- Using patient-centered diabetes medication adherence strategies can reduce individual patient costs by around 4 percent while setting the stage for better outcomes, according to a new report by Express Scripts. The potential for savings increases to more than 9 percent for patients with existing complications.
For the 11.6 million commercially-insured patients using diabetic medications, this could produce a total savings of more than $210 million per year in medical and pharmaceutical costs while reducing long-term complications from the extremely common metabolic disease.
“Adherence to diabetes medications is critical not only for preventing the catastrophic consequences of the disease, but also for lowering total healthcare costs,” explains the report.
While adherence rates have increased slightly since 2014, only 63 percent of diabetic adults with commercial insurance were adherent to their drug regimens in 2016, Express Scripts found.
This relatively low number indicates a significant opportunity for pharmacists and healthcare providers to improve the way they educate patients, deliver medications, and foster continued engagement.
Payers spend more than $9000 per diabetic individual on medical expenses, which is close to triple what it costs to care for a beneficiary without diabetes. Those costs can rise drastically when patients do not have access to injected or oral medications, either due to financial hardship or behavioral issues.
Out-of-pocket drug costs for patients are on the rise, significantly complicating the issue. A quarter of patients are paying more for their drugs in 2017 than they did a year ago, says one recent survey, and 14 percent have skipped filling a prescription because they could not afford it.
Failing to fill prescriptions can have serious impacts on individual health as well as broader spending trends.
Patients who remained adherent to their oral medications had 235 fewer ER visits and 50 fewer inpatient admissions per 1000 patients, the study found, which doesn’t just reduce stress and discomfort for individuals. Lowering utilization rates by improving adherence can also save money for the health system at large.
Source: Express Scripts
“Our data showed that diabetes patients who were not adherent to their oral diabetes drugs had 1.3 times higher medical costs compared to those who were adherent,” the brief continued. “Non-adherent diabetes patients had 1.5 times higher ER visit costs and 1.6 times higher inpatient costs than adherent individuals.”
Patients are much more likely to remain adherent if they receive home delivery of their therapies and have access to 90 days’ worth of medication instead of being limited to 30-day supplies.
More than 75 percent of home-delivery patients reported adequate medication adherence, compared to just over half of individuals picking up their drugs at retail locations. The data shows similar patterns for those receiving three-month supplies compared to 30-day supplies.
“Only about half of individuals treated for diabetes using retail as the only channel to fill their medications were adherent to oral diabetes drugs,” the report states.
Source: Express Scripts
Home delivery and longer-term supplies may be particularly effective for the growing number of older adults using diabetes medications, as patients over the age of 65 account for the largest proportion of diabetes patients in the country.
This group of patients was most likely to be adherent to their regimens, the study found, with nearly 75 percent of older adults staying on track with their diabetes therapies.
Perhaps somewhat counterintuitively, patients with more complex drug regimens, including those with more than 6 non-diabetes prescriptions, were more likely than others to remain adherent to their diabetes treatments.
Source: Express Scripts
These findings are consistent with results from our previous studies, which showed that the proportion of individuals adherent to their medications is higher among people who have diabetes, hypertension and high cholesterol, as opposed to people who have only one of these three chronic conditions,” the report notes.
Patients with multiple chronic conditions may be more aware of how their diabetes impacts their overall health, providing more of an immediate incentive to keep their blood sugar under control, or may be more skilled at managing a complex medication routine.
They may also receive more consistent attention from care coordinators, pharmacists, or population health managers – a key aspect of encouraging sustained medication adherence.
Pharmacists can become important partners in the effort to improve adherence, said ProMedica Pharmacy diabetes coach Chuck Riepenhoff, RPh, CDE.
One-on-one medication therapy management (MTM) planning can help diabetic patients understand the importance of their medications and how remaining adherent can benefit their health.
“The value of a community pharmacist is no doubt filling the prescription and making sure the prescription we’re filling is the right med at the right dose, and that there are no negative potential drug interactions,” he said to PatientEngagementHIT.com in 2016. “But we are also able to give that patient some very valuable information to take home with them about their medication.”
“Instead of only being able to spend 45 or 60 seconds with the patient talking about the basic things, in these MTM programs we’re sitting there talking to that patient for 45 to 60 minutes. When you spend that much time talking to the patient, you’re finding out a lot more details, some very valuable information.”
Medication synchronization, which allows patients to pick up all of their medications during one visit to the pharmacy, could also be a valuable – and cost-effective – strategy for upping adherence rates, especially for complex individuals.
“It takes the burden of ordering and organizing the medication away from the patient,” explained Riepenhoff.
An unrelated study from Humana and the University of Pennsylvania found that synchronized pick-up helped to improve adherence between 9 and 13 percent for individuals struggling with their regimens.
Even for patients who already demonstrated acceptable adherence rates, synching pick-up dates helped to improve their ability to follow instructions by up to 5 percent.
In 2013, Express Scripts itself revealed that 30 percent of patients failed to take their medications as prescribed due to late refills and late renewals, lending more credence to the idea that altering pick-up strategies at the pharmacy could produce significant improvements in adherence rates.
Along with patient lifestyle changes and enhanced preventive care, these low-cost, high-impact techniques could help to further reduce unnecessary spending for payers and utilization rates for healthcare services while improving overall outcomes patients.