Generics, Adherence Programs Are Keys to Moderate Hypertension Spend

From Health Plan Weekly

Recent guidelines that lower the threshold for hypertension treatment likely will raise costs by increasing the number of people receiving treatment, yet the wide range of generic medications available likely will moderate cost increases.

In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) published a new set of guidelines and recommended starting treatment at 130/80 mm Hg rather than at the previous commonly accepted threshold of 140/90 mm Hg.

According to Mesfin Tegenu, R.Ph., president of PerformRx LLC, the ACC/AHA guidelines could raise treatment costs because they recommend new, lower targets for blood pressure and earlier classification for hypertension, expanding the need for therapy to a broader patient population.

With a wide variety of available hypertension drugs in generic form, it is rare for a brand name hypertension drug to be preferred on formulary. "In the instances where a brand name agent is desired which is not on formulary, the request could be reviewed through the prior authorization process," Tegenu says.

Compliance and adherence can be problems in caring for hypertensive patients, since hypertension is a largely silent condition and the medications have side effects that patients consider troublesome.

Combination products — which are readily available in this class — may be able to improve medication adherence by reducing the pill burden for the patient, says Beckie Fenrick, Pharm.D., senior partner of consulting at RemedyOne.

Meanwhile, plans and PBMs are addressing patient compliance with programs to improve medication adherence that "may include outreach by pharmacists to assist patients in overcoming reasons for non-adherence," Fenrick adds.

For instance, PerformRx uses automated reports based on pharmacy claims data to monitor compliance and targets non-compliant patients for drug therapy management by providing education about their medication, according to Tegenu.

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