UPMC Diabetes Wellness Program to Cut Drug Spending, Chronic Care
The diabetes wellness program aims to lower brand and generic prescription drug spending and provide members with a coach to ensure effective chronic care management.
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- UPMC Health Plan’s new diabetes wellness program targets Medicare Advantage members with diabetes or at-risk of diabetes to help drive chronic care management at an affordable cost, the health plan announced in an emailed press release.
“UPMC Health Plan is taking an innovative and holistic approach to help our members manage diabetes and other chronic conditions so that they can live an active, vibrant life,” said Diane Holder, president and chief executive officer of UPMC Health Plan.
“Through reduced prescription medicine copays and personalized, evidence-based disease management programs, our members can work with an integrated team of health care professionals to develop a care plan that provides both the knowledge and the support they need to improve their health.”
Many UPMC members are at-risk for diabetes and more than one out of every four of UPMC’s Medicare Advantage members in their UPMC for Life program has diabetes, the health plan stated.
In 2017, diabetes reigned as one of the most prevalent and most expensive chronic diseases and remains so today. The disease ravages the nation, with 84 million Americans at-risk for and 30 million suffering from diabetes, shouldering a high cost burden as a result.
READ MORE: CVS Health Expands Diabetes Program, Includes Preventive Care
Prescription drug costs are largely responsible for diabetes’ costly chronic disease management.
UPMC for Life, UPMC’s Medicare Advantage product, will help members manage their prescription drug spending through lower copays available to most members. UPMC Health Plan already has no copay for their predetermined list of generic diabetes prescriptions, as Tier 1 drugs in UPMC’s prescription drug payment model.
Not only will prices for generics drop, but brand drug prices will also decrease, the health plan anticipates. The healthcare payer announced it has rearranged its brand diabetes medications’ payment tier. Brand diabetes medications will shift from a Tier 3 to Tier 2. Once this change takes effect in 2020, members could have a $10 copay for a month’s supply of brand diabetes medications.
To qualify, members must retrieve the drug from a preferred pharmacy. UPMC partners with pharmacies across the state of Pennsylvania, including Giant Eagle, Rite Aid, and Sam’s Club.
Insulin costs will also decrease for UPMC for Life. Members will be able to buy three months’ worth of insulin for $20. As a result, members may save more than $300 annually.
READ MORE: Medicare Diabetes Prevention Program May Have Cost Concerns
Of these cost savings, the most monumental for UPMC is the 90-day supply refill. The savings apply whether the member goes to a preferred pharmacy or orders the refill by mail.
Six complying health plans constitute UPMC for Life, four health maintenance organizations (HMOs) and two preferred provider organizations, though there are some exceptions or additional benefits that vary based on the health plan.
Some of the HMO plans, for example, offer a quarterly allowance which members can put towards the hundreds of wellness products available in UPMC’s catalog.
The plan not only works to reduce prescription drug spending but also seeks to enhance members’ health through custom chronic disease management and wellness programs. Through the program, members connect with a personal health coach who guides them through and encourages them to pursue healthy living habits.
Other benefits in UPMC’s general UPMC for Life plan can help members with their chronic disease management. The SilverSneakers fitness program encourages healthy activity with a free session with a fitness training instructor and at-home fitness kits.
READ MORE: Cigna’s Digital Diabetes Prevention Program Cuts Costs, Ups Outcomes
Through at-home products and services, the plans intend to benefit not only the member, but also their caregiver. To help answer the many questions that arise when caring for a loved one, UPMC has licensed counselors who can meet up to six times a year with the caregiver and six times with the member.
When members reach the more advanced stages of diabetes, they may choose from a variety of services including medication management and home-delivered meals to ease the care burden.
All of these benefits, and others, will be available starting in 2020.
As open enrollment approaches, other payers are also announcing solutions to the cost and prevalence of diabetes.
Like UPMC, some have adjusted copays in order to make the needed prescriptions more affordable. For example, Blue Cross Minnesota recently announced its plan to help lower costs for members with diabetes. The plan eliminated their insulin copay for both Tier 1 and Tier 2 insulin medications.
Others focus on preventive care to keep members from ever contracting the disease. CVS Health recently expanded its diabetes care model to include both preventive care and hypertension care. Hypertension is frequently a comorbidity with diabetes. By offering members an internet-connected blood pressure cuff and personal coaching, CVS Health hopes to reduce both hypertension and the risk of diabetes.
These efforts may be having an impact. Some studies show that while the number of individuals with diabetes remains high, the incidence of diabetes may be falling. The reasons for this shift, however, are unclear. Even if the statistics are accurate, the country still has a long way to go to lessen the impact of this chronic condition.
