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CVS Suggests Patients Benefit from Narrow Pharmacy Networks

Such networks save money and help with adherence

Research funded by CVS Health and published in JAMA Internal Medicine suggests that narrow pharmacy networks allow beneficiaries to save money.

The published Research Letter examines the differences in patients who choose the cost savings of a narrow pharmacy network compared with others who select a broader network.

In narrow or preferred-pharmacy networks, in-network pharmacies negotiate reduced prescription prices with insurance plans. Plans then offer their members reduced cost-sharing as an incentive to use in-network pharmacies, thereby increasing the network’s prescription volume. In 2014, 75% of Medicare Part D and 70% of exchange plan enrollees were in a narrow or preferred network drug plan. Narrow networks are common in commercial plans as well.

However, concerns have been raised that these networks adversely affect medication adherence owing to reduced geographic access. On the other hand, others argue that networks encourage members to establish a pharmacy home where pharmacists can better support adherence and coordinated care.

The researchers assessed the effect of narrow network implementation on members’ medication adherence. They also examined whether pre-post adherence changes between plans that implemented narrow networks and those that did not were different in the following two subgroups: plans with and plans without 90-day prescription programs, which are known to boost adherence. Combined with narrow network implementation, these programs may be associated with synergistic improvements in medication adherence.

Among commercial health plan members, implementation of a narrow pharmacy benefit network was not associated with reduced adherence in four medication categories: statins, antihypertensives, antidiabetic drugs, and antidepressants. In fact, the researchers observed slight but consistent adherence improvements. They did not assess the clinical differences associated with these adherence changes. Control plans had higher medication possession ratios than intervention plans, reducing their ability to improve adherence. CVS/Caremark administers adherence programs for all its plans, so any bias introduced by such programs would be nondifferential between the intervention and control plans.

Although these results may not apply generally to prescription drug plans that are managed by other pharmaceutical benefit managers or other narrow network designs, this study suggests that incorporating a narrow network feature into a plan’s benefit design slightly improves and does not adversely affect medication adherence. The narrow network approach, when permitted, merits consideration by plans and payers who seek to optimize their members’ drug adherence while reducing overall health care costs.

Source: JAMA Internal Medicine; September 8, 2015.

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