One of the biggest challenges I face as a family nurse practitioner is helping patients manage their medications.
I can recall many times in my career when I’ve written a prescription for a medication that I felt confident would help a patient, only to later find out they weren’t able to fill it because of price or insurance coverage issues. I’ve heard heartbreaking stories from patients who filled their prescriptions but had to ration doses for treatments that were essential to controlling their chronic diseases.
Unfortunately, most doctors don’t find out patients aren’t taking their medications as prescribed until their next visit — frequently months later. When care teams understand challenges earlier, they can connect patients to at-home prescription delivery or coordinate with a pharmacist for additional support.
That’s why regular, proactive medication check-ins are so essential for patients managing complex or chronic conditions. The fact is that patients often face barriers to sticking with medication plans. And these can take the form of economic, logistical, and personal challenges during care journeys.
As leaders across healthcare strategize how to level up their medication adherence strategies, it’s important to understand what challenges patients face and how technology can help address them.
Contextualizing specialty pharmacy within the greater healthcare landscape
Specialty pharmacy refers to a very narrow — and incredibly crucial — segment of medications intended to help treat those facing complex or chronic conditions. But when we look at specialty pharmacy within the context of the larger healthcare industry, the impact of this sector exceeds its patient base. Only 2% of filled prescriptions in the U.S. are for specialty pharmacy medications. However, a report by the Assistant Secretary for Planning and Evaluation found around 50% of medication spending goes toward these treatments.
That figure is expected to grow in the next few years. The same brief revealed specialty drug spending surged 43% from 2016 to 2021, even though the number of specialty prescriptions only increased by 0.5%. And another study projects “specialty medicines will represent about 43% of global spending in 2027 and 56% of total spending in developed markets.”
As the U.S. population continues to age at an accelerated pace — and will predictably experience more chronic and complex conditions — the need for specialty pharmacy will only increase. Thus, working to simplify and enhance operations associated with supplying patients with these treatments and supporting them to get the most benefit out of them is imperative.
The importance and challenges of adhering to complex therapies
Medication adherence is classically tied to better patient outcomes. And for specialty pharmacy, the benefits are incredibly evident.
An analysis of acute myocardial infarction patients discovered a significant increase in one-year mortality rates for those who only filled some or filled none of their prescribed treatments versus individuals who filled all of them. In fact, an estimated 125,000 adults die every year from cardiovascular disease due to nonadherence.
But actually achieving full medication adherence is easier said than done. And working through logistics to initiate treatments and maximize the value they can deliver to individuals can be burdensome. Hurdles throughout the process include completing prior authorizations, applying for financial assistance, and refilling supply.
One study of patients with heart failure found 48% of them discontinued their medication due to refilling problems. And another 27% ironically stopped taking treatment because they experienced improvement. Of course, the elephant in the room is money. Specialty therapies — such as the antiviral hepatitis C medication Sovaldi priced at roughly $1,000 per pill — usually cost far more than standard drugs, inherently presenting financial and insurance challenges.
These findings speak to a greater need for healthcare to support those facing chronic and complex conditions by simplifying specialty pharmacy operations, advocating for individuals requiring specialty treatments, and educating people throughout their care journeys about side effects or changes — positive or challenging — they could expect.
How intelligent care enablement can help improve specialty pharmacy medication adherence
Specialty pharmacies play a key role in helping address barriers to specialty pharmacy adherence. But challenges to the effectiveness of these service lines reflect much of what healthcare grapples with writ large: staffing, administrative burden, economic viability, and disjointed workflows.
That’s why it’s crucial to understand how intelligent care enablement — scalable technology that uses AI to support patients and providers through complex care — can empower organizations to enhance the care experience for pharmacists and patients to ultimately support better medication adherence. Some notable advantages of Memora Health’s digital healthcare platform include:
1. Streamlining specialty medication follow-up
One crucial aspect of supporting patients to adhere to treatment plans is consistent and helpful communication. Usually, this involves manually reaching out to individuals by telephone to ask questions and assess their compliance statuses. This process can be cumbersome for pharmacy professionals, but also presents issues with inconsistency at the patient experience level.
Proactively engaging individuals with medication-related prompts, Memora Health’s platform leverages SMS texting to intelligently automate follow-up tasks. This means pharmacists make fewer phone calls, and can reallocate their attention to laser-focusing on patients who might need the most immediate assistance. It also means every patient with a basic cell phone can receive the same high-touch follow-up consistently associated with better outcomes.
99.4% of self-reporting oncology patients enrolled in Memora Health’s Care Program at Penn Medicine remained fully compliant with their medication regimens. Read the full case study here.
2. Supply patients with education resources to help them overcome adherence obstacles
Intelligently automating follow-up is a key piece of the puzzle when it comes to standardizing and improving specialty pharmacy adherence. But what if technology could go beyond reminders and questions to actually provide evidence-based recommendations to patients?
Memora Health’s AI-supported platform does just that. Using natural language processing (NLP) to read patient questions about medications and a retrieval-based system to respond with clinically approved answers, our technology recognizes routine care questions about side effects, unexpected symptoms, or when their treatment will kick in. As an added bonus, it can comprehend when a patient needs to refill their prescription, and surface the right resources to streamline the process.
3. Proactively engage patients to quickly escalate medication concerns
No matter how much technology advances, there will always be certain concerns and questions that require human intervention. Patients having side effects from their prescribed medications are looking for guidance, and intelligent care enablement is able to send immediate responses to patient concerns, then connect that patient to a care team member when appropriate. The last thing someone experiencing a medical concern like this one should do is wait on a phone line.
That’s why Memora’s technology features automated triaging to help streamline resolving these outstanding circumstances. Our AI-backed platform is customized to understand a spectrum of alarming responses from patients. It can differentiate between scenarios that need the attention of the correct professional — who can then review an individual’s communication history and reach out to assess their situation — or recommend an ER visit in more severe cases.
Improving medication adherence with any patient can be challenging. But things can get even trickier when treating those with complex or chronic care needs. By embracing forward-thinking and intelligent technologies, systems can arm their healthcare professionals with the right tools to partner with the individuals they treat. And, ultimately, that could go far in breaking barriers to realize more positive outcomes through medication adherence.
Want to learn more about how Memora Health can help your team improve medication adherence? Speak with one of our experts today!