Evaluation of Emails Promoting Mail-order Pharmacy

Study Overview
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Brief Summary
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In this evaluation, four versions of emails will be sent to eligible health plan members who are not currently enrolled in the health system's mail-order pharmacy. A control group will not receive any communication. The researchers hypothesize that the use of content informed by behavioral nudge theory in the emails should lead to increased enrollment in the health system's mail-order pharmacy.

Detailed Description
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The utilization of a mail-order pharmacy can increase adherence to medications. The health system's mail-order pharmacy (from here, simply referred to as mail-order pharmacy) can also provide reduced costs for medications. Ongoing outreach efforts involve sending emails and other communications encouraging enrollment in Geisinger's mail-order pharmacy to eligible members of the system's health plan (i.e., those who take maintenance medications). The study will compare a standard promotional email from these outreach efforts, as well as three new emails with content informed by behavioral science research, against a no-contact control arm and each other.

Official Title
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Evaluation of an Email Intervention Promoting Enrollment in Mail-order Pharmacy

Conditions
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Health Care Utilization

Intervention / Treatment
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* Behavioral: Fear Appeals
* Behavioral: Message about Future Healthcare Costs
* Behavioral: Endorsement from a Doctor
* Behavioral: Comparison Table
* Behavioral: Highlighting Cost Savings and Convenience


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: An active member of the health plan (Medicare, Commercial, or Exchange) Currently prescribed maintenance medications Not currently subscribed to the health system's mail-order pharmacy Has an email on record Exclusion Criteria: Explicitly opted out of receiving emails from the health system Only has eligible current prescriptions for fewer than 28 days Only has prescriptions that cannot be sent via mail-order pharmacy (e.g., antidepressants, specialty-tier drugs) Is a Medicare member in the coverage gap Shares an email address with another selected participant (who was randomly chosen for inclusion among all those sharing the same email address)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: 1 x 5 design
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard Email<br>The standard of care email is the same as one used in prior outreach efforts at the health system, emphasizing reduced cost for medications and convenience. | Behavioral: Highlighting Cost Savings and Convenience<br>* Email<br>|
| Experimental: Email with Healthcare Cost Savings<br>The email emphasizes future reductions in healthcare costs due to increased adherence with mail-order pharmacy, in addition to mentioning reduced prices for medications. It also uses fear appeals by stating the risk of hospital stays and how mail-order pharmacy could be an easily-achievable way to avoid this negative consequence. | Behavioral: Fear Appeals<br>* Email<br>Behavioral: Message about Future Healthcare Costs<br>* Email<br>Behavioral: Highlighting Cost Savings and Convenience<br>* Email<br>|
| Experimental: Email with Endorsement<br>The email is a letter from a doctor at the health system's health plan--who may been seen as a trusted source of information--encouraging the benefits of using a mail-order pharmacy. | Behavioral: Endorsement from a Doctor<br>* Email<br>Behavioral: Highlighting Cost Savings and Convenience<br>* Email<br>|
| Experimental: Email with Comparison Table<br>The email includes a table comparing the benefits and drawbacks of mail-order and chain pharmacies, which appeals to their sense of agency and allows them to make the choice that best suits them. | Behavioral: Comparison Table<br>* Email<br>Behavioral: Highlighting Cost Savings and Convenience<br>* Email<br>|
| No Intervention: No Contact<br>Members do not receive an email. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mail-order Pharmacy Enrollment | Binary variable indicating if there was an enrollment in the health system's mail order pharmacy | 1 week from the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Email Opens | Binary variable indicating if the email was opened | 1 week from the intervention | 
| Email Link Click | Binary variable indicating if the link to the mail-order pharmacy website was clicked | 1 week from the intervention | 
| Email Unsubscribes | Binary variable indicating if the recipient requested to unsubscribe from receiving emails from the health system | 1 week from the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Psychology, Pharmacy, Postal Service, Electronic Mail, Communication, Economics, Behavioral, Loss Frames, Fear Appeals