Jason Henry, HIV program coordinator for nonprofit Frederiksted Health Care, knew his organization could do more, if they had more money, or more time. Henry’s personal passion is to help serve its patient population-which is almost entirely below poverty level. Through its approved Ryan White Part C program, the nonprofit was paying $5,000 to $7,000 a month to provide medications for 30 uninsured HIV patients. That figure covered only generic medication and exceeded federal reimbursements. If Henry and his team could find a way to reduce this expenditure, he knew he wanted to use the money to reinvest into providing medication for other patients.
Looking at his options, Henry explored the 340B federal drug program. It would enable Frederiksted Health Care to greatly shrink medication expenses, but it practically required a partner to ensure that participation in this tightly regulated process went smoothly. Regulations change frequently and the steps required for approval can be tedious. For this reason, 340B-registered partner pharmacies like HealthStat Rx are in unique positions to serve as consultants to ensure that providers obtain-and retain-necessary approvals.
Henry contacted HealthStat Rx, a national medication adherence consultant, to provide comprehensive medication management services. The result has made 340B a success for the organization, but more importantly, the practice is also experiencing significant care improvements for those suffering from chronic illness by participating in the HealthStat Rx program. HealthStat Rx has shown its value not only in 340B compliance but also in an unexpected bonus-its medication adherence program.
With 100% of its HIV clients now enrolled in 340B, Frederiksted has realized 200% savings in medication costs. Just as Henry hoped, the practice now reinvests these savings and covers 100% of medication expenses for patients below the poverty line. According to Henry, a full-time employee has been liberated from tedious patient medication management follow-up into a more strategic role.
Most importantly for Henry and his patients, outcomes for the population Frederiksted serves have improved as demonstrated through patient lab results and decreased viral loads in HIV patients.
“We are seeing an improvement in patients’ lab results, and in the case of our HIV patients a reduction in viral loads,” said Henry. “From an efficiency standpoint, I used to have an employee who would spend all day picking up and delivering medication to clients who did not have transportation. I can now apply that person to other care-related tasks essential to our organization.”
Due to the success of this program, HealthStat Rx’s relationship with Frederiksted has expanded to include medication therapy management (MTM) services for their entire patient population.
What Frederiksted experienced is not an outlier. Proper adherence, particularly in therapies for chronic diseases including HIV and hepatitis C, is essential to successful outcomes. According to the World Health Organization, “Adherence to therapies is a primary determinant of treatment success. Poor adherence attenuates optimal clinical benefits and therefore reduces the overall effectiveness of health systems.” 1
Every element of a MTM program, from the engagement with the clinician to prescription fulfillment to the delivery and direct patient outreach, is designed to support adherence. In our view at HealthStat Rx, nothing beats adhering to the physician’s plan for health in aligning outcomes. The data support this. For example, we recently conducted a study on the effects of MTM on adherence and outcomes in a population of patients taking highly active antiretroviral therapy (HAART), which was published in The American Journal of Pharmacy Benefits:2
In the case of HAART, near-perfect adherence is required to obtain a successful treatment outcome. Data analysis showed that medication adherence was increased by 28% over baseline. By a second measure there was a 69% increase in patients who were at least 95% adherent to all medications; 95% represents the commonly applied definition of an acceptable level of adherence to HAART. Further, the percentage of patients whose viral loads were considered undetectable increased from 28% to 66%.2
While adherence is key, you cannot achieve great adherence without a multilayer approach that involves the organization, like Frederiksted, the physician, and also the patient. Proper medical adherence programs do not rely on “one fix,” such as a phone call or a great package. They rely on excellence in execution on multiple levels.
This multilevel, matrix approach was particularly key for Henry and his team, and drilled into the details of daily medication management. For example, for any patient on 3 or more medication therapy regimens, HealthStat Rx provides bubble packaging, a feature that has received a very positive response from physicians and patients.
As Henry explained, “A provider said to me, ‘I have patients that once they try this, they never go back.’” “The transition for our HIV our patients was pretty easy,” Henry added, “as all we had to do was modify the prescriptions and send them over to a new pharmacy.”
For non-HIV patients, HealthStat Rx trained both staff and patients on the new, simpler process. The HealthStat Rx program enables physicians to be proactive with a patient’s medication, instead of waiting for a patient to ask for a refill. Patients are empowered to take a much more active role in their own care. “I had a patient stop me in the hall to tell me how well this program works,” Henry said. “Another patient told me that this was the first time that she did not have to worry about her grandmother taking her medication.”
1. World Health Organization. Adherence to long-term therapies: evidence for action. 2003. Available at http://www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed February 20, 2014.
2. Dunham PJ, Karkula JM. Effects of a pharmacy-care program on adherence and outcomes. Am J Pharm Benefits. 2012;4(1):e8–e14.
O’Connor joined HealthStat Rx as chief operating officer in 2011. He is a champion of medication adherence to both reduce healthcare costs and improve the lives of chronic disease state patients. His strategic vision and implementation expertise lead HealthStat Rx’s reach and services expansion in the United States. He can be reached on LinkedIn or at email@example.com.