Featured Health Business Daily Story, Jan. 6, 2017

HCSC Enlists Pharmacists to Boost Medicare Adherence Levels

Reprinted from DRUG BENEFIT NEWS, biweekly news and proven cost management strategies for health plans, PBMs, pharma companies and employers. Sign up for an $86 two-month trial subscription today.

By Angela Maas, Managing Editor
December 23, 2016Volume 17Issue 24

Health Care Service Corp. (HCSC) is enlisting pharmacists at four supermarket chains in five states to help improve medication adherence rates in its Medicare Advantage, Part D and dual-eligible populations with diabetes, hypertension and high cholesterol.

The Pharmacists Adding Value & Expertise (PAVE) program, which provides health plan data to the pharmacists on prescription refill rates but does not reimburse them for their intervention, has improved medication adherence rates by 18% in its first six months, the health plan says.

HCSC launched the initiative in early 2016, targeting more than 5,000 members who filled prescriptions at more than 200 participating Jewel-Osco, Safeway and Albertsons pharmacies in Illinois, Montana and New Mexico. Due to the success of the pilot, HCSC now is expanding the program to include H-E-B stores in Texas and members in Oklahoma.

“This creates a win-win relationship with the pharmacist — we’re providing them with data that allows them to augment their relationship with the patient,” says Jay Gandhi, Pharm.D., divisional vice president for enterprise pharmacy at HCSC. “This promotes member engagement — we wanted to create a program that allowed members to be comfortable with discussing their disease and condition with someone they trust, in the community they’re in.”

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HCSC uses its proprietary claims data to identify members with diabetes, hypertension and high cholesterol who have not been adhering to the medication regimen prescribed by their physicians. Gandhi says the plan used a “cut point” of 80% adherence and decided to target those who fall under that level.

“We provide the data to the pharmacist, and they engage with the member,” Gandhi says. Through this engagement, the pharmacists can help the members determine what strategies will work best to adhere to their medication regimens.

Data Exchange Is ‘Most Challenging’ Aspect

For example, pharmacists can help members set up reminders on their phones to take their medications, distribute pill boxes to help members organize their medications or contact a member’s physician to address more complex clinical issues such as side effects.

“The program was quite easy to do, although the data exchange side of it is always the most challenging,” says Gandhi. “The pharmacists have been very willing and capable of doing this, and the patients have been warm and welcoming of this.”

In its expansion, the program also will target interventions that go beyond medication adherence — it will focus on limiting the inappropriate use of certain high-risk medications in members older than age 65, including certain sleep medications, estrogen therapy and some types of antidepressants. In addition, the program will include drug utilization reviews and appropriate use of specialty medications.

“We all are aiming toward better health outcomes for our members,” Gandhi says. “As we looked at all our strategies, we came to discover a needed individualistic approach.” Members have diverse needs and lives, and no one medication adherence program will suit everyone as a one-size-fits-all solution. “We just couldn’t do a pill box for everybody.”

Pharmacists Are Clinical Extension of Plan

Instead, the health plan decided to focus on a program that uses pharmacists as a clinical extension of the health plan, he says. This works by “preserving and empowering the member-pharmacist bond,” and also makes it possible for members to receive medication adherence counseling on their own schedules, whenever they pick up their prescriptions, he adds. “Pharmacies are open 24 hours a day for a reason.”

Members in the PAVE program aren’t targeted by other medication adherence initiatives, according to HCSC. For those not yet enrolled in the program, the health plan uses industry mainstays such as refill reminders and physician letters to improve adherence.

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