicians increased.
- Executive office buy-in was essential for instituting more aggressive step-therapy implementation
If you implemented this solution again, what would you do differently?
Attempt to decrease the workload on prescribers