Enhancing Statin Therapy Efficiency

Blue Cross and Blue Shield of Texas

In 2007, Blue Cross and Blue Shield of Texas (BCBS Texas) initiated an innovative pilot program designed to increase patients' adherence to their statin drug therapy. People who are prescribed these drugs often are at risk for major adverse cardiac events such as myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery – risks that are greatly lowered by following the prescribed statin regimen. Unfortunately, however, studies have shown that only half of the individuals prescribed these drugs after a heart attack are adhering to their prescribed regimen later.

In an effort to address patient underutilization of statins and physician overutilization of brand-name statins, BCBS Texas (in collaboration with their pharmacy benefit manager Prime Therapeutics) designed a program to enhance statin therapy efficiency. This innovative program used medical records to identify members at risk for major adverse cardiac events and pharmacy claims records to further identify those who were untreated or not adhering to their statin therapies. The program then sent letters to these patients' physicians notifying them of the nonadherence and urging the doctors to follow up with their patients. In addition to increasing statin use, the program also improved economic efficiency through a pharmacy benefit step therapy plan that encouraged the use of generic statins. The program thus integrated statin underuse and promotion of generics in one strategy.

This design proved effective. The pilot program implemented at a large national employer with more than 44,000 insured members resulted in a significant increase in statin use among members at high risk for a major cardiac event; for every 17 at risk members whose healthcare provider received notification of statin therapy nonadherence, one member began following the prescribed regimen. The resulting cost of increased statin utilization was more than offset by the increased use of generic forms of the medications and, in fact, resulted in savings of several thousand dollars.

Program contact:  Tom Tran, PharmD, 972.766.8910, tom_tran@bcbstx.com.