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Solutions to Improve Medication Adherence and Member Health

Senior man taking pills

The right medication regimen is a critical part of most treatment plans. This is especially true for our members with long-term, chronic conditions such as diabetes, high blood pressure, and high cholesterol. Equally important is the need for members to take medications as prescribed. This is called medication adherence. It can have a tremendous impact on their 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:

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.

PreCheck MyScript® helps providers choose effective and affordable medications

Many prescribing decisions are made during patient office visits, and often, providers lack access to a patient’s drug benefit information, including coverage limitations and out-of-pocket costs. As a result, patients often abandon their medications after leaving the provider’s office due to costs or delays in getting prescriptions authorized.

The PreCheck MyScript® digital benefit look-up tool can help change that by allowing network providers to see in real-time what members will pay for medication, what lower-cost alternatives may be available, and if prior authorizations are required.

With PreCheck MyScript, providers have the information they need to:

  • Discuss options and anticipated costs with patients
  • Initiate a prior authorization request online or avoid it by choosing a drug that does not require it
  • Prescribe the most clinically appropriate, cost-effective medication for patients

As a result, PreCheck MyScript can help reduce members’ out-of-pocket costs, facilitate medication adherence rates, and improve health outcomes. Learn more about how PreCheck MyScript improved point-of-prescribing decisions and affected member savings in 2020.

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 Program*

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.

* 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.