Decisions decisions! Benefit managers and prescription benefit plan sponsors face the challenging balancing act of getting more members to take their medications while controlling their health plan costs. The logic appears intuitive: the more members stay compliant with their drug regimens, the fewer emergency room visits and in-patient hospitalizations. Studies have shown that 25% of prescriptions go unfilled and almost 50% of patients don’t take their medications as prescribed. The problems are that (1) more drug compliance means more up-front costs via increased drug spend; and (2) trying to determine what types of incentives or penalties need to be used in order to motivate members to take their medication is a work in progress.
At WBC (wbcbaltimore.com), we have found that the most popular technique being currently utilized is benefit design, the so called “value-based” benefit design. This is where co-payments are reduced or waived for those proven medications that help regulate health status for chronic conditions such as diabetes and asthma. But is that enough? 
Some plan sponsors don’t think so. They are trying a new incentive: a compliance lottery! Here’s how it works: certain drugs are identified as being lottery-eligible. A special dispensing mechanism records which patients are taking their drugs and gives them the chance of winning a lottery prize ranging from $10 to $100 each day they are compliant. Aetna is one of the first health plans that is exploring this approach with some pilot programs.
Will it work? We don’t know, but we have our doubts. People do love lotteries, but research has shown that the penalty approach, i.e., the fear of loss, trumps the anticipation of gain as a motivational force. Maybe a better approach is to create a fear of not winning the lottery! Plus, the current monitoring systems might be gamed. They can monitor dispensing, but it doesn’t neccessarily mean the patient is taking the medication.
We’ll be watching the results to see if paying members to take their meds proves to be a viable option in our ongoing efforts to improve health status and quality of life while managing costs.
