Technology and Value-Based Pharmacy Innovation

Medication adherence was already one of the nation’s largest issues in normal times, and with the spread of the COVID-19 pandemic the times are far from normal. According to the CDC, 90% of people hospitalized for COVID-19 in the U.S. have underlying conditions, including hypertension, diabetes mellitus and cardiovascular disease—all of which require regular medication adherence for patients to remain healthy. Increasing medication adherence reduces preventable hospitalizations, which is especially crucial in these unique times.

CMS’s recent changes to 2021 Medicare Advantage (MA) Star Ratings have shifted this year’s focus to medication adherence by pausing measurement for the majority of Part C measures. As discussed in our last blog, the majority of Part D measures are still in effect and medication adherence will be the primary way for plans to improve their 2021 MA Star Ratings. Health plans should have a full suite of pharmacy resources available to keep consumers adherent and match individuals with a method that fits their level of need. Plans need to be vigilant about monitoring adherence, intervening when consumers miss refills, and helping consumers get the prescriptions they need to stay adherent. It’s important to consider the two key factors of access and engagement when discussing pharmacy choices with consumers.

Access

All consumers need continuous access to their medications throughout the pandemic, but access can have different implications depending on a person’s risk of medication non-adherence. Social determinants of health (SDOH), such as health literacy, financial issues with co-insurance payment and mobility issues, factor into each consumer’s risk level and influence their ability to access or take their medications as prescribed.

Lower Risk

Consumers with fairly static medications, a credit card and low potential for mail theft

  • Mail order pharmacy provides the right level of access.
  • CMS’s refill-too-soon overrides allow for uninterrupted access to medication regardless of individual refill schedules.
  • Consumers can follow stay-at-home and social distancing guidelines with 90-day supplies delivered to the home.
  • Retail pharmacies, such as CVS and Walgreens, are meeting this need by temporarily waiving drug delivery fees.

Medium Risk

Consumers with a more involved but still consistent (no changes in a 60-90 day) medication regimen and few challenging SDOH factors

  • Home delivery with an added layer of compliance packaging provides the right level of access.
  • Consumers can follow a more involved medication routine correctly without the added stress of sorting and tracking each dose by hand.
  • Amazon Pharmacy’s PillPack offers this type of sorted multi-dose packaging.

High Risk

Consumers with a more complex medication regimen and a higher number of SDOH risk factors

  • Home delivery doesn’t necessarily solve the problem of access.
  • Consumers may not have a credit card and may need flexible payment options if their medications change month-to-month.
  • AdhereHealth’s AdhereRx pharmacy ensures medication synchronization, access to medications by offering scheduled hand-delivery via private courier, allowing for cash payment on delivery (COD), and offering payment plan options.

Engagement

Consumers differ in their need for engagement as well. A consumer’s need for engagement is often determined by the complexity of their medication regimen, their care team access and their overall health literacy. Although risk level below mentions a numerical range of medications, it’s important to remember that there are many other factors involved. The complexity of an individual’s conditions and their SDOH factors are just as important as the number of medications they take.

Lower Risk

Consumers with an average of 1-3 consistent medications and adequate health literacy

  • Low engagement with a pharmacist is needed, but it is beneficial to have the option to engage with a clinician as needed.
  • A passive engagement model used by mail order and retail pharmacies works well.

Medium Risk

Consumers with an average of 4-5 fairly consistent medications and adequate health literacy

  • Compliance packaging and adherence reminders along with the passive option to reach out to a pharmacy clinician covers engagement needs.
  • Amazon Pharmacy’s PillPack compliance packaging simplifies consistent complex routines and reduces the need for pharmacist engagement, while still offering consumers the option to reach out for support when needed.

High Risk

Consumers with lower health literacy and an average of 5 or more daily medications, multiple physician prescribers and the drug regimen may also change frequently

  • Proactive clinician engagement must be a priority.
  • Clinicians need to be able to identify any SDOH issues behind non-adherence and connect consumers with resources that can help, while identifying non-adherence or drug therapy problems quickly.
  • AdhereRx solves this problem by using licensed clinicians trained in empathetic interviewing to engage consumers in monthly Comprehensive Medication Reviews (CMRs) and Drug Utilization Reviews (DURs).

Providing consumers with a range of pharmacy resources will benefit a plan’s Star Ratings, and more importantly, it will ultimately help more people stay adherent to their medications safely throughout this crisis.

If you missed our last blog, 2021 MA Star Ratings Shift Focus in Response to COVID-19, take a look at that post and subscribe to our blog for a full downloadable list of the changes to 2021 MA Star Ratings measures. Next, we’ll highlight how predictive analytics combined with these pharmacy resources are the best-in-class solution for medication adherence.

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