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October 23, 2017

Addressing The Growing Epidemic Strangling Our Healthcare System

iStock-832153718_baseball_family_duo_1900x986.jpgAccording to the Centers for Disease Control and Prevention (CDC), about half of all U.S. adults have a chronic condition such as diabetes, high cholesterol, cancer, arthritis or heart disease, and of those, more than half have multiple chronic conditions.[1] The significant prevalence of chronic disease is a real threat for the U.S. healthcare system. The good news is these conditions have effective pharmaceutical therapies that can help manage and control them—but only if the patient follows the regimen as prescribed.

Medication adherence is a major problem for those with chronic conditions. As many as one-third of prescriptions are left at the pharmacy. Of those taken home, only half of patients are adherent to their medications and even fewer are as the complexity of therapy increases.[2] Yet many studies show that those who are adherent have healthier outcomes, and lower total healthcare costs.[3]

In general, medication adherence increases pharmacy costs, but in doing so, it decreases the overall cost of care. For example, if all diabetes patients were adherent to their medication therapies, it would save $5 billion in medical costs by avoiding 341,000 hospitalizations and nearly 700,000 emergency room visits.[4]

It only makes sense for patients to adhere to their prescribed therapies, so why don’t they? For some, it’s economic. The cost of the medication is just too much and seen as another monthly bill. Some don’t have access to a convenient retail pharmacy or forget to refill or pick up their medication. Quite often, patients simply forget to take their medication or skip it when they’re feeling better. Along those same lines, side effects and other interactions can cause patients to become non-adherent.

Controlling Chaos with Adherence

Making maintenance medications more accessible is a priority for many payers. EnvisionRx’s Rx90 program is one way that we help plan sponsors improve care and reduce cost—and offer members more choices and savings for the medications they need to treat their chronic health conditions. Rx90 is a comprehensive solution that reduces pharmacy spend and overall health plan costs through increased adherence.

Getting patients to change their behavior isn’t easy. A successful strategy needs to address all of the reasons that cause members to be non-adherent to their care plans. Rx90 helps improve patient adherence to drug therapy plans by addressing the reasons behind non-compliance.

    • 90-day fills. Studies show that people who receive larger quantities of maintenance medications are more likely to adhere to their therapy. With Rx90, patients have the option to fill their maintenance medications for 90-days at any of nearly 13,000 Walgreens, Rite Aid and Costco pharmacies nation­wide, or—for the same price—have them delivered to their door through EnvisionPharmacies’ mail service. Instead of remembering to refill prescriptions every month, members need only to fill four times per year.
    • Cost savings. Fewer fills equal more savings for both the plan and the member. The savings from a 90-day prescription can be like getting a free month of medication.
    • Member communications. Through targeted communications, members receive clear program information that will ensure adoption and satisfaction.
    • Clinical support. In addition to convenient pharmacy choices and lower cost drugs, Rx90 helps change patient behaviors by integrating clinical support from pharmacists and EnvisionRx, providing targeted, disease-specific communications and interventions. Rx90 orchestrates the member experience using a variety of communication and outreach tools to convert adverse behavior into desirable outcomes.

Disrupting the cycle of poor medication adherence is critical. It pays to take any reasonable step to help patients with chronic conditions to remain adherent to their medication. By improving adherence and helping patients make better choices, Envision helps plan sponsors save money by tailoring the program to meet their unique needs. As a result, clients can save an average of 2–7% on annual drug spending. And, since Rx90 is offered at no cost to the plan sponsor, it’s an easy decision that leads to improving the member experience and reducing cost.

The benefit of medication adherence in those with chronic conditions is ultimately healthier members and an overall reduction in medical costs. As the use of prescription medications for chronic diseases continues to surge in the U.S, the best way to manage the costs and care of your members who require maintenance medications is a program that helps remove the barriers of nonadherence.

[1] Ward BW, Schiller JS, Goodman RA (2014). Multiple Chronic Conditions Among US Adults: A 2012 Update. Preventing Chronic Disease 2014; 11:130389.

[2] World Health Organization (2003). Adherence to Long-Term Therapies. Evidence for Action. World Health Organization, Geneva Switzerland.

[3] Roebuck C, Liberman J, Toyama-Gemmill M & Brennan, T (2011). Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending. Health Affairs, 30:1, January 2011, pp 91-99.

[4] From Hope to Cures (2017). Improving Health Care. PhRMA. Retrieved from: http://www.fromhopetocures.org/infographic/infographic-improving-health-care

 

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Get even more insight and learn how you can increase medication adherence for your plan members with chronic conditions:

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