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It’s time for stakeholders to cooperate in order to limit the wasted spending on prescription medications and chart a path to collectively improving value derivation.
Adherence in real-world conditions, streamlining prior authorizations and securing stakeholder buy in on the price/value curve can reign in drug spending no matter who becomes president. Here are three ways to help reign in drug costs.
1. Focus on adherence in real-world conditions. Earlier this year, Curant Health released early results of our C The Cure program for a cohort of hepatitis C patients co-infected with HIV. The study showed that 90% of patients co-infected with hepatitis C virus (HCV) and HIV who enrolled in Curant Health’s C The Cure program experienced sustained virological response at 12 weeks (SVR12) post treatment. This is the only second real-world data set known for HCV patients with this profile and treatment regimen. The patient cohort included HCV patients who were both treatment experienced and treatment naïve. Participants were predominantly infected with HCV genotype 1 and most had followed treatment regimens, such as Harvoni or Sovaldi.
“It’s one thing to achieve high cure rates in tightly controlled clinical trials, but achieving high cure rates in real-world conditions for co-infected patients who have difficulty accessing therapies is something else entirely,” says Vickie Andros, PharmD, director of clinical services for Curant Health. “The ability to overcome challenges related to access and helping patients maintain outstanding adherence to their medication regimens allow us to achieve positive outcomes like these.”
According to IMS Health Informatics, medication nonadherence remains the longest lever available to impact more than $200 billion in wasted healthcare spending.
Next: Streamline the process
2.Streamline the prior authorization process (or until that happens, enlist the clinical pharmacist and their teams). Prior authorizations are here to stay and they are becoming cumbersome to the point that clinicians are having to choose between additional administrative burden or treatment of additional patients. Do your prior authorization forms include more than what is essential for completion and evaluation? Are the most important fields or data points made abundantly clear to the clinicians or administrators who will be completing and evaluating them? They should be.
With physicians spending as little time as seven minutes per patient interaction, including just one minute on prescription education and the importance of adherence, who is going to provide the information patients desperately need to ensure outstanding adherence to prescription medications? In our model, this burden falls to a team of clinical pharmacists and patient care coordinators, not the prescriber’s over-burdened team.
3.Get ahead of the curve, especially as cancer trends toward a chronic condition. We have been discussing the needs and pathways for improved alignment among all members of the continuum, especially payers (including PBMs), providers, manufacturers and patients for years. While new cures for hepatitis C haven’t bankrupted the U.S. healthcare system, there are currently 3,400 immunotherapy trials currently ongoing in the United States. Cancer patients, and there are more than 14 million of them in the United States, are living longer and ultra-high cost immunotherapeutics for multiple oncologic conditions are entering the market.
Payers, providers and manufacturers should be sitting around the table right now discussing how the entire continuum, patients included, is going to survive the coming flood of $1 million per patient per year therapies. Pricing needs to be part of the discussion among all parties before new specialty medications enter the market.
As I wrote for Managed Healthcare Executive last December, “Biopharmaceutical manufacturers and payers are beginning to realize that their interests, while appearing divergent, are best served when working together. Manufacturers need to keep prices high to recoup investments in R&D, maintain shareholder value and invest in the next breakthrough therapies. Payers need to keep costs low for their plan sponsors.
“In the new world of value-based care, these interests, as demonstrated by the at-risk landscape... payers and manufacturers would do well to work on pricing and access in advance of new therapies coming to market. We are a long way off from real alignment, but as the drumbeat of new legislation on drug pricing grows louder, the traditional adversaries are dipping their toes into the unfamiliar waters of cooperation.”
It might not be time to take a dive off of the high board into the deep end of the pool, but it is time for all parties to wade deeper into the waters of cooperation in order to limit the wasted spending on prescription medications and chart a path to collectively improving value derivation.
Marc O’Connor is chief operating officer for Curant Health. Curant Health provides medication management, patient support and pharmacy fulfillment services for patients nationwide.