Patient Advocacy: The Next Frontier of Provider-Pharma Collaboration

By Miriam Paramore, President, OptimizeRX

The debate over prescription drug copay coupons continues to rage between pharmaceutical and insurance companies. While pharmaceutical companies offer brand copay coupons as a tool to offset patient out-of-pocket costs for name-brand drugs, insurance companies encourage the use of lower-cost generic medications as the right strategy for addressing spiraling prescription drug prices. 

Providers and patients often find themselves caught in the middle. And unfortunately, in tandem with the ongoing debate, the reality on the frontlines of care delivery is that patients need help affording their medications. 

The shift toward value-based care demands greater industry collaboration to bridge the healthcare gap and cut expenses without sacrificing quality. Medication affordability is a big part of this equation. When the right data-sharing and connectivity framework exists, pharmaceutical companies and providers can essentially work together to become patient advocates, empowering healthcare’s most important asset with resources for lowering costs and improving overall health in a sustainable way.

Medication Adherence: Challenges and Opportunities

Patients currently struggle under a trifecta of challenges: higher copays, a shrinking pool of generic alternatives, and high-deductible health plans. 

The Kaiser Family Foundation reports that, during the 10-year span between 2005 and 2015, the average medical costs for covered workers rose 66 percent, while wages grew only 31 percent. It’s worth noting, too, that the increased costs weren’t limited to only patients: the average payment by health plans rose 56 percent over that same time period. 

As patient costs continue to rise, many patients find themselves actively seeking ways to control their healthcare costs. In some cases, this equates to medication non-adherence.

Notably, it’s also well documented that lowering a patient’s out-of-pocket costs can improve follow-through with medication therapies—a significant industry challenge—and patient outcomes. Consequently, medication affordability strategies can have significant impact on healthcare costs related to poor outcomes and disease progression, which one 2013 study estimated to be between $100 billion and $300 billion annually.

For this reason alone, helping patients control costs must be at the forefront of the industry discussion.

Provider roles

Consumers naturally look to physicians to help them manage their healthcare costs and understand their treatment options. As a result, providers are uniquely positioned to share information about cost-saving measures such as brand coupons with their patients.

Surescripts reported in 2017 that 77 percent of all prescriptions were delivered electronically, with 69 percent of prescribers and 98 percent of pharmacies utilizing digital prescription services. The company also noted that prescribers rely heavily on price and benefit data to help make a fully informed decision about medications, with 74 percent reporting a desire to consider patients’ benefit information before prescribing and 59 percent desiring to review the cost of similar medications. 

To that end, pharmaceutical companies that can communicate medication cost information along with drug discount programs within a physician’s electronic workflow bring great value to the table. Existing solutions provided across point-of-prescribe networks allow providers to search for a brand name drug within the EHR and gain real-time access to coupons and vouchers that the patient can present to the pharmacy provider. 

This improved access to price and benefit information also allows providers to review the costs of similar medications and take advantage of price transparency as part of the decision making process. In the past, wholesalers, distributors, and health plans largely obscured drug costs so that physicians knew nothing about the prices.

Becoming Better Patient Advocates

Because siloes plague the healthcare system, and because the system is vast and complicated, patients need advocates to help them navigate each step of the process. The strengthening trend toward data sharing offers providers and pharma alike the opportunity to join forces to improve patient care. 

In a recent study of adherence and healthcare costs, researchers found that providers were often the most powerful predictor of medication adherence, and financial assistance plays an important role. Communication, coupled with a focus on empowering patients to find affordable drug options, can greatly enhance adherence and outcomes and improve patient loyalty. 

In a healthcare landscape that finds physicians striving to build a personal brand in the market, empowering and advocating for patients throughout the process may prove to be the holy grail.

Miriam Paramore is a seasoned executive with 30+ years of experience in healthcare and deep expertise in health information technology. As President of OptimizeRx, she is leading the charge towards the company’s mission to serve as the preferred digital communication channel between pharma and the point-of-care. Follow her on Twitter or LinkedIn.