Affordability Can Close the Adherence Gaps

This from a recent National Bureau of Economic Research study: a $10 increase in the out-of-pocket cost of chronic condition medications results in a 23% drop in consumption and a 33% increase in monthly mortality.

Ten more bucks. Adherence drops by nearly a quarter. Deaths go up by a third.

The study was based on patients covered by Medicare’s prescription drug program, but it points to the consequences of higher cost-sharing for any population.

Rx Savings Solutions exists to make medication more affordable for people and payers. However, we know the benefits extend beyond hard dollar costs. One is the impact on adherence. Anecdotal evidence from one sample client population suggests we can make a big difference.

That Burning Feeling

As someone who used to battle acid reflux, I can attest that missing even one dose could have put me in a world of hurt. Three weeks with no meds would’ve been unthinkable. But that’s how long a 52-year-old member went before he discovered us.

The guy was on a pricey prescription, $280.12 per 30-day fill. He’d been adherent every month for as far back as we have claims data. Then he stopped for 21 days. On the same day we notified him of a $2.57 therapeutic alternative, he contacted his doctor to request the switch (which we could’ve done for him) and had the lower-cost script the next day. Which could you stick with more easily?

A table showing the costs to fill an expensive GI medication and an affordable alternative

Poorly Timed Gap

Considering where we all were mentally, the early days of the COVID-19 pandemic reality were not a good time to stop treatment for depression or anxiety. Maybe this 65-year-old member was in financial straits—or expected to be soon. Whatever the case, he stopped taking his $100-per-fill antidepressant. For 28 days.

Medications in this class can take almost that long to start working, but symptoms can return much more quickly. Our notification email to this member arrived during that window. After requesting our suggested alternative and discussing with his doctor, he got back on track with $0 cost per fill (and only $1.66 for the client).

A table showing an expensive antidepressant and an affordable alternative

Two Types of Benefits

Adherence gaps aren’t good for any serious condition, but especially Type 2 diabetes. Extended periods of elevated blood sugar levels can lead to ER visits, lengthy hospital stays or worse. This member went 38 days without treatment after stopping Januvia¨ ($114 out of pocket).

We’d sent two notification emails a month apart for a lower-cost alternative. He acted on the second one, using our concierge service to get doctor approval for the switch. It dropped his out-of-pocket cost to $44 and saved his employer $210 per fill.

A table showing an expensive diabetes drug and an affordable alternative

Most importantly, he resumed treatment and avoided hospitalization. The average stay for a Type 2 diabetic is 7 days at a cost of $50,000-$70,000.

We can’t access every detail behind every adherence gap across nearly 9 million members. But we can draw correlations between claims data and the timing of member engagement and conversion. It’s clear that lives are saved and sustained when people have visibility into lower-cost medication options, as well as a simple way to switch.

Knowing the impact of just a $10 increase on consumption and mortality, we’d hate to see what a $70, $100 or $275 jump might mean. Thanks to Rx Savings Solutions, these three members won’t be part of those statistics.