Mahoney John J
Pitney Bowes, Stamford, CT, USA.
Am J Manag Care. 2005 Aug;11(5 Suppl):S170-6.
Concerned about rising prevalence and costs of diabetes among its employees, Pitney Bowes Inc recently revamped its drug benefit design to synergize with ongoing efforts in its disease management and patient education programs. Specifically, based on a predictive model showing that low medication adherence was linked to subsequent increases in healthcare costs in patients with diabetes, the company shifted all diabetes drugs and devices from tier 2 or 3 formulary status to tier 1. The rationale was that reducing patient out-of-pocket costs would eliminate financial barriers to preventive care, and thereby increase adherence, reduce costly complications, and slow the overall rate of rising healthcare costs. This single change in pharmaceutical benefit design immediately made critical brand-name drugs available to most Pitney Bowes employees and their covered dependents for 10% coinsurance, the same coinsurance level as for generic drugs, versus the previous cost share of 25% to 50%. After 2 to 3 years, preliminary results in plan participants with diabetes indicate that medication possession rates have increased significantly, use of fixed-combination drugs has increased (possibly related to easier adherence), average total pharmacy costs have decreased by 7%, and emergency department visits have decreased by 26%. Hospital admission rates, although increasing slightly, remain below the demographically adjusted Medstat benchmark. Overall direct healthcare costs per plan participant with diabetes decreased by 6%. In addition, the rate of increase in overall per-plan-participant health costs at Pitney Bowes has slowed markedly, with net per-plan-participant costs in 2003 at about 4000 dollars per year versus 6500 dollars for the industry benchmark. This recent moderation in overall corporate health costs may be related to these strategic changes in drug benefit design for diabetes, asthma, and hypertension and also to ongoing enhancements in the company's disease management and wellness programs.
由于担心员工中糖尿病患病率上升和成本增加，必能宝公司（Pitney Bowes Inc）最近对其药品福利设计进行了改进，以配合其疾病管理和患者教育计划的持续推进。具体而言，基于一个预测模型显示糖尿病患者用药依从性低与后续医疗成本增加有关，该公司将所有糖尿病药物和器械从二级或三级处方状态调整为一级。理由是降低患者自付费用将消除预防保健的经济障碍，从而提高依从性，减少昂贵的并发症，并减缓医疗成本总体上升速度。药品福利设计的这一单一变化立即使大多数必能宝员工及其受保家属能够以10%的共付保险费率获得关键的名牌药物，与非专利药物的共付保险费率相同，而之前的成本分摊为25%至50%。两到三年后，糖尿病计划参与者的初步结果表明，药物持有率显著提高，固定复方药物的使用增加（可能与更容易依从有关），平均药房总成本下降了7%，急诊就诊次数下降了26%。住院率虽然略有上升，但仍低于经人口统计学调整的Medstat基准。每位糖尿病计划参与者的总体直接医疗成本下降了6%。此外，必能宝每位计划参与者的总体健康成本增长速度明显放缓，2003年每位计划参与者的净成本约为每年4000美元，而行业基准为6500美元。近期公司总体健康成本的这种缓和可能与糖尿病、哮喘和高血压药品福利设计的这些战略变化有关，也与公司疾病管理和健康计划的持续改进有关。
