In the world of medication adherence, the challenges are significant. Patients often struggle to consistently take the medications prescribed to them, and two key factors play a major role in this issue: accessibility and cost. Pharmacy Benefit Managers (PBMs) have been under scrutiny, as policymakers and regulatory agencies investigate their impact on drug pricing. The entire drug supply chain, with PBMs at the forefront, has created a system that inflates medication costs, making it difficult for patients to afford their prescriptions.
Amidst calls for reform, innovators in the prescription drug pricing transparency space are working to bring about change. One such innovator is GoodRx, spearheaded by Doug Hirsch, the Chief Mission Officer. GoodRx aims to foster a more transparent healthcare marketplace and believes that small solutions will not be enough to fix the endemic issues. The high cost of medications forces many patients to make tough choices between filling their prescriptions or paying for essential needs like housing or food. This has long-term consequences for healthcare quality and costs.
Recent years have seen some winds of change in response to the exorbitant costs of prescription drugs. The Inflation Reduction Act (IRA) introduced provisions to address these concerns, and the launch of the Mark Cuban Cost Plus Drug Company (MCCPDC) garnered significant attention. Collaborations between MCCPDC, Amazon Pharmacy, and nonprofit health plans like Blue Shield of California are seeking to provide more affordable and convenient pharmacy care.
Blue Shield of California, under the leadership of CEO Paul Markovich, is actively engaged in the transformation of the healthcare system into a value-based model. Their goal is to ensure that members have access to the medications they need at a lower cost. These partnerships and initiatives are putting pressure on the drug supply chain, potentially leading to long-term changes.
However, drug pricing transparency and healthcare transformation are not limited to high-profile collaborations. Sempre Health, a healthcare platform, has been making remarkable strides in lowering prescription drug costs and improving medication adherence for patients with chronic illnesses. Founded in 2015, Sempre Health offers behavior-based, dynamic medication pricing to consumers, incentivizing adherence through a rewards program.
Sempre Health operates on the concept of a good-driver discount, where discounts increase each month for patients who pick up their prescriptions on time. By connecting various stakeholders in the healthcare industry, Sempre aligns their interests, creating a win-win scenario for patients, pharmaceutical companies, and health plans. Initially partnering with Blue Cross NC, Sempre successfully lowered medication costs for people with diabetes, resulting in improved adherence and substantial savings for members.
Health plans have embraced Sempre Health's approach, leading to an increase in participating plans from 1 to 18. These commercial health plans have gone a step further by using their own funds to implement adherence programs for their Medicare Advantage beneficiaries, in compliance with new Medicare Advantage rules. Sempre's impact is also being recognized by PBMs, with the company now partnered with two of the largest PBMs in the industry.
A study published in the Journal of Managed Care and Specialty Pharmacy found that patients in the Sempre Health program demonstrated a significantly higher adherence rate compared to a control group. This increased adherence resulted in a 16% reduction in emergency room visits. Although total medical spend may not have decreased, the shift from inpatient and emergency care to outpatient visits reflects improved health outcomes.
Sempre Health utilizes text messaging to engage with its members, offering a frictionless experience that has proven more effective than app-based approaches. Pharmaceutical companies, such as Organon, have also witnessed significant benefits from partnering with Sempre Health. By offering medication refill reminders and ongoing text support, the company has achieved over 20% adherence rates compared to copay cards alone.
Looking ahead, Sempre Health anticipates delivering $60 million in member savings by the end of 2024. The company plans to expand its program to include more drugs, starting with brand drugs and eventually incorporating specialty drugs. Specialty drugs, known for their high cost, present a significant opportunity for Sempre Health to make a substantial impact.
The combined efforts of various networks and initiatives, along with renewed policy interest in disrupting the pharmacy value chain, offer hope for improving medication adherence, a long-standing challenge in healthcare. The winds of change are starting to blow, and they are making progress in the last mile.
