Aetna is initiating a program designed to encourage members to buy medications that are proven to be effective in managing high-risk clinical conditions.
The Hartford, Conn-based insurer announced the incentive program, called Aetna Healthy Actions Rx-Savings to encourage individuals with chronic conditions to get prescriptions fulfilled to manage their conditions.
Aetna says the program co-pays for medications for individuals enrolled in self-funded benefit plans who have high-risk clinical profiles and are taking medications for chronic health conditions, including asthma, diabetes, high cholesterol, high blood pressure and heart disease.
Under the program, medications are paid in whole or in part by participants' employers. Marriott International Inc., a pilot customer for the program, has reported positive results.
"Reduced co-pays resulted in increased adherence rates, which we believe may lower the number of costly medical emergencies and hospitalizations in our workforce, and ultimately help alleviate our healthcare costs over time," said Jill Berger, vice president of health and welfare for Marriott.
Aetna's program enables self-funded employers to offer a drug class co-pay discount to employers based on a member's clinical risk profile and relevant evidence-based standards.
Eligible members are identified through ActiveHealth Management's CareEngine System, which can proactively identify at-risk individuals who currently use a drug covered in the program, as well as those who could benefit from using a drug covered in the program.
"The use of evidence-based medicine in combination with pharmacy benefit design may significantly help to improve the overall quality of care for members with targeted chronic health conditions by reducing the cost barrier to patient compliance with recommended drug therapies and treatments," said Ed Pezalla, MD, national medical director for Aetna pharmacy management.
The drug classes and conditions applicable in this program include anti-diabetic medications, inhaled steroids for asthma, beta blockers for cardiologic conditions, and statins for those who have high-risk conditions such as diabetes and coronary artery disease.
Aetna reported that clinical studies have shown that co-payments and deductibles can affect patients' compliance with medications and treatment plans.
"Lower costs have been shown to help improve medication adherence, and we believe this will lead to improved care and reduced costs," Pezalla said. "As we gain a deeper understanding of the effect of reduced out-of-pocket costs on member adherence to prescribed therapies, Aetna will apply these insights to future benefit design efforts."