3 Strategies for Payers to Improve Member Medication Adherence

Ensuring members’ medication adherence is a step toward decreasing payers’ overall costs and improving patient outcomes.

But medication adherence is highly personal territory that can be impacted by a number of uncontrollable factors, such as financial hardship.

Value-based care invites payers into a much closer relationship with their members, one that looks after not just their physical condition but the social determinants of health that can affect something as simple as refilling a prescription.

With this member-centric perspective, payers can innovate new ways to move members toward higher medication adherence by recognizing their individual challenges such as cost, confusion or forgetfulness, and providers’ lack of information.

Diminished copays

Cost continues to be a major barrier to medication adherence. In an attempt to diminish members’ out-of-pocket spending, some payers have started zeroing out copays.

Blue Cross and Blue Shield of Minnesota (Blue Cross) took a monumental step in August 2019 when it announced its intent to eliminate the copay for insulin.

Insulin prices have been climbing for over a decade, leading many members with diabetes to halve, skip, or forego their treatment. Blue Cross knew that skipping an insulin medication can have serious health consequences for members with diabetes, prompting it to test a $0 and how it will help ensure that members do not have to take extreme measures.

Other plans, such as Alignment Health Plan, are following suit. Some of the Alignment plans offer around 500 generic drugs with no copay.

Eliminating the financial disincentive by eliminating the financial barrier may seem like a simple fix, but the solution is not foolproof.

In January 2019, academic, medical, and pharmaceutical researchers from across the US collaborated to test whether a $0 copay would improve medication adherence and prevent negative patient outcomes for patients with a cardiovascular disease known as myocardial infarction.

The study offered a set of patients with myocardial infarction with a voucher to cover 100 percent of their prescription out-of-pocket costs. Seventeen percent said that they had not filled a prescription in the previous year due to financial difficulties.

The patients who were offered the voucher had a 3.3 percent higher medication adherence rate than those in the control group, although their adverse event outcomes were no different.

The study concluded that the voucher was helpful but would not decisively end poor medication adherence habits or outcomes.

“These results suggest that multifactor interventions are likely needed to achieve population-level health benefits,” the researchers wrote. “Co-payment reductions may be considered part of broader-scale strategies to incentivize risk-based treatment selection and promote adherence to guideline-recommended therapies.”

Mobile messaging

Members may also forget to refill their prescriptions, procrastinate their trip to the pharmacy, or experience confusion about their medication requirements.

Many payers engage and educate members by calling or sending a letter to the member or provider to remind them about the member’s prescription refill. However, these methods typically prove ineffective and leave payers wondering how to successfully remind their members about their refills.

Mobile messaging is a potential alternative that has had mixed results.

Digital reminders reach the member immediately, experts note, potentially preventing members from forgetting or procrastinating their refill.

Having the message on their mobile device means that the member can reference the message whenever they need to, wherever they are. It may also feel more personal, as text is more closely associated with correspondence from an acquaintance than a letter or phone call.

However, with the number of messages, alerts, and sheer volume of information that members receive via text or mobile device each day may lead to alert fatigue. Members may avoid opening the message or it may get lost in the mix of digital messages as members prioritize it lower than personal texts.

To combat this issue, payers may consider combining their messages with a reward.

Blue Cross Blue Shield Arizona (BCBSAZ) started a mobile messaging program in August 2019 that uses text messaging to connect with members immediately and guide them toward better medication adherence.

Taking note of the alert fatigue members experienced in similar programs, BCBSAZ paired the reminders with a discount. Members can receive up to $45 or $50 off their copay. This financial reward should not only incentivize members to open and read the messages, but also to follow through and refill their prescription.

Real-time prescription information

Before the member ever receives the prescription or completes a refill, their conversation with the prescriber can impact whether the member pursues medication adherence. Payers play an integral role in this by providing clinicians with the information and technology necessary to discuss patient barriers to medication adherence.

Real-time EHR tools can decrease members’ out-of-pocket costs by informing the prescriber of potential lower cost, compatible, alternative drugs. It also accounts for social determinants of health such as difficulty accessing transportation by telling the physician if home delivery or pickup at a retail pharmacy could be an option.

Cigna’s Surescripts real-time prescription benefit and Humana’s real-time benefits check, IntelligentRx, both implemented in 2019, helped these major payers enable value-based care and medication adherence.

In a value-based care environment, payers are strategically positioned to guide members to better medication adherence. As solutions evolve and develop, eliminating copays, providing digital reminders, and supporting prescribers’ decision making with sufficient information can lead to lower costs and better outcomes for both the member and the payer.