The managed care industry is charged with helping to make care more affordable for its members and customers — while always seeking to improve quality.
Organizations that facilitate better medical outcomes and save costs at the same time are truly fulfilling their holistic health promise to members and customers.
Drug adherence is often overlooked when improving outcomes and reducing costs: Prescribed drugs don’t work when members don’t take them consistently, at the correct dose and time, or at all.
Medication nonadherence costs as much as $300 billion in lost productivity and unnecessary health care spending annually, and accounts for 10 percent of hospital admissions and as many as half of medication treatment failures, according to Risk Management Healthcare Policy. Worst of all, nonadherence results in 125,000 preventable deaths each year.
However, managed care organizations can have a positive impact on adherence. For example, commercial members of IngenioRx, pharmacy benefit manager for Anthem health plans, increased adherence significantly and improved health outcomes while minimizing expenses in several treatment areas, according to the IngenioRx 2019 Drug Trend Report.
Specifically, more than 6 in 10 members with chronic conditions who were nonadherent in 2018 achieved full adherence in 2019 by participating in IngenioRx’s programs.
One driving force in improving adherence was to increase the percentage of members receiving 90-day supplies of drugs. IngenioRx efforts resulted in 18.6 percent of members with 90-day prescriptions in 2019, up from 14.4 percent in 2018.
Another key to adherence is ensuring the best price on medications so members can afford them. By evaluating each medication and its generic alternatives, or by comparing prices for the same drug among pharmacies, IngenioRx helps ensure the best possible price for members. Usually, generic drugs are less expensive. In these cases, IngenioRx encourages members to switch — when appropriate — to a less-expensive generic from a branded drug.
Another approach is one used by ZipDrug, a company IngenioRx acquired in June. ZipDrug offers members options on high-performing pharmacies that produce better outcomes and helps members with lower drug costs. Services can include guaranteed delivery and compliance packaging that provides specific instructions customized for their needs to ensure members can adhere to their doctor’s prescribed regimen.
When 100,000 Medicare members recently used the program, the group’s collective adherence improved 7 percent, while active members experienced average annual savings of $504 on copays, according to IngenioRx data. IngenioRx plans to expand ZipDrug’s innovative approach in key geographic and insurance products over the next few years.
While adherence improves effectiveness, adherence is particularly important for members with chronic conditions, whose lack of adherence could involve an ER visit, hospitalization or possibly even death.
Members with IngenioRx benefits increased their adherence in cardiovascular medications from 68 percent in 2018 to 75 percent in 2019. Oral anticoagulant adherence grew from 63 percent to 75 percent and oral breast cancer medications rose from 59 percent to 66 percent.
In 2019, IngenioRx saw inpatient utilization rates for members who became adherent to anticoagulant treatment, which can minimize serious bleeding events and recurrence of blood clots and strokes, fall 32 percent year over year, versus members who were nonadherent.
In continuing to drive adherence for anti-coagulants and reduce the number of strokes, IngenioRx is beginning a program in 2020 that uses predictive analytics to evaluate risk for members with atrial fibrillation and focuses on medication adherence outreach.
Regardless of the high-tech or more traditional methods used—predictive analytics, matching pharmacies, increasing on-hand supply of medications, or mail, phone and digital outreach—moving the adherence needle can improve outcomes and lower costs for all.