A yearlong steptherapy program focusing on 10 therapeutic drug classes that also attempted to minimize member dissatisfaction with any changes among these drugs lowered the average gross cost per claim by nearly 13% while denying only 10.2% of prior authorization (PA) requests.
The program was initiated by CVS/Caremark; the drugs it focused on included proton pump inhibitors (PPIs), nonsedating antihistamines (NSAs), selective serotonin reuptake inhibitors, 3hydroxy3methyl glutarylcoenzyme A reductase inhibitors, angiotensinconverting enzyme inhibitors/angiotensin receptor blockers, nasal steroids, hypnotics, bisphosphonates, urinary incontinence drugs, and cyclooxygenase2 (COX2) inhibitors.
As with other steptherapy programs, members are required to fill a prescription for a generic before selecting singlesource brands, but the program also allows a choice of 1 select preferred brand in most classes. Members and physicians were notified about the program 60 days and 30 days before implementation, and a dedicated call center was set up to handle PAs and other questions. The program effectiveness was measured through average gross cost per claim and average genericdispensing rate.
Following program implementation, gross cost per claim fell from $72.75 to $64.50 per average claim, and genericdispensing rate rose from 57.5% in August 2009 to 72.8% by July 2010. Genericdispensing rate improved significantly in all classes except for COX2 inhibitors; the program had the greatest impact among the PPI and NSA classes, which saw average gross cost per claim drop by $41.14 and $15.25, respectively. The call center handled 7600 calls between August 2009 and March 2010; 16.7% of callers began the PA process but were converted to a preferred brand or generic; and 54.1% of PA requests were approved.
The analysis did not adjust savings for increases in wholesale price inflation or for the effects of new brand medications