Reprinted from DRUG BENEFIT NEWS, biweekly news and proven
cost management strategies for health plans, PBMs, pharma companies and
employers.
By Diana
Manos, Senior Reporter
September 8, 2017 Volume 18 Issue 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.
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.
https://aishealth.com/archive/ndbn090817-04?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=117569300
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