Addressing Cost Barriers to Medication Adherence

Formulary design is important in reducing copays and improving medication adherence, says Sam Peasah, PhD, MBA, RPh, director for the Center of High-Value Health Care at the University of Pittsburgh Medical Center (UPMC).

This transcript was lightly edited; captions were auto-generated.

Transcript

How do the long-term health care cost savings from high adherence compare with the short-term financial burden on patients and payers?

A lot of generic medications, people are adherent to it, mainly because of the cost; it's cheaper. Some are $2, some are $5 , so the patients are able to buy them and then they stay on it. The problem has always been with high-cost medications. Those where the copays are maybe $40, some of them are $100, or if you don't have an insurance, then it's going to cost you a lot more to adhere to some of those medications.

In the short-term, if I don't value what a drug would do for me, then I'm not ready to invest into it, or if I feel like taking it maybe 40% or 60% of the time, I will achieve the same goal, then I'm not going to do it. In the short term, if you invest into some of these expensive products, the hope is that long-term, it’s going to benefit you. It's going to keep you out of the hospitals. It's going to keep you out of the ER. It’s going to overall improve your quality of life. That is the hope. For some prescriptions we've seen that. We've seen it especially in some of these newer medications that have come up. They are very expensive, so in the short-term, it's been a burden, but then in the long-term, some of them have yielded benefits where you're not getting all those negative consequences of some of the things that used to happen in the past. But the problem is, some medications are so expensive that we've not seen the long-term impact of being adherent. In our study in the GLP-1s [glucagon-like peptide-1s] and then the SGLTs [sodium-glucose cotransporters], we saw that on the in the long-term, they were beneficial, but it's not been sold for every product. Some have and some have not yielded that.

What role do factors like formulary design, copay assistance programs, and value-based insurance design play in improving adherence to these medications?

Yes, so we mentioned earlier that several programs have been put in place through health, and formulary design is one of those. If the copays are higher, we know that some people are likely to skip it. If you have a formulary design where you drop the cost of copays, it helps. I've seen programs, even UPMC, where they've done a zero copay on essential medications like diabetic medications as a formulary design. The goal is that, because these medications are essential for your overall health, let's take the cost out of it. Once they drop the cost, adherence obviously improves for these patients.

There have been cases like this. There's something called like the Sempre [Sempre Health] program, [where] most of the manufacturers have worked with payers to help at the point-of-sale, when patients decide to fill their prescriptions on time, they give them a discount on their copays. One, they are reminded to get their medications, and then, if they follow through, they still get to pay less at a point-of-sale. Those are some programs that have been put in place to improve adherence.

We did a study on that, where we compared those who had enrolled into the program with those who had not enrolled, and we saw that adherence had really improved a lot in these patients. There are several designs that are out there to help. You know about this [from] insulin where they copied [it]. All those ones are designed to help. Formulary changes and some of those programs out there are designed to help improve adherence, and we've seen it work when those things are done. So, I'll say, “yes,” if the barrier is cost, then obviously reducing costs in different ways, this is the way to go.