We believe better health outcomes ultimately come down to three things: the information that patients and healthcare professionals can access, both groups' ability to communicate and cooperate, and the technology that facilitates this collaboration.
Systemic breakdowns, however, occur at each of the information, communication, and technology levels. Patients are left in the dark about the price of a drug until they try to fill it. And their physicians are left in the dark about what pharmacy benefits their patient qualifies for and whether a prior authorization is required for a drug they prescribe.
As a result, patient outcomes suffer, and lots of money gets wasted.
Case in point: According to Tomas Philipson at Forbes, the cost of nonadherence in the United States is estimated to be $290 billion, or 2.3 percent of GDP. Such a costly problem must be solved -- and the solution starts with aligning information and technology so that patients and care providers can work together toward better outcomes.
The barriers to patient adherence can be a complex mix, says Neil Chesanow at Medscape (registration required to access the article), and vary from patient to patient. However, a deeper look into nonadherence reveals that there is often a breakdown during the adherence process. The key components of the process are:
- Getting the right prescription from a doctor or healthcare provider.
- Filling the prescription, which Chesanow cites as a "seemingly simple act of which can be a major barrier to compliance."
- Being consistently on the medication for the first six months, when the risk for noncompliance is highest.
- Taking the medicine in question indefinitely for chronic conditions.
Chesanow also notes the common reasons for nonadherence. These include forgetfulness (24 percent), perceived side effects (up to 20 percent), cost issues (17 percent), and the belief that drugs would have little or no effect on their disease (14 percent). Looking at the above reasons, we can see that patient education is a key factor in improving medication adherence.
From a patient's perspective, let's explore some common complaints they may have about medication and treatment plans. We'll also examine how pharmacy APIs can lead to a better patient experience, and ultimately improve medication adherence and health outcomes.
"I Don't Know If My Prescription Will Be Covered By My Insurance."
According to Gallup, the uninsured rate in the United States in the third quarter of 2016 was 10.9%. This marked the lowest rate since Gallup began tracking it in 2008. A key factor in this was the Affordable Care Act (ACA).
While the ACA has generally made healthcare more accessible, the coverage offered in health plans varies widely. What's more, Caitlin Owens at Morning Consult notes, "affordability problems remain, most prominently in the area of prescription drugs." It is because the ACA "left the pharmaceutical industry largely unregulated while requiring it to pay for some of the law's increased drug coverage."
According to the Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation, drug spending has been rising and is projected to rise even further. The department estimates that drug spending in the United States in 2015 amounted to $457 billion.
Thus, it's no surprise that out-of-pocket costs for prescription drugs are one of the biggest concerns for patients. Many people do not know the ins and outs of their health plans, and even for a savvy individual it can be onerous to understand their formulary benefits (i.e. a tiered list of preferred generic and brand name drugs used by health practitioners to identify those most cost-effective).
A pharmacy formulary API like that offered by PokitDok can provide information to all entities within the healthcare system such as pharmacy benefit managers, employers, insurance companies and healthcare providers. A formulary API consolidates and provides access to key information such as:
- Total cost of the medication
- A patient's out-of-pocket costs, and how much the insurer will cover
- Pharmacy plan details, such as premium, coverage, deductible, etc.
Access to this information provides physicians with real-time, up-to-date details that empower them to offer better drug prescription advice to patients. Through a formulary API, both healthcare professionals and patients have a clearer picture of all the financial options which can be a big consideration when it comes to improving medication adherence.
"I'm Afraid The Medicine Will Be So Expensive."
Related to the first issue is the fear that medication costs will be too high. In a Wall Street Journal article on rising out-of-pocket costs (subscription required to access the article), Lynn Quincy reports that about a third of Americans report postponing needed care due to cost. One of the ways they postpone care is by not filling essential prescriptions.
Adding to the problem is that the price of prescription drugs in the United States is high. Lydia Ramsey at Business Insider cites the following reasons for the high price and why it will remain high:
- Drug patents inflate prices and prevent competition that can lead to lower prices.
