Address Rx Affordability and SDoH through Provider-Pharma Partnerships
OptimizeRx Guest Contributor OptimizeRx Corporation
The healthcare industry has long recognized the role of social determinants of health (SDoH) as a vital piece of the healthcare puzzle. Defined as the conditions in which people are born, grow, live, work, and age, SDoH encompasses factors that impact care such as early childhood development, housing, transportation, employment, income and social support.
In recent years, the need to address SDoH has emerged as a healthcare priority among stakeholders seeking to control costs and improve clinical outcomes. And for good reason—the potential return on investment is notable. For instance, SDoH is connected to $1.7 trillion in healthcare spending for a mere 5 percent of patients.
Medication affordability and assistance is a big part of the SDoH equation—one that can potentially change the outcomes paradigm for many chronic diseases. A 2016 study by the Physicians Foundation reported that 25 percent of American adults have failed to comply with prescribed medical treatment because of cost. Specifically, 18 percent have skipped medication doses, while 27 percent have avoided filling a prescription. In the same study, the cost of prescription drugs was most often cited as the driver behind rising healthcare costs.
One way that providers can improve medication affordability for patients now is through better collaboration with pharmaceutical manufacturers. While research shows that coupons and vouchers help providers improve follow-through with drug therapies, many are simply unaware of available savings. As a result, billions are left on the table annually that could improve medication affordability for patients. When drug savings information and education materials are embedded directly into physician EHR point-of-care workflows, a substantial opportunity exists to address SDoH for improved outcomes.
A circular relationship exists between cost and medication non-adherence. When cost deters patients from accurately using prescribed medications, outcomes suffer, which often results in the need for additional medical services and more costly drug therapies. This, in turn, leads to more medication non-adherence, and the cycle begins again.
A 2014 study of adherence and healthcare costs reported that non-adherence results in as much as $528 billion worth of avoidable healthcare costs annually. Industry stakeholders agree that improving adherence would influence outcomes and save billions in unnecessary spending. Another study of SDoH in patients with diabetes reported that adults with perceived financial stress or financial insecurity posed a greater risk of cost-related nonadherence than those with no struggles meeting their own basic needs.
As the healthcare industry continues to embrace value-based care, outcomes play a significant role in the financial equation. In a system that ties reimbursements to quality of care, efficiency and effectiveness, providers must embrace strategies that improve their patients’ overall health outlook. To that end, access to drug savings information and educational resources that improve the outlook on medication adherence are important tools as providers try to more effectively address SDoH.
The increased use of EHRs and e-prescribing empowers providers to share drug savings information with their patients at the point of care. Pharmaceutical companies can leverage point-of-prescribe networks that communicate drug cost information directly into the EHR, allowing physicians to search drugs by name and immediately compare prices. Doctors can then access drug prices and discount vouchers in real-time, saving consumers money and increasing the likelihood of drug adherence.
Digital point-of-care communication engages providers where they already spend their time. Since the EHR is the biggest part of physician workflow, communication provides immediate access to important information about pricing and drug discounts, allowing doctors to consider the patient expense in their selection of medications.
As the U.S. government pushes to reduce the price of prescription drugs, manufacturers that effectively communicate cost savings to providers stand poised to become the drug of choice for those physicians. Long-term, the effort to help patients stretch their healthcare dollars and improve their outcomes will benefit both patients and providers.
A 2019 survey reported that 91 percent of physicians believe they play a role in addressing costs with their patients. Additionally, about 40 percent of patients address prescription drug costs in interactions with their doctors. Pharma-physician partnerships have the potential to strengthen the individual brand of each stakeholder and close the care gap. In a complicated system plagued by siloes, patients will benefit from healthcare advocates who guide them through the process.
Numerous studies have demonstrated the difficulty of identifying SDoH in clinical visits, so the need for solutions continues. Communication is an important step, allowing physicians to identify issues like medication affordability and then point patients to solutions. Collaborations between pharmaceutical companies and healthcare providers can help patients manage costs. As physicians seek mechanisms to reduce out-of-pocket expenses, tools like co-pay coupons can reduce the sticker shock associated with medications, increase medication persistence and improve adherence. While cost isn’t the only obstacle to medication adherence and improved outcomes, it’s arguably one of the most important.
Miriam Paramore is a seasoned executive with 30+ years of experience in healthcare and deep expertise in health information technology. As president and chief strategy officer, Miriam keeps a keen eye on the industry’s pulse to make sure OptimizeRx remains an industry leader with an optimal mix of technology and solution enhancements to support the company's continued growth.