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Aetna Specialty Pharmacy

* Aetna, Inc. attributes a successful first quarter to operational changes, including changes in its pharmacy strategy and drug utilization. First-quarter 2003 net earnings were $330 million, compared with a net loss of $2.83 billion in the prior year. Aetna executives were quick to say that the trend is not expected to be fully sustainable. The overall driver of the first-quarter results is significant moderation in health care utilization trends, plus implementation of several new cost-control programs in the area of disease management and case management, the company says. The MCO's overall drug trend has declined significantly, driven by efforts in specific drug classes and higher penetration of three-tiered formularies. The company reports that employer demands for more affordable products have allowed it to implement benefit design changes for a significant portion of its membership. Aetna's employer clients are allowing higher copays and deductibles and more management of the drug benefit, a trend that DCMR is seeing at other MCOs as well. Last year, Aetna decided to take all its PBM functions in-house and dropped a mail-order contract with Express Scripts (DCMR November 2002). The company says it is now serving some of its selfinsured customers with PBM services, and continuing to invest in clinical and marketing improvements for its PBM. Aetna has also implemented a program of targeted recontracting in the area of specialty pharmacy, and made investments in mail-order facilities. The company says it is now processing 35% of its mail-order volume--28,000 prescriptions per week--in its own facility, and that figure will be 100% by the end of the year. Disease management efforts are focusing in the areas of chronic heart failure, diabetes, and end-stage renal disease.

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