NCPDP Panel: Better Medication Adherence Begins with True Transparency
| Jessica Behrendsen
“How many people in the audience have been non-adherent to their prescribed medication?”
This question was posed by Vice President of Council for Affordable Health Coverage (CAHC), Sloane Salzburg, and CoverMyMeds, Director of Industry Relations and Government Affairs, Kim Diehl-Boyd, at the 2018 NCPDP Annual Technology & Business Conference during their well-attended panel, Medical Outcomes and Medication Adherence: Using Parts A, B and D Data to Close the Gap.
In a room with nearly all seats filled, almost every hand was raised.
Working in the health care IT industry, “non-adherence” is a term we consistently hear as the crux of a problem we’re all trying to solve. Increasing medication adherence is a goal we all align on, even as we provide solutions from different angles. For example, providing decision-support at the point of prescribing, giving more visibility for the patient through a real-time benefit check (RTBC) solutions, streamlining the electronic prior authorization (ePA) process or improving patient assistance programs.
The presenters took a deep dive into the root of this issue: What is driving medication non-adherence? What are the real numbers behind this dangerous problem? What policies at the federal level could help solve the problem?
Health Care Snap Shot
They began the presentation with a look at rising health costs. Patients are continuing to pay more and more for their medications leading to the greater potential for non-adherence. Non-adherence causes an estimated 125,000 deaths a year and up to 10 percent of all hospitalizations. By defining solutions that lead to better price transparency, we may be able to subsequently increase adherence.
“Drugs don’t work in patients who don’t take them.” - C. Everett Koop, Former U.S. Surgeon General
Reasons for Non-Adherence
It’s not just rising drug costs that lead to non-adherence. In a survey conducted by CAHC, patients referenced believing their condition was under control, or not making an appointment to renew their prescription, in addition to not being able to afford the prescription as reasons for not taking their medication.
What would help? Patients surveyed overwhelmingly stated that clear information related to their care would help them adhere, as well as better discussions with their doctors, and appointment/ medication reminders.
The good news is, the industry is actively working on solutions to these exact problems through the development of real-time benefit check and patient-focused applications. For example, RxBenefitClarityTM provides data including formulary restrictions, actual patient pay amount, patient deductible information and indicates the medication that will most likely be dispensed at the patient’s preferred pharmacy.
Policy Landscape
In addition to technology, we look to policy and law makers to align their efforts with the advancing technologies and standards that work for the betterment of the health care system and increase transparency and data sharing for improved outcomes.
Passing bills like the Bipartisan Budget Act of 2018, which permits Medicare A, B and D plans to share their data, will give plans the full picture and insights into true costs and care. There has also been movement on the highly-anticipated H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, which facilitates the use of ePA in Medicare’s prescription drug program.
The bill is rolled-up into the federal opioid efforts, and encompassed into H.R. 5773, Preventing Addiction for Susceptible Seniors Act. This bill is meant to reduce abandonment at the pharmacy and increase adherence by mandating the use of an electronic solution for prior authorization for Medicare Part D. The House Energy and Commerce Health Subcommittee recently passed the bill and you can learn more about it here.
Moving Forward
The presentation ended with another emphasis on the importance of RTBC solutions and clinical decision support, as well as a focus on the patient as an individual and not simply another name on a chart, which is a shared sentiment across the industry. Through technological solutions and continued movement in legislative polices, the issue of medication adherence can be exponentially improved.
