The Value of Medication Adherence

Encouraging members and their dependents to take their prescriptions as directed by their doctor or pharmacist has long been a concern for health plans. As the Covid-19 pandemic continues to spike in most parts of the country, the problem has intensified, with experts estimating that the increased cost to our healthcare system may be nearly $300 billion annually.

Traditional challenges of rising costs and a failure to read and understand health information have been exacerbated by the fear of in-person doctor visits. Overcoming these issues requires increased communication and support because there is no doubt that when people fail to take their medications as prescribed, health plans often end up dealing with higher claim costs down the road.

A Higher Level of Support

Providing a high level of support can help many members avoid serious medical
complications in the future. Collaborating with a PBM or member advocate to send a
text message when a refill is due can be a big help. Some plans offer a lower copay as an
incentive to fill prescriptions on time.

Taking the time to understand a member’s needs and concerns can go a long way in
increasing medication adherence. While concerns about using generic alternatives,
copay assistance programs and transportation are common, addressing language barriers,
disabilities and other social factors are measures that can make a big difference.
Providing a higher level of support will not only produce higher quality outcomes, but
lower pharmacy benefit costs as well.

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PBMs for Better or Worse

variouspillsWith enrollment in Medicare Part D and specialty drug costs exploding, it’s no surprise that forecasts predict 7 percent annual growth for PBMs over the next several years. Two trends noted in the report were the continued acquisition or startup of PBMs by insurance carriers and the need for employers to better understand their options when comparing proposals.

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