Ask About Adherence: Q&A with Prescriptions for a Healthy America

Ask About Adherence is a blog series featuring Q&A’s with experts in medication adherence. In this post, we speak with Joel White, Prescriptions for a Healthy America president, on the landscape of potential solutions to non-adherence.

Stay tuned for the next Q&A and be sure to share your thoughts in the comments section below. We’d love to hear from you on ways to improve medication adherence!

SAMANTHA DOUGHERTY: What legislative and regulatory initiatives related to adherence can we expect Prescriptions for a Healthy America to tackle this year?

JOEL WHITE:  A growing body of evidence suggests that medication adherence programs have the potential to reduce health spending and, in the process, generate significant savings for taxpayers.  Policies to promote medication adherence have the potential to improve health and significantly reduce health spending. 

Because improving incentives for patients to adhere to their prescribed medications is strongly supported by Democrats and Republicans, we believe legislative and regulatory reforms are ripe for enactment. Prescriptions for a Healthy America is strategically working with several Congressional Committees and personal offices to advance the issues in Congress this year. We are also working with the Administration to change the rules that hold back adherence opportunities. Areas in which we see an opportunity to improve adherence include:

• Medication Therapy Management (MTM). Right now, the Medicare Part D MTM program targets 25 percent of Medicare Part D beneficiaries, but only 9 percent of those beneficiaries opt in to the program. Congress should refine the eligibility criteria for MTM. We need to ensure MTM targets patients who aren’t effectively managing their medications.
• Medication Synchronization. Medication synchronization allows patients to pick up all their medications at the same time each month, while involving pharmacists to contact the patient in advance of each fill to conduct medication reconciliation and to deliver additional medication management services if needed. Research shows that patients enrolled in medication synchronization were 3.4 to 6.1 times more adherent to their medications than patients not enrolled and that health plans can achieve between 4 to 5 stars on Medicare’s star rating quality program through medication synchronization alone.
• Comprehensive Medication Management (CMM). CMM would reimburse medication management services through Medicare’s outpatient benefit in coordination between providers, pharmacists and patients. After a care plan is developed, providers would coordinate and be reimbursed for medication therapy, coach the patient and make adjustments to ensure optimal clinical and cost outcomes.

Prescriptions for a Healthy America is also working with the Administration on various regulatory solutions that will further improve patient medication adherence. For example, we have met with and asked CMS to:

• Create a Safe Harbor to allow private entities to support medication adherence activities in the same way HHS already allows for health IT support.
• Improve data sharing across Medicare Parts A, B and D to provide critical insights about enrollees’ use and spending on medical services, risk for adverse health events, and transitions in care.
• Explore ways in which incentives could be provided to Part D plan sponsors that can demonstrate a link between successful MTM program interventions and corresponding reductions in hospitalizations, use of emergency rooms, or physician visits that lead to Medicare program savings.

DOUGHERTY: What can stakeholders do to advocate for legislation and regulation that would improve patient adherence?

WHITE: Aside from contacting your own Member of Congress, interested stakeholders should join Prescriptions for a Healthy America in our advocacy efforts. We have a robust strategy and are rolling out tactics to help shape the dialogue. We are excited about our legislative and regulatory agenda. In 2014 we spent a lot of time generating these ideas. In 2015 we will get to work enacting them.

Our unique ability to bring our diverse membership together during monthly meetings is a relatively easy way to vet policy ideas through various healthcare organizations. Our multi-stakeholder alliance represents patients, providers, pharmacies, pharmacists, pharmaceutical manufacturers, and employers. Once a medication adherence policy has been approved by Prescriptions for a Healthy America’s Steering Committee, we work together to develop an advocacy plan and tailor the plan for Congress or the Administration depending on the most likely method of adoption- legislative or regulatory.

They can also go to our web site to get more information on all these activities, www.adhereforhealth.org.

DOUGHERTY: What do you consider to be the most significant barrier to passing legislation and regulation that would move the needle on patient adherence?

WHITE: Right now, awareness.  I think most Members of Congress don’t know there are solutions that can both improve health outcomes and save money. It’s a classic win-win scenario. We need to do a better job educating Members and staff and the Administration about the potential, and we will. We need more activists to help spread the word.

View all Ask About Adherence posts.