INTELLIGENCE IN ACTION

A Playbook for Success in Medication Affordability & Adherence

“We used to have no idea what a medication cost,” said Dr. Mike Jordan of East Lake Pediatrics in Palm Harbor, Florida. “But part of practicing medicine is making sure everyone is on the same page.”

This MGMA podcast episode features Dr. Michael Blackman of Greenway Health, Dr. Jordan of East Lake Pediatrics, and Nicholas Chambers of Surescripts.

With host Daniel Williams of the Medical Group Management Association (MGMA), Blackman, Jordan and Chambers define “success” for medical practices that use real-time insights to improve medication adherence and boost patient safety.

Listen Now: How Medical Practices Improve Medication Adherence and Patient Safety

Success is Finding What You Don’t Know

“It’s what you don’t know,” replies Blackman when asked about removing barriers to medication adherence, which can easily become spotty adherence—or cause the patient to abandon the prescription altogether—if the barriers aren’t removed.

Is the medication on formulary? Does it require prior authorization? What does it cost?

Blackman is the chief medical officer of Greenway Health, a technology firm that provides EHR and practice management solutions. And Blackman is all too aware of the barriers. If the medication isn’t on formulary, it isn’t covered. If the medication requires prior authorization, it takes time and energy to fill out paperwork and make phone calls. And if the medication is simply too expensive, the patient won’t pick it up at the pharmacy.

It was cross your fingers and make a wish, says Chambers of the time before health IT solutions like Real-Time Prescription Benefit came to the market. “The prescriber hoped the medication would just get dispensed at the pharmacy, no problem, and the patient wouldn’t face sticker shock or have prior authorization delays.”

Those days are over.

There is an electronic universe of information available on a patient’s health, their medication history, and their benefit plan—in short, the kind of information the provider needs to initiate a meaningful conversation with the patient, and ultimately prescribe a medication the patient can afford and adhere to.

Success is Having a Meaningful Patient Conversation

“If we take the time to prescribe a medication for a patient,” Blackman says, “we’re doing it for a reason.” The reason is patient care, first and foremost. This starts with what Blackman characterizes as “the most appropriate thing medically.” But the patient may not inform their provider that “the most appropriate thing” is unaffordable.

Blackman says that if we write a prescription and the patient can’t pay for it, they won’t take it, so it’s up to the provider to find an alternative. So, having the cost conversation is important—to make it known that it’s acceptable to discuss costs during the patient visit. And it’s acceptable to discuss costs, in large part, because of accurate information and real-time insights.

As Chambers explains, accurate information helps initiate meaningful conversations because providers get patient-specific cost and benefit plan data straight from the source of truth—pharmacy benefit managers—for a more informed decision on the front end, saving time and rework on the back end.

Success is where you discover that the patient can’t afford what’s originally been chosen, Blackman explains, and then you find an appropriate, lesser cost alternative, or come to find that the medication would cost a fraction of the price through a different pharmacy.

“All these little bits make a difference,” Blackman says.

Success is Improving Medication Adherence

“Real-time information is the best way to an efficient business,” Jordan says, “so we don’t get callbacks from the patient to the office, or even worse, we get no callbacks at all, because the patient isn’t taking the medication.”

Will the medication apply to the patient’s deductible? Will it conflict with other prescriptions based on the patient’s medication history? Has the patient been non-adherent in the past?

Having the data ahead of time to answer these questions and front-load any concerns during the patient visit—not after—is part of practicing medicine today, according to Jordan. It’s about making sure everyone is on the same page, working from the same playbook.

“Don’t feel like you can’t call us if it’s not working,” Jordan says, with the underlying message: We’ll find a way to make it work—and it might be as simple as switching to a different pharmacy or channel.

Patient-specific benefit and cost information, along with prior authorization alerts, make it simpler to prescribe a medication the patient can afford and adhere to. Today, more than half of all U.S. prescribers are using tools that offer this information in their EHRs.

Read more about medication affordability and adherence on Intelligence in Action.

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