Value-based care has steadily gained traction in the United States. At the beginning of the century, only three states had executed value-based care programs. Since 2018, that number has grown to 48 out of 50 states. Clearly, if you provide healthcare services in today’s market, you need to help patients find ways to reduce the burden of their chronic disease and live healthier lives.
Value-based care can only be effective if patients follow their prescribed care plan including taking their medications as directed. That is why medication adherence plays an essential role in value-based care. Both high prescription drug prices and slower time-to-therapy can create barriers to medication adherence. In this article, we describe how improving medication adherence by breaking down these barriers can drive value-based care.
Inability to afford prescriptions impacts medication adherence
It’s extremely difficult for a patient to predict how much a prescription medication will cost in the United States. The average American spends around $1,200 each year on prescription medications.1 The cost of specific medications can vary depending on the patient’s insurance, their pharmacy, where they live, and, among other factors, whether a generic version of a medication is available. As a result, a Gallup poll reports that 27% of Americans surveyed identified either healthcare or medication affordability as the country’s “most urgent health problem.”2
The affordability of prescription medications can be a serious roadblock to medication adherence. Higher out-of-pocket costs for prescription medications have been shown to correlate with an increased likelihood that a patient will quit taking the medication. Studies show that 33% of patients have intentionally skipped filling a prescription because of its high price.3 Nearly 6% have skipped taking their medication three times or more, while 29% stopped taking their prescription medication entirely without consulting with their physician.3
The connection between prescription affordability and medication adherence is clear. Patients can only take medications as directed when they can afford to purchase those medications. Part of the problem, however, is that many doctors are not aware of the cost of a drug before prescribing it. And, when patients arrive at the pharmacy to pick up their prescriptions, they are often left with a feeling of sticker shock.
Prescription price transparency can improve medication adherence
Prescription price transparency tools allow prescribers and patients to work together, at the point of care, to determine if the physician selected medication is affordable. Patients can assess the cost of prescribed medications before they purchase them. If a medication is too expensive, they can let the prescriber know right away. Prescribers can then select a more affordable alternative immediately, while the patient is still in the office.
Veradigm RxTruePrice™ allows clinicians to check a prescription’s price and insurance coverage before their patients pay for it. RxTruePrice allows healthcare providers to initiate the conversation simply by showing their patients a screen with options to select.
Improving medication adherence through prescription price transparency is one straightforward way to drive value-based care.
Specialty medications present unique medication adherence challenges
Specialty medications are becoming more commonly prescribed and can be a real challenge to patients’ pocketbooks.4 Per capita spending on specialty drugs has increased faster than other medications—an increase of 55% from 2014 to 2018.5
It is projected that in 2020, 50% of all drug spending was on specialty drugs, even though they represent only about 3% of all prescription medications.6 On top of that, specialty medications often take weeks to reach the patient, placing an unnecessary delay between the time a patient is diagnosed and the time when their therapy begins.
Because of the nature of specialty medications, fulfilling them can present some unique roadblocks. Sometimes that is simply because specialty prescription medications can also be expensive—but there are other reasons as well. Those reasons become clear when we look at specialty drug characteristics.
For example, they might:
· Be high cost
· Be for the treatment of rare or complex chronic conditions
· Require special handling and close monitoring
· Require unique, sometimes challenging, administration, such as injection or infusion
· Require special assessment of adverse effects or unusual response associated with the medication
As a result, specialty drugs are usually only dispensed through specialty pharmacies. The longer time to receive therapy is commonly the result of the complex number of steps required to fill a specialty medication. The drawn-out process by which specialty medications are fulfilled can have a negative impact on medication and care plan adherence.
Streamline specialty medication fulfillment to improve medication adherence
Slower time-to-receive therapy can decrease medication adherence but streamlining the prescribing process for specialty medications can help. With faster time-to-therapy, patients are more likely to adhere to their prescribed care plan, including their medications. Streamlining the specialty medication fulfillment process can also reduce the number of phone calls and faxes commonly burdening the office staff, leaving more time for patient care. Most importantly, medication adherence can lead to desired outcomes, thereby driving value-based care.
Veradigm’s software solution AccelRx™ can help make it easier to process the fulfillment of specialty medications. This innovative software solution is designed to help patients get their specialty medications quicker and, at the same time, reduce some of the burden on physicians by automating many of the specialty medication fulfillment steps.
Contact Veradigm to learn more about how their innovative solutions may help to promote medication adherence and drive value-based care.
1. Langreth R. Quick Take: Drug Prices. Accessed December 16, 2020, https://www.bloomberg.com/quicktake/drug-prices
2. Gallup Inc. Healthcare system. Accessed December 16, 2020, http://www.gallup.com/poll/4708/healthcare-system.aspx
3. Hamm N. How High Drug Prices Affect Patients. Updated May 6, 2019. Accessed December 16, 2020, https://www.managedhealthcareexecutive.com/view/how-high-drug-prices-affect-patients
4. Allscripts Healthcare L. Driving Improved Medication Adherence. 2020. https://veradigm.com/img/Medication-Adherence-Report.pdf
5. Parasrampuria S, Sen AP, Anderson GF. Comparing Patient OOP Spending for Specialty Drugs in Medicare Part D and Employer-Sponsored Insurance. The American Journal of Managed Care. 2020;26(9):388-39455.
6. Pharmacy Benefit Management Institute. 2019 PBMI Trends in Specialty Drug Benefits Report. Available at https://www.pbmi.com/.