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Better Medication Adherence May Bring $37 for Each Dollar Spent

Appointment-based medication synchronization programs may help improve patient adherence and reduce clinical spending for common chronic conditions.

- The healthcare industry may see savings of up to $37 for every additional dollar spent on improved medication adherence, according to a study published in the American Journal of Managed Care. Appointment-based medication synchronization (ABMS) could help patients improve their adherence to common conditions, resulting in reduced clinical spending that offsets the costs of using additional medications.

Patient medication adherence with ABMS programs

ABMS programs, where pharmacists work with patients to fill chronic medication on a single day each month, have been suggested as a promising way to improve adherence in community pharmacies. Prior to the monthly filing date, pharmacists review patients medications, address any concerns, and discuss any changes.

Using public prescription pricing data and claims data, researchers calculated the direct cost of an ABMS program targeting chronic disease management medications for high cholesterol, hypertension, and diabetes. The team assessed cost-benefit ratios for payers of the course of one year.

"Medical savings per additional dollar spent on medications ranged from approximately $1 to $37 depending on the medication and medication class considered," the authors wrote. "ABMS was most cost-beneficial for metformin and statins. Sensitivity analyses showed that cost-benefit was significantly impacted by medication costs and any service fees associated with ABMS."

Medication adherence rates are as low as 50 percent for some conditions, previous research has found. Adherence rates also tend to decline over longer periods of time and are lower in patients prescribed multiple medications. Up to 69 percent of medication-related hospital admissions can be traced back to poor adherence rates, the study added.

Researchers asserted that pharmacists, “particularly in community pharmacy settings,” have the opportunity to impact medication adherence. However, the success rates of counseling, monitoring and education efforts in community pharmacies have varied.

Receiving medication adherence counseling and education from a pharmacist can reduce patient hospitalizations and emergency room visits.

Research has shown that collecting all their prescriptions in one trip to the pharmacy increases patient medication adherence by as much as 13 percent.

"This system is designed to simplify the complexity of patients’ medication regimens and provide opportunities for consistent pharmacist–patient communications, which can help to clarify, modify, and enhance patient therapy," the study authors wrote. "Communications with physicians are also enhanced through a formal process of physician contact regarding patient enrollment in the program and periodic calls to address medication therapy issues."

"ABMS has demonstrated significant impact on patient adherence and persistence for chronic medications."

For example, researchers point to a study of rural pharmacies in the Midwest that found new chronic medication patients enrolled in an ABMS program had 3.4 to 6.1 times higher odds of adherence than matched comparisons over the course of a year.

Another year-long study of Ohio pharmacies with patients who had been taking chronic medications for 6 or more months found ABMS produced 2.3 to 3.6 times greater adherence odds.

"These studies indicate that ABMS can be effective in improving medication adherence and, thereby, possibly improve health outcomes; however, there have been no analyses of the economic consequences of these programs," authors wrote.

Researchers attempted to create a model of the economic impact of ABMS in community pharmacies for patients taking chronic medication for diabetes, hypertension, and hyperlipidemia. Conducted from a healthcare payer's perspective, the analysis sought to determine the value of chronic disease patients enrolling in community pharmacy ABMS programs.

The study focused on adult patients enrolled in an ABMS program who had been taking chronic medicine for six or more months and had received a minimum of two refills for at least one of six different types of medication. ABMS program enrollees were matched with patients in a control group receiving standard pharmacy services.

Results showed that between 81 and 100 percent of patients in the ABMS program scored highly on the proportion of days covered (PDC) by their medications. PDC scores for patients in the control group were between 12 and 27 percent lower.

Additionally, "with the exception of drug costs, which increased with greater adherence, direct medical costs were much lower, on average, for patients with higher PDC scores," the team found.

While the study found ABMS enrollment was linked to "slight increases" in medication costs due to better adherence, the program was also associated with lower disease-specific medical costs.

"Medical savings per additional dollar spent on medications ranged from $1.25 to almost $37 depending on the medication class," the authors wrote. "These results suggest that payer partnerships with pharmacies offering ABMS are cost-beneficial and provide a positive return on investment."

Researchers conducted additional analysis by lowering the medication costs to Veterans’ Health Administration (VA) levels and raising them to as high as the average wholesale price (AWP).

Results showed that disease-specific medical costs and the PDC distribution of ABMS patients both increased and decreased by 20 percent.

Finally, the study examined the impact of adding an ABMS service fee. Since most pharmacies offer ABMS fee of charge, researchers analyzed the effect of annual per-patient fees of $100, $150, and $200 to enroll in the program. Additional $5 and $10 co-pays per fill were included to reflect the average cost-sharing arrangements with patients.

“In sensitivity analyses, the benefit-cost ratio of ABMS was most sensitive to drug prices,” the authors wrote.

When drug costs were lowered to VA levels, estimated savings ranged from $40 to $301 per additional dollar spent on medications. Specifically, “favorable cost-benefit findings were robust” for drugs used to treat diabetes and hyperlipidemia.

With prices set at AWP levels, researchers found that there was longer a favorable cost-benefit ratio for drugs used to treat hypertension.

Introducing a $10 co-pay increased benefit-cost ratios from 3.8: 1 up to 59:1, depending on the class of drug and assuming that medication adherence did not drop with co-pays.

“Cost-benefit was robust to changes in medical costs and ABMS effectiveness,” the authors wrote.” However, after introducing payer reimbursements for ABMS, favorable benefit cost ratios were only maintained for diabetes and hyperlipidemia medications.

Researchers note that the “widespread implementation of ABMS faces a number of barriers.” For example, some business models may not incentivize pharmacy benefit managers (PBMs) to support ABMS programs.

“Additionally, ABMS would not benefit PBMs whose performance is measured solely on medication cost, as medication costs increase with improved adherence,” authors wrote. “Here, the disease-specific medical savings would show up on the income statements of other payers.”

Other potential hurdles include PBM disincentives for out-of-network pharmacies offering ABMS programs. ABMS programs could also potentially disrupt PBM efforts to transform their dispensing model into mail-order services or influence contract rebate terms.

Despite potential hurdles, the study highlights the ability for patients to receive interventions at the pharmacy that can lead to improved medication adherence and better outcomes. While increased medical adherence ultimately leads to more spending at the pharmacy, the study shows that these additional costs are offset by money saved from fewer hospital visits.

“To our knowledge, this is the first study to evaluate the cost-benefit of ABMS in community pharmacies,” authors wrote. “The results indicated that ABMS offers payers a positive return on investment. Although further research is needed to evaluate the long-term costs and outcomes of ABMS, payer partnerships with pharmacies offering ABMS may improve patient outcomes in a cost-beneficial manner.”

 

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