For population health managers looking for a quick ROI, look no further than prescription drug costs and utilization. The avoidable cost potential in prescription drug management is sizable, and it consistently ranks as a top opportunity to reduce spending across all payer populations.
To help organizations capture this opportunity, we recently hosted a webconference that presented a multi-faceted approach to reduce spending associated with prescription drug utilization.
In case you missed it, here are three lessons for any organization looking to gain ROI through prescription drug management in their self-insured population and beyond.
Providers do not consistently use generic brands, but it’s a critical strategy for cost reduction
There are two distinct avenues to encouraging generic use—influencing providers to prescribe generics when available and incenting patients to fill generic prescriptions.
Providers with the highest performance have generic utilization rates of 85%, but there is a lot of variation among physicians. Executives must first identify, then partner with these physicians to see increases in generic utilization and decreases in costs.
Leveraging benefit design is another way to encourage generic brand use. While this lever is often limited for providers, the provider-as-payer dynamic for your self-insured population unlocks this tool. Full population health managers can structure benefit plans that steer patients to the lowest cost drug alternatives through tiered co-pays or step therapy. Benefit plans should also promote consistent use of drugs where medication adherence is imperative (e.g. beta blockers for heart failure patients) by removing cost barriers and waiving co-payments.
Increasing medication adherence can reduce the total cost of care
Patient activation is also critical to successful medication management. If we can get patients more involved in their care, they will be more likely to take their prescription drugs, resulting in improved quality and cost.
For example, getting a complex, non-adherent patient to start taking their medication on time would reduce their inpatient stays and ED visits—and these reductions have big dollar impacts. For patients with congestive heart failure, improved medication adherence reduces annual medical spending on average by $8,881.
The clinical pharmacist should have a prominent role on the care team—for targeted patients
Patients not meeting therapeutic goals should receive a more tailored approach to care by working with a relatively new member of the care team.
Organizations focused on discharge planning and readmission reductions often place pharmacists on inpatient transitional care teams, where they can review complete medication reconciliation, perform patient education, and provide follow-up care.
In the clinic setting, population health managers are increasingly instituting medication therapy management programs that enable pharmacists to provide one-on-one, ongoing care to complex patients and prescribe or discontinue medication use independent of a physician. These pharmacists work in collaboration with the patient and their broader care team to create and monitor patient’s individual care plans.
Not every patient needs to receive these comprehensive services, but the ones that do have one or several of these characteristics:
- Multiple chronic conditions
- Multiple medications (polypharmcy)
- Relationships with multiple providers (polyprovider)
- Frequent use of inpatient, ED settings
- Referred by care manager due to medication concerns
Triaging comprehensive services by a pharmacist to the highest risk patients is key to gain a financial ROI in prescription drug management.
For more on managing prescription drugs, listen to our on-demand webconference or read our research briefing, Primer on Avoidable Costs.