In collaboration with Harvard Medical School Department of Healthcare Policy Innovative Healthcare P

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In collaboration with Harvard Medical School
Department of Healthcare PolicyInnovative
Healthcare Programs Promoting Health and
Wellness  October 6, 2008
V05-08-326
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Enhancing Statin Therapy Efficiency
Presented By Dr. Tom Tran Divisional Vice
President of Pharmacy Programs Blue Cross and
Blue Shield of Texas
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Overview

• Problem
• For people with high cholesterol levels,
  compliance with a prescribed regimen of statin
  drugs can help lower the risk for a major adverse
  cardiac event (MACE)
• Use of statins among individuals at highest risk
  is low, with utilization rates of only 50 a year
  after an individuals heart attack1
• In addition to the statin under-utilization,
  there is over-utilization of more expensive
  branded statin therapy (e.g., Crestor, Lipitor,
  Vytorin) when equally effective and less
  expensive generic medications (e.g., simvastatin,
  pravastatin, lovastatin) are available2
• Goal
• Improve statin therapy efficiency
• Increase statin use among individuals at MACE
  risk
• Increase use of generic statins
• Team
• BCBSTX pharmacy department
• BCBSTX account management
• National employer human resources department
• Prime Therapeutics (pharmacy benefit manager)

• Benner JS, Glynn RJ, Mogun H, et al. JAMA.
  2002288455-461.
• Cheetham TC, Chan J, Benson V, et al. Am J Manag
  Care 200511546-552.

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Predictive Modeling

• Pharmacy and medical data are integrated through
  Prime Therapeutics predictive modeling engine to
  identify high-risk members
• These members are at high risk for a serious
  adverse medical event based on medical evidence
  systematic analysis

• The Efficiency Ratio displays drug spend for
  high-risk members in comparison to the spend for
  all members within the particular drug class.
  This metric is used as an indicator of how well a
  populations pharmacy dollars are being spent
  within each drug class.

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Statin Efficiency Program

• BCBSTX implemented program with a national
  employer with 44,000 insured members
• Cholesterol lowering efficiency was low (17)
  during 3Q 2006
• __________________________________________________
  ________________
• Goal 1 Increase statin utilization among MACE
  risk members
• Tactics
• Providers received letter regarding non-adhering
  MACE risk members
• Non-adhering MACE risk members received
  informational letter, brochure, webinar
  opportunity
• Goal 2 Lower statin expenditures by increasing
  generic use
• Tactics
• Utilization management statin step therapy
  program designed to address over-utilization of
  branded statins
• Step therapy program implemented Jan. 1, 2007

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Outcomes/Success
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• THANK YOU
• For more information
• Visit www.bcbs.com
• Contact Paul Cholette, 312-297-5954,
  paul.cholette_at_bcbsa.com