Even before the COVID-19 pandemic, medication nonadherence was a major problem in the United States. In fact, it has been estimated that nonadherence costs the US healthcare system $300 billion each year.1
However, the current public health crisis has exacerbated nonadherence, which is costly and dangerous. Although health and safety have become a priority for nearly every American, health plans and pharmacy benefit managers (PBMs) are facing unprecedented challenges in ensuring their members adhere to their treatment regimens.
A Unique Set of Challenges
The COVID-19 pandemic has created several barriers to treatment adherence, making it difficult for health plans and PBMs to find effective answers.
Understandably, many people have become cautious of leaving their homes out of fear of exposure to the coronavirus. Some communities are also enforcing strict protocols regarding when citizens are allowed to leave their homes, which, when compounded by long lines, limits what a consumer can accomplish while he or she is away from home. This could put members in the difficult position of having to prioritize what items they deem as essential for themselves or their families.
Some pharmacies have seen changes in store hours. Community pharmacies, which have been deemed essential during this health crisis, are seeing a strain on their staff and resources2 that may affect their ability to keep their doors open. These factors can create long wait times or force consumers to travel further to pick up their prescriptions, both of which could contribute to a member choosing to skip refilling a prescription rather than deal with a perceived hassle.
Throughout the pandemic, there have also been several drug shortages. In May 2020, 109 medications were on the US Food and Drug Administration drug shortage list.3 The causes of these shortages varied, such as medication stockpiling or disruptions to the supply chain. In addition, a number of existing medications were believed to be a prevention or cure for COVID-19. As a result of these claims, the demand for these drugs increased, impeding access for patients who rely on these agents to treat their chronic conditions. For example, when hydroxychloroquine was touted as a cure for the novel coronavirus, it flew off the shelves, leaving many patients with lupus without their medication.4
Perhaps one of the most overlooked factors influencing medication adherence, however, is the widespread disruption of consumers’ routines. When a person’s daily schedule is suddenly very different from what it has been for years, it can be easy for that individual to forget to take a medication.
Opportunity to Empower and Engage
Ensuring that plan members adhere to their treatment regimens amid a pandemic requires some creativity. It is also an opportunity for health plans and PBMs to engage 2 often-overlooked pieces of the healthcare puzzle: pharmacies and members.
Although there is no telling how long the COVID-19 pandemic will continue to disrupt our daily lives, nor is it possible to predict if or when the next pandemic will hit, there are still several steps that health plans and PBMs can take to ensure that their members are equipped to remain adherent to their medications.
1. Empower members. By offering 90-day supplies and home delivery options, health plans and PBMs can give members the tools they need to take control over their treatment, while limiting the number of trips they take to the pharmacy. These tools are also critical to ensuring that plan members have safe, consistent access to their medications.
2. Engage pharmacists. For many patients, pharmacists are the healthcare providers they see most often. This gives pharmacists incomparable access to patients, and more opportunities for interventions, but pharmacists need the proper visibility and tools to do so. Your organization should open the lines of communication and provide the information and resources that pharmacists need to make an impact.
3. Enable early intervention. Several indicators reveal to health plans and PBMs if a member is at risk for discontinuing his or her treatment. By establishing guidelines within your organization that encourage early intervention, plan members can receive the support they need before their health has been compromised.
4. Use advanced technology. Even the smallest tasks can be made more difficult while working virtually. So, as teams continue to work apart indefinitely, it has never been more important to have access to advanced technology. Features such as real-time claims data and pharmacy benefit messaging at the point of prescription can make a major impact in identifying and taking action for a member in need of intervention. Being able to access your portal from anywhere, at any time, cannot be underestimated in today’s uncertain climate.
Nothing about our current environment is “normal,” so responding with a “business as usual” approach won’t cut it. We need to take this time to create, innovate, and empower.
As the COVID-19 pandemic stretches on, “we’re all in this together” has become a rallying cry across the country. It remains true; we need to commit to supporting each other, even if that means pushing ourselves outside of our comfort zones and beyond the status quo. This pandemic is an opportunity for health plans and PBMs to deliver something great for our members who rely on us.
Author Disclosure Statement
Dr Gonzalez in an employee of Abarca Health, a Pharmacy Benefit Manager.
- Lagasse J. Patients who skip medications cost healthcare $300 billion annually. Healthcare Finance. May 14, 2018. www.healthcarefinancenews.com/news/patients-who-skip-medications-cost-healthcare-300-billion-annually. Accessed December 14, 2020.
- Hayden JC, Parkin R. The challenges of COVID-19 for community pharmacists and opportunities for the future. Ir J Psychol Med. 2020;37:198-203.
- Dyrda L. 109 drugs on the FDA shortage list. Becker’s ASC Review. May 5, 2020. www.beckersasc.com/supply-chain/109-drugs-on-the-fda-shortage-list.html. Accessed December 14, 2020.
- Joszt L. Patients with SLE experienced delayed access to hydroxychloroquine during COVID-19 pandemic. AJMC.com. July 8, 2020. www.ajmc.com/view/patients-with-sle-experienced-delayed-access-to-hydroxychloroquine-during-covid19-pandemic. Accessed December 14, 2020.