- Laws prevent government agencies from negotiating drug prices with pharmaceutical companies, unlike in other countries where government agencies are able to set maximum prices.
- Generic drug alternatives aren't able to compete with branded drugs.
- Lack of comparative cost research between branded and generic drugs.
This creates an environment where there is no transparency and a lack of information for healthcare professionals or patients to make informed decisions about medication. Pharmacy APIs can make a difference here when they are integrated into existing healthcare IT systems.
Using a combination of applications such as a formulary API and a pharmacy plan API can yield the necessary information regarding drug options and costs on both the patient's and insurer's sides. Clearly delineating how much the patient will pay for his medicine empowers him to make better decisions regarding the short and long-term financial costs of medication adherence.
"It's So Difficult to Find an In-Network Pharmacy!"
A common reason behind medication nonadherence is the inconvenience of finding an in-network pharmacy. Following a physician's advice on medication can be a hassle, and the smallest roadblock can become an excuse not to do it.
An in-network pharmacy API is the solution. This API collates other important information such as the patient's health plan and formulary, and geolocates in-network pharmacies that are most conveniently located for the patient.
This saves time and effort for the patient, who would otherwise have to go through lists and manually find the nearest in-network pharmacies. Instead of long minutes of frustration, an in-network pharmacy API does the job in seconds. This API is also able to identify mail-order options for the patient, making it more convenient for them to refill their prescriptions when necessary.
An in-network pharmacy application can create a much more seamless patient experience, and makes it more likely that patients will follow through with their treatment plans.
"I'm Worried About Medication Errors."
The Patient Safety Network defines a medication error as "an error (of commission or omission) at any step along the pathway that begins when a clinician prescribes a medication and ends when the patient actually receives the medication." According to PS Net, half of adverse drug events are preventable.
Leah Binder at Forbes reports that medication errors affect "an estimated one million each year, contributing to 7,000 deaths." Medication errors are a legitimate concern for most patients, and Binder cites the slow adoption of technology by hospitals as one reason for such errors.
So, how can pharmacy APIs help reduce medication errors? These APIs can minimize system and medication gaps, which are two main causes for medication errors, according to the Joint Commission International. They do so by consolidating and updating information in real-time, which provides all entities with access to the same database for each patient.
The uniformity of information at all points of access ensures that any errors in prescribing medicine can be minimized. Healthcare professionals get an overview of the patient's medical history, can access medication history and thereby make better decisions when prescribing drugs to treat the patient.
From the patients' point of view, the knowledge that every healthcare professional they encounter has full knowledge of their history and situation instills a higher level trust in the healthcare system.
Additionally, electronic prescribing can lead to better patient adherence. According to Norra MacReady at Medscape (registration required to access the article), "the risk for primary nonadherence was 17 percentage points lower with e-prescriptions than that associated with paper prescriptions."
"I Feel Like I Don't Get Enough Information About My Prescription."
Here's a staggering statistic reported by Chesanow at Medscape: Some 3.8 billion prescriptions are written every year in the United States, yet more than 50 percent of them are taken incorrectly or not at all.
Medical writer and Doctor of Pharmacy Suzanne Albrecht agrees. She found that the rate of medication nonadherence is about 20-50 percent, and notes that lack of adherence has a high cost: an estimated $100 billion annually in the US.
Patient miseducation or even ignorance about their medication is a key factor contributing to medication nonadherence, according to Albrecht. Here's where healthcare professionals can have a positive impact. Darren Young at Mediware believes that taking the time to provide more thorough information and advice to patients is key to improving patient adherence. Teach them what they need to know to improve their health via proper use of their medicine.
Using pharmacy APIs can make this process easier, as the physician or pharmacist has all the pieces of the puzzle via a pharmacy plan application and a formulary application. At their fingertips, they have information such as:
- Which medication a patient is eligible for
- Drug information such as tier level, authorization, step requirements, quantity limits, etc.
- Estimated total cost and breakdown
When patients are empowered with information and understand their own roles in adhering to medical advice, they are more likely to comply. Pharmacy APIs have a role to play in improving communication and interaction between patients and healthcare professionals.