Medication Adherence Policies. The Right Prescription for a Healthy America

Transcription

1 Medication Adherence Policies The Right Prescription for a Healthy America

2 WHO WE ARE More than 50 members representing patient, provider, pharmacy, pharmaceutical, and employer organizations all focused on improving America s health by identifying legislative and regulatory solutions that will improve medication adherence.

3 WHY MEDICATION ADHERENCE? How do we save $ while keeping Americans healthy? Unnecessary hospitalizations and disease progression If patients were more adherent, we could save the US healthcare system more than $100 billion annually on avoidable medical costs. Data and tech hold promise to improve health. But how? Healthcare costs continue to tightening budgets at all levels.

4 $200B+ Potential Annual Savings From Better Use of Medicines Better use of medicines could eliminate up to $213 billion in US health care costs annually, representing 8% of the nation s health care spending. Avoidable Annual US Health Care Costs (Billions, 2012) Nonadherence $105 Medication Errors* $21 Suboptimal Prescribing** $87 Total Avoidable Costs $213 $0 $50 $100 $150 $200 $250 *Category includes: medication errors ($20 billion) and mismanaged polypharmacy ($1 billion) **Category includes: untimely medicine use ($40 billion), inappropriate antibiotic use ($35 billion), and suboptimal generic use ($12 billion) IMS Institute for Healthcare Informatics. Avoidable costs in US healthcare: the $200 billion opportunity from using medicines more responsibly. June Accessed March 2015.

5 The Human Cost $213 Billion in Avoidable Costs $22 $6 Millions of Lives Affected 10 million hospital admissions $45 78 million outpatient visits $ million prescriptions 4 million emergency room visits

6 Difference in Annual Spending of Adherence Patients vs. Non-adherence Patients Medication Adherence Lowers Health Care Use and Costs Despite Increased Drug Spending $2,000 $- $1,058 $656 $429 $601 Medical Spending -$2,000 Drug Spending -$1,806 -$4,000 -$6,000 -$4,413 -$4,337 -$8,000 -$10,000 -$8,881 CHF Diabetes Hypertension Dyslipidemia Roebuck MC, Liberman JN, Gemmill-Toyama M, et al. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs. 2011; 30(1):

7 Adherence Policies Can Save Money Due to a growing body of evidence, in 2012 the Congressional Budget Office (CBO) began recognizing increased use of prescription medications leads to reductions in health service costs, such as hospital or physician costs. Pharmaceuticals have the effect of improving or maintaining an individual s health...adhering to a drug regimen for a chronic condition such as diabetes or high blood pressure may prevent complications taking the medication may also avert hospital admissions and thus reduce the use of medical services. CBO 1 Recent evidence suggests Medicare savings due to better use of medicines may be 3 to 6 times greater than estimated by the CBO for seniors with common chronic conditions 2 : High cholesterol: more than 3 times greater Congestive heart failure: nearly 4 times greater Diabetes: more than 4 times greater Hypertension: nearly 6 times greater

8 More than 1-in-4 Americans with Chronic Conditions Opt Out of Adhering to Medications without Consulting a Health Care Professional 8 *This question was asked of those who answered no when asked if they were currently taking medicine or were prescribed a medication for their chronic health condition 20 Net 28 % 0 Never prescribed Dr said no need to take meds Cond. under control, stop taking meds No appt to renew prescrip. Can t afford prescrip. Side effects Haven t gone to pharmacy Other Don t know

9 What would be effective in helping you take your medicines? Research Funding Pharmacist Incentives Physician Incentives Patient Reminders 77 Improve Packaging Med Synch Encourage discussion Promote Health IT Clear informaiton Total Effective Very Effective

