MedCity Influencers

The $3 billion wasted drop in the well

We have long known that improvements in medication adherence are the longest lever available to impact wasteful healthcare spending in the United States. We know further that improvements in adherence affect both sides of the value equation in the right direction: improving outcomes and reducing costs. When news broke recently that $3 billion is wasted […]

We have long known that improvements in medication adherence are the longest lever available to impact wasteful healthcare spending in the United States. We know further that improvements in adherence affect both sides of the value equation in the right direction: improving outcomes and reducing costs.

When news broke recently that $3 billion is wasted on cancer drugs every year due to the size of the vials in which they are sent to hospitals, it seems the coverage was rampant. Things have gotten so bad that number is a drop in the well. $3 billion equals only 1 – 3 percent of money wasted every year due to medication nonadherence according to the Centers for Disease Control and Prevention (CDC): $100 – $289 billion.

Healthcare stakeholders are so focused on the practices of the Turing’s and Valeant’s of the world that we fail to recognize that we have the ability to save tens of billions of dollars on prescription drug spending every year, starting right now, by using the longest lever available to stem the rising tide of wasted healthcare spending: medication adherence.

Unfortunately, medication adherence in the United States is appallingly low. Broadly speaking, the Centers for Disease Control and Prevention estimates 20-30 percent of prescriptions written never get filled and in about 50 percent of cases medication is not continued as prescribed. More specifically, take HIV treatment. According to Kenneth L. Schaecher, MD, FACP, CPC as published in the American Journal of Managed Care, “In the United States, the rate of adherence to HIV therapy is generally low.  A meta-analysis of adherence studies—the durations of which ranged from a few days to 1 year—observed a rate of 55% who “achieved adherence” among a pooled group of 17,573 patients. The definition of ‘achieving adherence’ in the studies ranged from above 80% adherence to 100% adherence. By comparison, in sub-Saharan Africa, the pooled adherence rate in studies comprising 12,116 patients was 77%.”

Neil Versel reported recently in Medcity News about the barriers to adherence for a wide variety of low income patients for patients with a wide variety of conditions including diabetes.

We were pleased to learn of the Enhanced MTM model test beginning January 1, 2017 that will give stand alone, basic Prescription Drug Plans in five Medicare Part D regions the ability to “vary the intensity and types of MTM items and services based on beneficiary risk level and seek out a range of strategies to individualize beneficiary and prescriber outreach and engagement. Applicants can accomplish these goals by leveraging the core competencies of their own organizations, and of their network pharmacy providers, along with those of medical prescribers to accurately identify and effectively intervene with all beneficiaries whose issues with medication management have caused, or are likely to cause, adverse outcomes and/or significant non-drug program utilization and costs.”

We know with great certainty that medication therapy management when done in a thorough, patient-centric way piloted by clinical pharmacists at the helm moves both of the value-based levers in the right direction by improving outcomes and reducing costs.

A study published in 2012 by Curant Health CEO Patrick Dunham and Jeffrey Karkula, RPh, BSPharm, demonstrated that for a population of HIV patients taking Highly Active Antiretroviral Therapy (HAART):

  • Medication adherence increased 28% over baseline through enhanced medication therapy management
  • There was a 69% increase in patients who were at least 95% adherent to all medications; 95% represents the commonly applied definition of an acceptable level of adherence to HAART.
  • The percentage of patients whose viral loads were considered undetectable increased from 28% to 66% with medication therapy management.
  • The same patients’ overall healthcare costs decreased $3,000 per patient per year.

The 1917 Clinic, a Ryan White grantee at the University of Alabama-Birmingham, serves a large patient population that struggles with adherence. University clinicians recently presented findings and analysis of 652 HIV patients over a 38 month period who received Enhanced Pharmacy Services from Curant Health as part of their treatment plans. Of the 157 patients who were not virally suppressed at enrollment, 103 achieved viral suppression during follow-up tests, which ranged from 6 weeks to one year after enrollment.

That’s a statistically significant increase in the proportion of patients receiving HIV treatment achieving viral suppression, an increase from 73% to 88% of patients at the clinic enrolled in Curant pharmacy services who were able to achieve suppressed viral loads.

As the nation’s largest payer and arguably the nation’s largest driver of healthcare innovation, the Centers for Medicare and Medicaid Services should lead the charge on improvement in medication adherence and our next president should ensure they do so. In the meantime, we will continue put all of our available resources to use improving medication adherence and outcomes for the thousands of patients we serve daily.

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