The Official Medtipster Blog

Adhering to medication means taking the medication correctly, as instructed by a health care professional. This includes filling and refilling the prescription, taking it regularly, and continuing to take it for as long as prescribed. While this may seem simple, the World Health Organization has reported an average medication adherence rate of only 50 percent for people with chronic illnesses in developed countries. So, why is only half of the population taking their medicines as prescribed? Moreover, why is it important to adhere to your medication regimen anyway? Read on to find out why it’s important and how you can improve your adherence.

Why Adherence Matters?

Simply put, it can improve your overall quality of life. Evidence suggests that for many chronic illnesses, higher medication adherence reduces hospital visits. Fewer visits to the hospital mean lower medical costs as well.

Adherence to medication may be ‘easier said than done’ for many people. There are a variety of barriers that may make it difficult for patients to follow their medication therapy. Here are a few of those barriers and suggestions for how to get around them.

Cost

Often times, patients just cannot afford their medications. Perhaps there are alternative drugs available that do not cost as much. Talk with your prescriber or pharmacist. They may be able to help you find a more affordable drug.

You can also visit the Medtipster website, www.medtipster.com, to determine the cost of a prescription. The tool can help you compare the price on related drug products.

Side Effects

Your medicine may trigger unpleasant side effects, causing you to stop taking it. Talk to your doctor about these side effects. They may be able to switch you to a different medicine to reduce the side effects. They may also have suggestions for minimizing the side effects. Your doctor has your best interest in mind and is a knowledgeable resource to help improve your quality of life.

Feeling Better

There are five pills left, but you started to feel better and decided to stop taking your medicine. Before you stop, talk to your prescriber. Stopping early may cause more health problems. For instance, if a patient has a bacterial infection and stops taking his or her medicine early, some bacteria may still be alive. These bacteria could start a whole new strain of resistant germs. (U.S. Food and Drug Administration, 2009). Even though you may feel better, try to continue to take your medicine(s).

Forgetfulness

Make taking your medicine a part of your daily routine. Once you are used to taking your medicines regularly, it will not seem like a burden on your lifestyle. Buying a pill minder dispenser may help; it’s an easy daily reminder to take your medicine. Write down a schedule of when to take your medicines or add it to the calendar on your electronic device.

Health Care Beliefs and Attitudes

Some patients hold certain beliefs or attitudes that stop them from being adherent to their medication regimen. For example, a patient may believe that taking a medication as prescribed will not lead to a predicted outcome or that a particular disease state is not significant or will not lead to severe untoward outcomes. Talk with your prescriber about your beliefs. He or she may have more information about your illness and medicine than you know.  Your prescriber can tell you why it is in your best interest to adhere to taking your medicine(s).

Adhering to your medicine can improve your overall quality of life, so take care to adhere to your prescribed medication regimen. For a better result, you will be glad you attended to your health.

www.Medtipster.com Source: Navitus Clinical Journal, Vol. 9 – January 2013

Approximately one to five percent of the population uses specialty medications. Nonetheless, spending for specialty medications has increased between 15 and 20% for the last several years and is expected to represent up to 40% of an employer’s total medical spend by 2020. Controlling specialty medication cost is therefore a critical focus area for plan sponsors. With more and more specialty drugs coming down the pipeline, it will be increasingly important for plan sponsors to manage this area of their drug spend.

Managing this highly complex area involves coordination among multiple parties, including plan sponsor, pharmacy benefit manager (PBM), medical administrator, specialty pharmacy and the patient.

Benefits of Specialty Drug Control
Growth in specialty spending is expected to outpace non-specialty spending due to:

1. High proportion of newly approved drugs in the specialty market
2. Complex and expensive manufacturing processes
3. Limited competition within specialty medication therapy classes

It is clear that plan sponsors can benefit from managing specialty costs. While specialty medications may represent a low percentage of the drugs purchased by the plan sponsor’s members, the cost of these medications represents much more than the actual percentage of medications purchased.

In addition to cost control, helping members adhere to their regimens with specialty medications is essential, as high adherence rates have been shown to reduce hospitalizations, promote better health outcomes and lower overall health care costs.

Ways to Manage Specialty Medications

1. Implement a Mandatory Program

We recommend that plan sponsors implement a SpecialtyRx program as mandatory for members with specialty needs. Specialty programs coordinate personalized support for patients impacted by chronic and complex diseases, such as rheumatoid arthritis, multiple sclerosis and cancer. Such diseases often require complicated medication regimens that include specialty medications. By mandating use of a specialty pharmacy vendor, plan sponsors reap the benefits of reduced drug discounts with specialty pharmacy partners (versus the typically higher retail pharmacy pricing), superior clinical oversight, and individual member case management

2. Incorporate a Split-Fill Program

A  Specialty Split-Fill Program reduces days’ supply to 15-day intervals for qualifying high-cost specialty medications that typically have high discontinuation rates within the first three months of therapy. This prevents unnecessary dispensing of two weeks of therapy, should therapy be discontinued within the first half of the first three months of a prescription. This program also allows specialty pharmacy to initiate earlier clinical interventions due to medication side effects that require dose modification or therapy discontinuation. According to the May 2012 issue of Managed Care, a health plan with about 500,000 members saved approximately $300,000 in its first year with a split-fill program.

3. Know your Specialty Costs Through Pharmacy & Medical

Plan sponsors should equip themselves with information about their specialty drug spend and track specialty costs not only through their PBM but through their medical vendor as well. Less than 20% of health plans and employers currently receive reporting from their PBMs or other health care vendors on medical specialty utilization. Given that plan sponsors identified specialty drug costs as one of their two most important outcomes for specialty management, and that 50% or more of the specialty spend resides on the medical side, this gap represents a critical area of opportunity.

4. Managed Specialty Programs relieve clients of the burden of managing their specialty populations and assume this responsibility through a comprehensive, patient-centric program that offers:

• Built-in utilization management edits (e.g., prior authorization, step therapy) to ensure members use lower cost specialty products, where appropriate.
• Continually negotiated lower discounts with specialty pharmacies.
• Price increase protection built into rebate contracts for specialty drugs, where available, to account for price inflation; that is, when certain products increase in price, rebates for those products automatically increase as well.
• Continual monitoring of new drugs entering the pipeline. Their Pharmacy & Therapeutics Committee will continue to monitor and evaluate specialty drugs, including any biosimilars being released. Biosimilars are products that are chemically similar to other products; very few have received FDA approval at this point. We expect biosimilars will be significantly less expensive than their specialty brand medication alternatives and will play a bigger role in controlling specialty trend in the future.

As an example, a plan sponsor’s employee has a very expensive specialty medication. This specialty drug utilization represents less than 2% of total utilization, but accounts for, on average, half of the plan sponosor’s drug spend. The previous discount for the drug was under 20% off the average wholesale price. After its transition to a managed specialty program, the discount for this drug rose to 47% off the average wholesale price, providing a savings of more than $140,000 in the first three quarters.

How to Begin to Control Specialty

If you do not currently use a mandatory program, talk to your provider today to implement the program. Plan sponsors can reap the benefits of  preferred pricing via a specialty pharmacy, and their members can benefit from the one-on-one specialized care from the case managers available through  specialty pharmacy vendors.

Be proactive and take control of this sector of your plan’s drug spend. By maintaining a tightly managed specialty program, not only will plan sponsors benefit from reduced costs, but their members will also benefit from improved overall health.