Consumer Outreach Boosts Generic Cholesterol-Fighting Drugs.

Generic Use Up 500%, Saving $230 Million Since January '06

ST. LOUIS -- Benefit plan sponsors and patients have saved $230 million on cholesterol-fighting drugs since January 2006, when Express Scripts (Nasdaq: ESRX) began encouraging consumers to discuss generic alternatives with their physicians. The company, one of the nation's largest pharmacy benefit managers, reported the savings at its annual Outcomes Conference today.

Use of generic cholesterol-fighting drugs has increased from 8 percent to 44 percent among consumers who access prescription drugs through Express Scripts. The generic versions of Zocor([R]) (simvastatin) and Pravachol([R]) (pravastatin) became available last year and lovastatin had been available since December 2001.

Express Scripts achieved the shift through a behavior-changing outreach model, which combines financial incentives, tailored communications showing personalized savings and one-to-one phone assistance timed to coincide with new savings opportunities.

The company began by recommending a 2006 formulary that preferred generics and Zocor([R]) to its employer, union, government and health plan clients. The formulary positioned patients to make the transition to simvastatin upon its availability later in the year because virtually all Zocor([R]) prescriptions would automatically switch to simvastatin.

Outreach Coincided with Savings Opportunities

The company used the new formulary and the availability of simvastatin as opportunities to communicate with consumers. It mailed letters, timed to coincide with the events, in late 2005 and July 2006. The first letter alerted consumers to the formulary and related copayments and encouraged a dialogue with physicians regarding generic alternatives.

The second letter was personalized to show each consumer how much he or she could save on copayments by switching from the non-formulary brand they had been taking to a generic or formulary brand. The comprehensive consumer outreach effort also used interactive web based tools and consultations with call center patient care advocates to provide education on savings opportunities.

Company researchers found that consumers included in the outreach effort increased their usage of either Zocor or simvastatin at a far greater rate than consumers in plans not participating in the outreach program. More than 50,000 consumers were included in the sample studied.

Before January 2006, utilization of Zocor([R]) or simvastatin was about the same for both groups. Soon after the first mailing, the outreach group increased Zocor([R]) usage to a level about 30 percent higher than the other group. Even as usage increased for both groups during the next 12 months, the gap persisted and widened after the second mailing in July.

"These results demonstrate that providing personalized savings information timed to coincide with new savings opportunities can change consumer behavior, leading to greater use of money-saving generic drugs," said Emily Cox, PhD, senior director of research for Express Scripts.

Generic Switch More Likely Among Consumers Using Home Delivery

Researchers also found that consumers to whom it reached out and who also used the company's home delivery pharmacy were more likely than retail pharmacy patrons to switch to the generic drug. The odds that a consumer using home delivery and part of the outreach program would switch to the generic were 84 percent but only 64 percent for a retail pharmacy patron.

"Consumers using our home delivery pharmacy can authorize us - because we are a pharmacy - to contact their doctor about changing their prescription, making it easier for them to switch to the lower cost alternative," explained Cox.

Beginning in January, the company's home delivery pharmacy called consumers who were using both home delivery and a non-formulary brand drug, educating them about the formulary and related copayment amounts. The pharmacy offered these consumers assistance in understanding how to take advantage of the availability of a less-expensive formulary drug and, at the patient's direction, called their physicians to request a new prescription. Doing so would result immediately in a lower copayment and, for the majority choosing Zocor([R]), an automatic move to simvastatin after the Zocor patent expired, saving even more money.

When compared with consumers not receiving such assistance, the assisted consumers switched to formulary drugs at a much greater rate -- with increases in the odds of switching to the preferred agent ranging from 38% to 50% for union and employer plans, respectively. Success was measured as the percent switching to a formulary drug within 150 days based on calls made in March and April.

Consumers Using Retail Pharmacies Alerted to Savings

Consumers using a retail pharmacy were alerted to available savings with personalized letters sent immediately after a consumer had picked up a prescription for a more expensive non-formulary anti-cholesterol drug. These "rapid response" communications, timed for greatest consumer awareness, resulted in a 24 percent conversion rate to a formulary drug with 90 days. A control group not receiving the letters converted at only a 13 percent rate.

Zero-Dollar Copay Boosts Generics

In addition, the company tested the impact of short-term enhancements to financial incentives, in this case offering to eliminate the copayment for the first six months for consumers switching to a generic. Significantly, the greatest impact occurred with cholesterol-fighting drugs, where the "zero-dollar-copay" program resulted in nearly a three times greater conversion to the generic - 12.6 percent vs. 4.7 percent. This study used a randomized placebo controlled design, the most rigorous available.

"Our research findings demonstrate that our outreach model for changing consumer behavior, which integrates personalized communications, assistance, incentives and opportunity, is fully repeatable. Looking ahead, plan sponsors can use it to take advantage of generics coming on the market for Ambien([R]), Imitrex([R]) and Fosamax([R])," said Cox.

Express Scripts, Inc. (Nasdaq: ESRX) is one of the largest pharmacy benefit management (PBM) companies in North America, providing PBM services to over 50 million patients through facilities in 13 states and Canada. Express Scripts serves thousands of client groups, including managed-care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at http://www.express-scripts.com.