Budget-friendly copays encourage adherence, especially with expensive disease states.
Taking the right medications when and how they’re prescribed can be life changing – as well as lifesaving – for patients with chronic conditions. Unfortunately, a substantial number of Americans sometimes struggle to afford their prescriptions, creating a barrier to proper utilization.
This was especially true last year, during the height of the pandemic, when nearly 70 percent of patients had to make personal or financial sacrifices to be able to afford prescribed medications. Almost 10 percent said they cut pills in half or skipped doses because of cost.
Two of the most challenging conditions for patients and plans to manage are diabetes and cardiovascular disease. In addition to being among the most expensive non-specialty conditions for plan sponsors, these disease states are intricately linked; Adults living with diabetes are at a significantly higher risk of dying from a heart attack or stroke.
Common problems, complex issues
About 10% of Americans have been diagnosed with diabetes, while approximately 30% of American adults have prediabetes, which places them at greater risk. Of Americans with diabetes, 36.6% are nonadherent, which leads to $210M in annual nonadherence-related health care costs. Adherence in this class is critical because compared to adherent patients, those who were nonadherent have 1.5 times higher ER visit costs, nearly twice as high inpatient costs and nearly $500 per person in higher total health care costs1,
Cardiovascular disease effects about 7% of American adults, including about 795,000 each year who suffer a stroke, which could be treated by anticoagulants. Anticoagulants, blood thinning medications, are a major staple in the treatment of atrial fibrillation, a quivering or irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications. The use of these medications can decrease this risk by 50%; however, only 16% of people with AFib are taking the recommended anticoagulants prior to a stroke.
In many cases, these conditions are related: Adults living with diabetes are at a significantly higher risk of dying from a heart attack or stroke.
A path to affordability and better health
When plan sponsors ensure low, predictable copays, patients are more likely to fill their prescriptions and take their medications as prescribed. For example, when plans enroll in Express Scripts PBM’s Patient Assurance program, their participating members are 30% less likely to abandon their insulin regimen after initial insulin fill.
This allows them to focus on their care without worrying about cost – which pays dividends for patients, who enjoy better health, and plan sponsors, who see fewer avoidable downstream medical costs.
See how our solutions can help
Express Scripts PBM Patient Assurance Program
The Patient Assurance program protects patients from high out-of-pocket costs, capping member copays at $25 for up to a 34-day supply of select diabetes and cardiovascular medications.
1 Diabetes dilemma: U.S. trends in diabetes medication use. A 2017 Express Scripts Report.