CHICAGO – Medication nonadherence costs the U.S. health care system between $100 billion and $300 billion in avoidable health care costs annually, representing 3 percent to 10 percent of total U.S. health care costs.1 In an effort to help improve medication adherence rates with its Medicare and dual-eligible (Medicare/Medicaid) members, Health Care Service Corporation (HCSC), the nation's largest customer-owned health insurer, launched the multi-phase Pharmacists Adding Value & Expertise (PAVE) program in collaboration with Jewel-Osco, Safeway and Albertsons Pharmacies in Illinois, Montana and New Mexico and the Texas Pharmacy Association.
PAVE is a first-of-its-kind program that engages members and pharmacists in a clinical intervention program to address the various causes for nonadherence. In the first six months of the program, medication adherence rates have climbed more than 18 percent as measured by proportion of days covered, a metric commonly used to measure medication adherence.
"Through the PAVE program, we have demonstrated that there is no 'one size fits all' approach to medication adherence and that focusing on one-to-one member interactions is an ideal way to help build trust while boosting the member's engagement in their care," said Jay Gandhi, PharmD, divisional vice president, Enterprise Pharmacy, HCSC. "When members are engaged in conversations concerning their health with providers they trust, they are more open to having an honest dialogue about their individualized clinical, financial, physical, social and cultural barriers that they may be experiencing as it relates to medication adherence. Community pharmacists have the respect, understanding and trust of our members and we want to preserve and empower that member-pharmacist bond."
By leveraging its proprietary claims data, HCSC identifies members who have not been adhering to the medication regime prescribed by their doctors and enlists community pharmacists to engage with our members and discuss their treatments. Some common solutions included setting up reminders on members' phones to take medications at a certain time, distributing pill boxes to help members organize medications or contacting the member's doctor to address more clinical and complex issues.
"Patients' adherence to their medications is critical to managing their health and well-being. Our pharmacists are acutely aware of this and welcomed the opportunity to partner with Blue Cross and Blue Shield to improve their members' medication adherence," said Mark Panzer, senior vice president of pharmacy health and wellness, Albertsons Companies. "We are working as a team to optimize treatment outcomes and maintain better health for HCSC members, our valuable customers."
"I applaud HCSC's efforts to develop new programs such as PAVE that will clearly help improve their member's health," said Kim Roberson, division director-pharmacy practice, Texas Pharmacy Association. "We were pleased to collaborate with them during development and will continue to support these and similar efforts."
Pharmacists Adding Value & Expertise (PAVE) was launched in early 2016 to more than 5,000 members who filled prescriptions at more than 200 participating Jewel-Osco, Safeway and Albertsons pharmacies in Illinois, Montana and New Mexico with a focus on adherence to diabetes, hypertension and cholesterol medication. Due to the program's success, the company will significantly expand the program over the year to include HEB stores in Texas and members in Oklahoma. The program will also target interventions that go beyond medication adherence to include activities to limit inappropriate use of certain high risk medications in members over 65 years of age like some sleep medicines, estrogen therapy and some types of antidepressants; drug utilization reviews and appropriate use of specialty medications and pharmaceuticals.
About Health Care Service Corporation
Health Care Service Corporation is the country's largest customer-owned health insurer and fourth largest health insurer overall, with more than 15 million members in its Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross and Blue Shield Association. HCSC has a rating of A+ (Strong) from Standard and Poor's, A1 (Good) from Moody's and A (Excellent) from A.M. Best Company. For more information, please visit HCSC.com, visit our Facebook page or follow us at twitter.com/HCSC.
1 Iuga, Aurel O and McGuire, Maura J (Feb. 20, 2014) Adherence and health care costs. Risk Management and Healthcare Policy. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/#