Featured Health Business Daily Story, Dec. 27, 2017

Hypertension Standard May Boost Programs, Not Drugs

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By Judy Packer Tursman, Senior Reporter
November 24, 2017Volume 18Issue 22

A new clinical practice guideline’s lower threshold for hypertension increases the prevalence of the condition to include nearly half of adults in the U.S. But this doesn’t necessarily mean patients below the old standard will require antihypertensive drugs.

Instead, the guideline focuses on alternative approaches for many at-risk individuals, thus opening the door to opportunities for health plans ranging from adherence incentives to lifestyle management and disease management programs, industry experts say.

“The major impact to health plans and PBMs, in my opinion, is the potential increase of members that would need to be followed in disease management programs,” Mesfin Tegenu, R.Ph., president of PerformRx, LLC, a Philadelphia-based PBM, tells AIS Health. PerformRx is a unit of the AmeriHealth Caritas Family of Companies.

The American Heart Association (AHA) and the American College of Cardiology (ACC) on Nov. 13 jointly issued the first comprehensive new high blood pressure guideline in more than a decade. It recommends treating high blood pressure earlier — with lifestyle changes and, in some patients, with medication — at a hypertension threshold that begins at 130 /80 mm Hg rather than the previous guideline’s standard of 140/90. The new “normal” is less than 120/80, and the elevated blood pressure range is 120-129/80.

This revised standard raises the prevalence of hypertension to include 46% of adults in the U.S., up from 32% under the previous guideline.

Yet the AHA/ACC document says that “nonpharmacological treatment (not antihypertensive medication) is recommended for most U.S. adults who have hypertension as defined in the present guideline,” but who wouldn’t meet the previous 140/90 definition. “As a consequence, the new definition results in only a small increase in the percentage of U.S. adults for whom antihypertensive medication is recommended in conjunction with lifestyle modification,” it says.

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Change May Boost Medical, Not Rx Costs

On the front line, Tegenu explains that PerformRx has always worked to identify and prevent disease progression. “Once the diagnosis is made, health plans and PBMs in partnership with providers monitor these members that were previously not given a diagnosis of hypertension. While these programs always result in an increase in medication utilization, there is not expected to be a significant increase in drug costs overall. In fact, if identified patients seek treatment, we expect lower overall health care cost in the long run as cardiovascular complications are prevented through proper monitoring and management.”

The vast majority of hypertension drugs are already available as generics. “The cost to treat hypertension, even with multiple medications, is relatively inexpensive for the majority of treatment regimens,” he says. “Almost all generic hypertension medications are on a preferred formulary status for all plans that we manage.”

Undertreatment Is Big Issue

The annual cost of drug therapy for hypertension typically is less than $200 per year, Tegenu says. Those on multiple drugs may incur costs of $200 to $600 annually, on average. “I do not believe the drug spend will be significantly impacted by this change,” he says. “The major issue with hypertension is underutilization/treatment.”

In its 2016 commercial drug spend report, Express Scripts evaluated the most expensive 15 traditional and specialty therapy classes. High blood pressure/heart disease ranked ninth in drug spend. Drugs to treat high blood pressure and heart disease have the highest number of prescriptions per member per year at 2.48, the PBM said, and generic medications in this therapy class comprised fully 96.7% of total 2016 market share.

Debbie Lucas, vice president at Avalere Health, LLC, says the consulting firm hasn’t analyzed the impact of the new guideline on drug cost. Yet, according to a recent publication, “Potential U.S. Population Impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline” by Paul Muntner, et al., the substantial increase in the prevalence of hypertension will result in a small increase in the use of antihypertensive medications. Since most antihypertensive medications are available as generics, increased use of drugs may not have a large impact on overall costs to plans or patients via copays or coinsurance, she also notes.

Health plans are well positioned to offer incentives to patients to improve adherence to medications “via reducing or eliminating co-pays/co-insurance,” she says. They also can promote and/or expand program offerings for lifestyle management, including weight loss, healthy diet and physical activity.

Read the guideline at http://tinyurl.com/yb8j2ou9. View the Muntner article at https://doi.org/10.1016/j.jacc.2017.10.073.

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