Featured Health Business Daily Story, Oct. 2, 2017

Express Scripts Study Reinforces Importance of Rx Adherence

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By Diana Manos, Senior Reporter
September 8, 2017Volume 18Issue 17

A new report on diabetes issued by Express Scripts Holding Co. confirms that medication adherence is the way to get the most bang for the buck on improving diabetic outcomes at lower costs.

The latest Express Scripts research shows that patients who follow their oral diabetes protocol saved more than $210 million in 2016 health care costs and avoided unnecessary emergency room (ER) visits and hospitalizations. But despite the progress being made in helping patients adhere to their diabetes regimens, Express Scripts researchers say there is still “substantial opportunity” to improve.

Authors of the Aug. 25 Express Scripts study, titled “Diabetes Dilemma: U.S. Trends in Diabetes Medication Use,” found that when health care organizations focus on preventing type 2 diabetes by promoting healthy sustainable lifestyles and improved medication adherence, patient outcomes improve. The study also found that forgetfulness and procrastination were “significant barriers” to medication adherence and good outcomes.

The study analyzed claims data on 26 million members covered by private insurers “to identify new opportunities to work with plans to deliver safer, more effective and more affordable diabetes treatment,” said Glen Stettin, M.D., chief innovation officer at Express Scripts, in an article introducing the report.

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Adherent Patients Save Money

Researchers found that “people who were adherent to their oral diabetes medications experienced 235 fewer ER visits and 50 fewer inpatient hospitalizations per 1000 patients, and they spent nearly $500 less on total healthcare costs compared to nonadherent patients, potentially avoiding more than $210 million in healthcare spending in 2016.”

In addition, ”people with diabetes who were nonadherent to their oral diabetes drugs had 1.3 times higher medical costs and 4% higher total healthcare costs compared to those who were adherent, spending an average of $11,176 vs. $10,683 in 2016.”

This is good news for health plans and plan sponsors, Stettin said, because it shows that despite the high cost of diabetes care, lifestyle changes and wise use of diabetes medications can help move the needle on “the costs and suffering associated with the disease.”

Some 11.6 million Americans insured under private health plans were on diabetes medications in 2016, the study found, with each diabetic patient costing their health plans $9,000 or more in medical expenses. This amounted to nearly three times higher spending than for patients without diabetes. The study also found that payers spent three times more on patients taking diabetes medications than on those being treated with non-diabetes medications. In addition, plans spent nearly six times more on patients taking insulin than for those using non-diabetes drugs.

The study found that 84.4% of diabetic patients used oral medications in 2016. Of these, more than 36% of them were taking two or more diabetes medications, with more than 3% taking four or more medications.

In addition, researchers showed that 11.4% of people treated for diabetes used both oral drugs and insulin together for treatment.

Yet despite all of the potential for improved health provided by available medications, only 63% of people more than 20 years old were adherent to their diabetes drug regimen in 2016, according to the study.

Other payers also are focusing on medication adherence to lower diabetes costs and improve outcomes. Courtney Jay, a spokesperson for EmblemHealth, the first insurer to receive full recognition from the Centers for Disease Control and Prevention for its diabetes prevention program, says Emblem addresses medication adherence in its diabetes self-management classes. “These classes are peer-led and encourage self-efficacy in the participants, which includes maintaining a relationship and good communication between the participant and their provider,” Jay says.

“Improving medication adherence requires building on a coordinated set of proven practices in the field and policy actions in both the public and private sectors,” according to the Network for Excellence in Health Innovation (NEHI). Diabetes patients who receive case management, including biweekly automated calls and self-care training by nurses, are 21% more adherent to their medications than those who receive usual care, NEHI says.

According to Stettin, Express Scripts Lab is partnering with more than 300 health plans to test new solutions and address important issues in diabetes care. One of those is a collaboration with Mango Health, whose mobile health platform is designed to help members achieve better diabetes outcomes (DBN 5/19/17, p. 1).

Last March, Mango and Express Scripts unveiled their partnership, which integrates Mango Health’s mobile applications with the Express Scripts platform and services for participating members. The Mango app offers a gamified approach that encourages positive behaviors that meaningfully improve outcomes for patients, according to Jason Oberfest, CEO at Mango Health. The app also offers support and advice from Express Scripts’ specialist pharmacists in more than 20 specialties, for diabetes patients and others.

“Our partnership with Mango, which includes additional, unique clinical features within the app, is bringing higher user engagement and user retention results,” says Jennifer Luddy, a spokesperson for Express Scripts. “These figures help drive clinical results such as improved health literacy and increased medication adherence.”

Mark Bini, vice president of product development at Express Scripts, says, “Our partnership is bringing higher user engagement and user retention results versus the base Mango Health app. Over the next few months we will be tracking the results of our clinical integrations from the standpoint of improved health literacy, increased medication adherence and overall patient outcomes.”

Another tactic for improving adherence is Express Scripts’ Diabetes Care Value Program, which provides payers with condition-specific cost management and a quality pharmacy network — supported by the Express Scripts Diabetes Therapeutic Resource Center (TRC). This program has boosted the average medication adherence rate for enrolled patients by 5%, according to Express Scripts.

Read the Express Script report at http://bit.ly/2vy1PNa.

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