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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Fighting Specialty Drug Costs

Prescription-drugsTo help control rising specialty drug costs, the National Business Group on Health has issued a lengthy report including 5 public policy recommendations they hope will educate the marketplace and encourage effective, strategic partnerships.

According to NBGH officials, plan design is the key to managing the use of specialty prescriptions as well as the costs. The report details progress resulting from the aggressive use of utilization review, case management and prior authorization for specialty drugs. Other measures yielding positive results are the design of a specialty tier into the benefits plan and taking measures to administer specialty prescriptions in a facility separate from the hospital. Prescriptions authorized by a hospital or billed under the medical benefit are harder to track and often more costly.

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