10 Key Opportunities to Improve Adherence 1. Make it easier for patients to access their medications Medication Synchronization Allow 90-day fills for Medicaid patients Reduce cost sharing 2. Improve management of medications by clinicians Medication Therapy Management Comprehensive Medication Management erx and Electronic Standards Electronic Prior Authorization, Fill/Refill Data 3. Provide incentives for better outcomes Linking pharmacy and medical data to realize medical savings from improved medication management Quality Measurement

11 Medication Synchronization Medication synchronization programs coordinate medication refills so that all of a patient s chronic fill medications are refilled on the same day every month, reducing the need for frequent pharmacy trips 90% 80% 70% 79.5% Percent of Patients Adherent Med Sync vs. Control 71.8% 68.9% 66.1% 76.6% 76.2% 60% 50% 40% 40.8% 38.3% 40.3% 37.0% 40.2% 37.4% 30% 20% 10% 0% ACEIs/ARBs Beta blockers DCCBs Thiazide diuretics Metformin Statins Control Adherence Med Sync Adherence

12 90-day vs. 30-day fills 2012 CMS Study on Adherence, Waste and Cost Rates for 90-day Refills Used California Medicaid claims data Patients with 90-day refills had greater medication adherence, greater persistency, nominal wastage, and greater savings than those with 30-day refills. 90-day fill patients were 20% more adherent than those on 30-day refills. Estimated savings resulting from the use of 90-day rather than 30-day fills ranged from $7.70 to $26.86 per person per year (PPPY). These savings only reflect reductions in pharmacy costs and not the expected savings in medical spending associated with adherence.

13 Medication Management National: Part D Medication Therapy Management (MTM) Offered to Medicare Part D beneficiaries meeting three criteria: 2-8 Part D medications, 2-3 chronic conditions; and Part D drug spending in excess of an annual threshold - $3,507 for 2016 Conducted by a pharmacist or PBM staff CMMI Enhanced MTM Model Test- ongoing States: States can implement MTM/CMM programs and pharmacyassisted disease management programs for Medicaid beneficiaries Examples include: California CMM Pilot Ohio MCO CareSource- Comprehensive MTM Program Minnesota- MTM offered to MinnesotaCare (Medicaid FFS and MC) recipients who are not eligible for Part D and are taking at least 1 Rx for a chronic condition Kentucky Passport Health Plan (MCO)- Late Refill Program Massachusetts Neighborhood Health Plan (MCO)- Antidepressant and Asthma Disease Management Programs; Link pharmacy & medical claims data

14 Adherence Programs in the States Medicaid MTM Synchronization* Both NY *These states have enacted medication synchronization legislation/regulations

15 Health IT to Support Medication Electronic and timely access to medication information Electronic Prior Authorization (epa): Electronic transmission of information between the prescriber, payer and pharmacy to determine prior authorization requirements. Paper-based prior authorizations result in 265 million rejected and 75 million abandoned prescriptions every year. Management epa streamlines the PA submission and determination process and prevents the delay of patient treatment. Rx Fill: Electronic transaction that sends messages to the prescriber on their patients fill/refill status.

16 State Policy Recommendations for Improving Medical Outcomes and Lowering Costs Measure where your state is related to medication adherence levels. Establish a state report on annual adherence levels. Coordinate care between the pharmacy and medical benefits. Link claims data to enable identification of patients at high risk for mismanaging their medications and related hospital visits. Provide the tools and services necessary to assist beneficiaries in properly managing and adhering to their medication regimens. Synchronization, MTM and CMM services Electronic standards to streamline communication (epa, fill/refill data) 90 day fills

17 1. Measure where your state is related to medication adherence levels. Establish a state report on annual adherence levels. 2. Coordinate care between the pharmacy and medical benefits. Link claims data to enable identification of patients at high risk for mismanaging their medications and related hospital visits. 3. Provide the tools and services necessary to assist beneficiaries in properly managing and adhering to their medication regimens. Synchronization, MTM and CMM services Electronic standards to streamline communication (epa, fill/refill data) 90 day fills

18 Contact Joel White President Sloane Salzburg Senior Director