By Leslie Small
At the annual Medicaid Health Plans of America conference,
Express Scripts Holding Co. Senior Vice President and Chief Medical Officer
Steve Miller, M.D., had a simple message for health plan leaders: "You
have to think long term if you're going to have better outcomes."
One area in which Medicaid is not heeding that call, Miller
said, is how it approaches treating and preventing HIV.
While the number of HIV patients is decreasing, the amount spent
on treating HIV has risen in recent years — and the culprit is rising drug costs,
Miller said. Thus, Medicaid programs and plans are often choosing to cover the
least expensive medications, which tend to be multi-tablet regimens, rather
than pricier single-tablet therapies, he said.
While that approach may cost less in the near term, patients
treated this way are less likely to be adherent to their treatment plans than
those who get a single-tablet therapy.
According to Miller, that link between medication adherence and
simplified treatment regimens is key, as medication non-adherence can lead to
complications that ultimately make patients more expensive to treat.
Commercial health plans, which have less of an issue with
finances than Medicaid, almost always choose single-tablet regimens for
patients, according to Miller. Medicaid beneficiaries with HIV, on the other
hand, are getting single-tablet regimens less than 60% of the time.
"So the reality is we're sub-optimizing that care, and
therefore we're actually going to cost ourselves a lot more in the long
run," he added.
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