Plans re-evaluate their COPD programs in light of changes

New drugs to treat chronic obstructive pulmonary disease (COPD) have increased treatment options. However, they have also caused health plans to re-evaluate their chronic-condition management strategies.

"Costs of pharmacy have really increased, and part of it is keeping people compliant with their medications," says Mary Mazzola Spivey, president and chief operating officer of BlueChoice HealthPlan of South Carolina.

Two drugs to join the COPD treatment roster are roflumilast and Arcapta Neohaler (indacaterol inhalation powder), both recently approved by FDA. Arcapta Neohaler was approved last July and is a long-term, once-daily bronchodilator treatment for patients.

Roflumilast is a new class of drug for COPD treatment and works by suppressing an enzyme that causes inflammation in the airways. Patel says he believes adoption could be quicker for this medication.

"It's the first in its class," he says. "P&T committees are going to [consider it] an option for a severe patient."

Another significant change in the treatment of COPD has been the switch from CFC-driven prescription inhalers for asthma and COPD to inhalers with hydrofluoroalkane, an ozone-safe propellant. As a result of the switch, fewer generic inhalers are currently on the market.

"In some cases, the copay for generics was as low as $5 and then the brand is $20, $30, $40, or $50 in terms of copays, so a lot of members did see a cost impact when they switched over," Patel says.

According to DRIVE4COPD, a workplace wellness program, the disease accounts for nearly $50 billion in annual healthcare costs. In addition, researchers have found that employees with COPD have more than 4 times higher total mean healthcare costs than those without the disease.

Mazzola Spivey says while pharmacy costs have increased, BlueChoice HealthPlan of South Carolina has seen a decrease in overall medical costs for COPD patients thanks to a disease management program the company offers for members with COPD.

The program-which is opt-out only-was 1 of 4 health plan programs identified as a HEDIS Best Practice. It includes personal coaching for members and focuses on patient education and self-empowerment for treatment and care.

"Uncontrolled COPD necessitates a lot more primary care physician visits and unfortunately a lot more inpatient hospitalizations, so the goal is to use a lot of motivational interview techniques," says Lena Bretous, MD, MPH, medical director of health and disease management for BlueChoice.

In recent years, the plan has seen the rate of spirometry testing increase for COPD patients, while the rate of emergency room visits has dropped from 7.0 per 1,000 per year in 2008 to 6.3 per 1,000 per year in 2010. According to Dr Bretous, the prevalence of COPD has remained relatively stable in recent years, however, the plan has seen some changes in patient distribution.

"What we have seen is that typically COPD was an illness that happened more in men than women, but we currently have seen a higher percentage of women with COPD," she says.

For BlueChoice, COPD disease management has allowed them to anticipate potential problems in patient care and help minimize them. For example, Dr Bretous says after the recent inhaler switch, some patients paid more for brand inhalers.

"We realized that there were fewer options in terms of generics and that some patients would get a little bit less control because of that," she says. "We tried to enhance some of the information that we give them in terms of their diet, so that they don't push themselves into a COPD exacerbation."

Overall, some employers have reduced or eliminated copays in exchange for participation in treatment programs. Depending on the treatment program, some patients see benefits just for participating in the program while others must show drug compliance or a behavioral change to enjoy the benefit.

Patel says that programs that require medication adherence can be difficult to implement, but they often have the best outcomes as well.