The backstory

The relationship between medication adherence and wasted healthcare spend is generally uncomplicated in nature; one component can negatively or positively impact the other. In reality, when medication adherence is improved, the amount in wasted healthcare spend long-term is lowered.

When news broke recently that $3 billion is wasted on cancer drugs every year due to the size of the vials in which they are sent to hospitals, it seems the coverage was rampant. Things have gotten so bad that number is a drop in the well. $3 billion equals only 1 – 3% of the money wasted every year due to medication nonadherence according to the Centers for Disease Control and Prevention (CDC): $100 – $289 billion.

A new method

We are pleased to learn that the Centers for Medicare and Medicaid Services (CMS) will be introducing the Enhanced MTM model test in January 2017. The purpose of this new model is to give stand alone, basic prescription drug plans in five Medicare Part D regions across the country the capability to fluctuate the intensity and types of MTM services. The expectation is that this wll result in more strategic and individualized patient care, as well as better patient outcomes.

The facts

We know that when MTM is done with clinical pharmacists at the helm, value-based levers will increase outcomes and reduce healthcare costs. This is apparent in our recent study that looked at the effects of highly active antiretroviral therapy (HAART) in HIV patients. Some of our findings:

  • Medication adherence increased 28% over baseline through enhanced medication therapy management
  • There was a 69% increase in patients who were at least 95% adherent to all medications; 95% represents the commonly applied definition of an acceptable level of adherence to HAART.
  • The percentage of patients whose viral loads were considered undetectable increased from 28% to 66% with medication therapy management.
  • The same patients’ overall healthcare costs decreased $3,000 per patient per year.

We understand that it may take CMS, the nation’s largest payor, to lead the charge on healthcare innovation; implementing this new Enhanced MTM model test is a step in the right direction. In the interim, we will continue to use our patient-centric services to improve medication adherence for the thousands of patients we serve on a daily basis.

Interested in learning more? Read Curant COO Marc O’Connor’s article on how medication adherence impacts the $3 billion wasted healthcare spend in MedCity News.

Want to continue the conversation on factors that impact medication spend? We’d love to hear from you! Send us an email.