Aetna tries paying patients to take their meds

Aetna, through its nonprofit foundation, is funding research to find out whether a daily lottery with cash prizes will help improve patients' medication adherence.

The Aetna Foundation last fall gave researchers a $400,000 grant to fund a study at the University of Pennsylvania that will use prizes of $10 and $100 as rewards for taking medication as prescribed.

"If it looks like it works, we'll try to incorporate it in things we do," said Aetna Chief Medical Officer Troyen A. Brennan, MD, MPH.

Kevin G. Volpp, MD, PhD, director of the Center on Health Incentives at the Leonard Davis Institute for Health Economics at the University of Pennsylvania's Wharton School, and Stephen E. Kimmel, MD, associate professor of medicine at the University of Pennsylvania School of Medicine, have designed a two-arm randomized trial with 100 participants to test a daily lottery as incentive for taking warfarin as prescribed.

An electronic monitor will track whether all participants are taking their medicine.

The 50 people enrolled in the lottery will have a 1-in-10 chance of winning $10 every day they take their medication and a 1-in-100 chance of winning $100. Each day a text message will tell a subject whether he or she has won the lottery, or, if the dose wasn't taken, whether he or she would have won, Dr. Volpp said.

The 50 people in the control group will use the same monitor but won't be entered in the lottery.

Aetna chose to sponsor the research because adherence is key to quality of care, Dr. Brennan said. He said statistics show that a year after beginning medication, only about 50% of patients are taking their medications as directed.

Direct and indirect costs of medication nonadherence are estimated to total as much as $177 billion annually in the U.S., said Ray Bullman, executive vice president at the National Council on Patient Information and Education, a nonprofit coalition of organized medical groups -- including the AMA, a founding member -- businesses and government agencies.

The group issued an August 2007 report on the topic of prescription drug adherence, recommending that all sectors of the health care system be involved in addressing the problem. The report noted that prescription drug spending is the fastest growing component of medical cost for most health plans, at an estimated increase of 17% every year.

David B. Nash, MD, chair of the Dept. of Health Policy at Jefferson Medical College in Philadelphia, said that with the proper safeguards, it's appropriate for a health plan to sponsor this kind of research because it's in their financial interest to keep members healthy. (See correction)

"They know their whole future is at stake with regard to this issue," he said.

Dr. Nash serves as a board member of InforMedix, which manufactures the Med-eMonitor, the tool Dr. Volpp and Dr. Kimmel are using.

About 75 people have enrolled so far, and Dr. Volpp said he expects to see results by next spring.