INTELLIGENCE IN ACTION

Affordable Medication and Adherence: Two Sides of the Same Coin

It’s not enough to treat the disease. For patients to afford and adhere to their medications—with chronic conditions financial pressure and healthcare consumerism on the rise—prescribers need in-workflow tools that enlarge the scope of patient conversations at the point of care.

In this MGMA podcast episode, Christopher Apostol, D.O. of Evans Medical Group, Donna Maddox of athenahealth, and Yousuf Ahmed of Surescripts discuss four key takeaways arising from the technological impact of patient-specific information delivered to the electronic health record (EHR) at the point of care—exactly when and where it’s needed most. Listen below.

Listen Now: Achieving Medication Adherence Through Meaningful Patient Cost Conversations

More Affordable Medications Mean More Adherent Patients

"Non-adherence is becoming an increasing problem. Patients come with uncontrolled conditions: hyperlipidemia, diabetes, hypertension. Using technology to ask different questions opens an opportunity for patients to be real with me."

– Christopher Apostol, D.O., Evans Medical Group

The exam room is a sacred space between provider and patient, where the proper focus is on the clinical efficacy of treatment, not prescription costs. Besides, the ability to see costs based on patient-specific benefit information, and initiate a conversation about affordability with the patient, only became available for prescribers in recent years.

These factors can make it more difficult to broach prescription costs with patients.

Our 2019 survey of 1,001 U.S. consumers shows that patients want to talk dollars with their doctors, but just 23% of patients said their doctor or nurse started the conversation. And it’s a missed opportunity: Innovative technology enhances provider-patient interaction for more informed care and a better patient experience, because the provider can select a more affordable (and clinically relevant) medication, and one the patient can adhere to when it comes time for a refill.

Having the cost conversation goes “beyond treating the disease,” as Apostol says. In the exam room, he asks, “Are there days that you miss taking your medication?” Or: “Have you been unable to timely fill your prescription?” These questions, made possible by the technology described below, probe whether the patient can afford treatment in the first place—which is key to adherence.

Nearly half of all U.S. prescribers used Real-Time Prescription Benefit last year to access medication pricing information. This saved patients an average of $36.68 per prescription in 2021, when prescribers used Real-Time Prescription Benefit to identify a less costly alternative. Open our 2021 National Progress Report to learn more.

Medication Adherence: A Non-Starter When the Drug is Unaffordable

"What Surescripts has done is create the largest network of direct electronic connections with the largest number of payers in the U.S., with drug pricing and medication alternatives sent directly to the EHR at a critical moment: the point of prescribing."

– Yousuf Ahmed, Product Innovation, Surescripts

Adherence and affordability are two sides of the same coin.

Even just a $10 copay increase raises the likelihood of prescription abandonment by 10%—and contributes to non-adherence, which causes one-third of adverse drug events resulting in hospital admissions.

In our survey of 300 primary care physicians about access to patient data, most said they wanted to see patient-specific benefit information at the point of care—before prescribing—and compare costs among similar medications. This ensures that patients can afford treatment before they go to the pharmacy to pay for it.

Surescripts empowers prescribers to confidently choose affordable medications and have cost conversations based on intelligence sent straight from the source: the patient's prescription benefit plan.

Mounting Financial Pressure Amid the COVID-19 Pandemic

"It's often a cost barrier. Having the information around the cost and availability of a medication—at the time of need—is what we’re giving to providers to share with their patients. It makes adhering to a medication realistic.”

– Donna Maddox, Executive Director, Product Management, athenahealth

Costs were an issue for patients even before the COVID-19 pandemic.

Our 2019 survey of 1,001 U.S. consumers suggests that their experience with their prescriptions affects the healthcare decisions they make. Nearly all patients (94%) who skipped a medication due to cost said they were willing to take a lower-cost alternative, had their doctor or nurse suggested it to them.

The pandemic only heightened the need for greater visibility into prescription costs at the point of care. In 2021, 19% of 300 surveyed patients said it had become harder over the past 18 months to afford their medications (and two-thirds of prescribers said prescription costs are one of the biggest issues in healthcare).

With access to accurate cost and coverage information and the power to efficiently handle—or avoid—prior authorizations through a single, trusted connection, prescribers are saving their patients millions of dollars each year. And they’re getting their patients to therapy sooner.

Centering the Patient Experience

"Physicians want technology to be an enabler: simple and easy to use, with clinical decision support. And the information must be accurate. Patient-specific information at the point of prescribing builds trust in the patient-provider relationship."

– Donna Maddox, Executive Director, Product Management, athenahealth

Consumerism is shaping many corners of healthcare.

Patients want convenient, connected and cost-effective care. Providers and technology companies are working to fill that need, and the availability of patient-specific cost information in the EHR points to a truly advanced prescribing experience that is helping to make medications more accessible and affordable.

“We know the technology works,” Maddox says, because athenahealth patients have had a cost savings of over $30 per prescription, which translates to several million dollars of total savings. “There’s a point of decision-making between the provider and patient when they switch to a lower cost—but still clinically relevant—medication.”

Not only does this save money and improve outcomes for patients, but it also gives time back to prescribers to deliver exceptional care.

“And that’s beautiful,” Maddox says.

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We make it simpler to optimize medication affordability and adherence by sharing prescription benefit intelligence throughout the care journey. And by delivering trusted insights, more prescribers are inspired to adopt and use the tools offered in their EHRs. Read more about medication affordability and adherence on Intelligence in Action.

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