September 9, 2015 – Curant President and CEO, Patrick Dunham, in Managed Healthcare Executive – In the midst of the shift from fee-for-service to value based healthcare, pharmaceutical manufacturers continue churning out high-priced therapies. They may be justified to do so as long as the outcomes of the medication therapies outweigh the costs. We define “value” as healthcare outcomes divided by costs. It is easy to understand the value of a $94,500 course of a $94,500 course of Harvoni to cure hepatitis C compared to a $577,000 liver transplant.

Newly approved therapies such as the PCSK9 inhibitors with their $1,000-per-month-for-life price tags cause the value equation to become more complicated for chronic care management. Aon Hewitt recently reported that it expects specialty drug costs to rise 23% next year largely driven by oncology and cholesterol therapies (PCSK9 inhibitors).

As the industry grapples with the next stage of value-based insurance design and chronic care management, payers should consider the following three items in their specialty therapy approval process.

  1. Minimum levels of patient engagement required to improve adherence levels.

Sending a patient out of the door with a prescription expecting them to self manage and be adherent to their therapy has proven ineffective. This practice is a primary cause of abysmally low medication adherence rates and $105 billion in wasted annual U.S. healthcare spending. During the JP Morgan Healthcare Conference earlier this year, one pharmaceutical manufacturer told my colleague that adherence to oral oncological therapies is 40%. In other words, 60% of patients dying from cancer are non-adherent to their treatments.

Medication possession rate (MPR) is one commonly accepted metric on adherence, but it only tells part of the story. The minimum required next step is: “You filled your prescription. Now let’s make sure you take your meds.”

Chronically ill patients, especially the sickest of the sick, need at least one dedicated care team member to provide frequent and sustained medication support and adherence counseling, in order for their multiple medications to work effectively and realize their full value.

It is not easy, but in real-world scenarios, it has proven effective in moving both components of the value equation in the right direction. In a cohort of HIV patients on highly active antiretroviral therapy (HAART), consistent patient outreach to ensure adherence, along with customized prescription packaging improved adherence by 28%. The result of which increased the number of patients whose viral loads are undetectable from 28% to 66% and whose overall healthcare costs decreased by $3,000 per patient per year.

To read Patrick’s full article, visit Managed Healthcare Executive.

To learn more about Curant Health, contact Kristin Lindsey, Marketing Director, at klindsey@curanthealth.com.