Solutions to Improve Medication Adherence and Member Health

By May 11, 2020December 31st, 2020Employee Well-being Employers Pharmacy
A person taking their daily medication from a pillbox

Many members are managing long‑term, chronic conditions, such as diabetes, high blood pressure, and high cholesterol. One critical part of their treatment plan is following a medication regimen. Taking medications as prescribed — called medication adherence — can have a tremendous impact on a member’s quality of life, longevity, and health outcomes.

When members don’t consistently take their medications as prescribed by their doctor, their health suffers. In addition, they may face complications that require costly and avoidable health care services.

The Stats on Medication Adherence

Here’s what we know:

  • Up to 30 percent of individuals with a chronic illness never even start their medication therapy1
  • Half of medications are not taken as prescribed2
  • Individuals with low to intermediate medication adherence are 5 times more likely to be readmitted to the hospital3
  • 125,000 people die each year because of complications related to nonadherence2
  • Nonadherence costs up to $300 billion annually4

Independence Blue Cross Solutions Can Improve Medication Adherence

We offer several solutions to improve medication adherence. These programs make it easier for members to get their medications and help them to stay on track with their treatment plan. Some of these programs are included for fully insured customers; self‑funded customers can choose to add them.

90‑day fill options to improve convenience and lower costs

We make it easier for members to get their maintenance medications, and most members can save with the convenience of a 90‑day supply. There are two options that offer members a 90-day supply:

  • Mail order/home delivery: Members can sign up for free delivery of their maintenance medications to the address of their choice. They can manage their mail orders through our member website or by phone. Most members save money when using mail order.
  • Retail 90: This benefit offers a convenient option for members who prefer picking up their prescriptions at a retail pharmacy. They can get a 90‑day supply of maintenance medications at a retail pharmacy for the same cost‑sharing as mail order/home delivery. For members in most fully insured plans, Walgreens is their retail pharmacy option for this benefit. Self‑funded customers can choose from three Retail 90 options upon contract renewal.

Monitoring adherence to keep members healthy

We offer our Medication Adherence program for self-funded groups to help members stay on track with their medications. The Medication Adherence program targets 18 disease states managed with medication, including diabetes, hypertension, high cholesterol, and asthma. Self-funded customers may also tailor the program for their population.

In this program, we monitor for signs of non-adherence and use personalized engagement and support to help our members. Even before their first fill, we educate members about the:

  • Diagnosis
  • Treatment plan
  • Importance of adherence
  • Value of setting up daily reminders

Then, we check to make sure the first fill occurs. Over time, we watch for late refills, send refill reminders, and check in with members as needed. If we detect low adherence, we contact both the members and prescribing doctor.

Proven Results for Our Medication Adherence Program5

Results from the Medication Adherence program show it can impact member behavior and health:

  • 40 percent of nonadherent members became adherent within six months
  • Customers saw an average total health care savings of more than $40 per intervened member per month

To learn more about our Retail 90 benefit options and Medication Adherence program for Independence Blue Cross prescription drug plans, please reach out to us.

1 Network for Excellence in Health Innovation. Ready for Pick‑Up: Reducing Primary Medication Non‑Adherence. Published October 20, 2014. Accessed November 16, 2018.
2 Food and Drug Administration. Why You Need to Take Your Medications as Prescribed or Instructed. Updated February 16, 2016. Accessed November 16, 2018.
3 Patient Preference and Adherence. Medication adherence as a predictor of 30‑day hospital readmissions. Published April 20, 2017. Accessed November 27, 2018.
4 Risk Management and Healthcare Policy. Adherence and health care costs. Published February 20, 2014. Accessed November 16, 2018.
5 October 2017 through September 2018 OptumRx book of business results for clients that have implemented the Medication Adherence program. Nonadherence is defined as someone taking their medication less than 80 percent of the time during the measured time period, or Proportion of Days Covered (PDC). PDC is a measure of adherence calculated as the number of days with medication on hand divided by the number of days in the specified time period.

 

Jeffrey Green

About Jeffrey Green

Jeffrey Green leads product management for the prescription drug benefit for Independence. He is responsible for product development, benefit strategy, plan design, and supports sales and marketing. He works closely with informatics, actuarial, pharmacy services and Independence’s PBM to show how the use of analytics and other approaches can improve quality and total cost of care when providing medical and prescription drug benefits together.