EHRs Can Play Important Role in Medication Adherence

By Thomas Borzilleri, CEO, InteliSys Health
Twitter: @InteliSysHealth

In the crowded EHR market, many vendors are looking to stand out—by offering ever-better customer service, or by adding capabilities to help providers better meet the goals of the Triple Aim. One area in which EHRs can do more is aiding providers in tackling medication adherence.

Prescription drug management is one corner of medicine that suffers from a lack of transparency. It’s also marked by multiple breakpoints in communication that limit doctors’ and insurers’ efforts to make sure patients take their drugs properly, to avoid adverse events. But EHRs can become a conduit for both increased transparency around drug prices and for increased communications around whether patients are taking their drugs as prescribed.

It’s time to lift the veil on drug prices
Here’s the first problem. Affordability is the number one barrier to medication adherence. Yet no one—not doctors, not insurers and certainly not patients—really knows what prescription drugs cost. Then, doctors typically have no idea, once the e-prescription has been sent to the pharmacy, whether the drug is ever picked up, or is being taken as directed. Meanwhile, insurers are unsure what has been prescribed and not taken (or paid for out of pocket) – only what medications have resulted in a claim.

These breakpoints in visibility and transparency have serious consequences. So, too, does the affordability crisis for medications, as consumers face increased cost-sharing through deductibles, coinsurance and drug coverage “donut holes.” The National Institutes of Health estimate that approximately 125,000 deaths per year in the United States are due to medication nonadherence and that between 33 percent and 69 percent of medication-related hospital admissions are due to poor adherence.

Solutions are available now
EHRs can and should add capabilities to deliver price transparency and medication adherence intelligence. Tools exist now that can provide the prices for any drug at the five cheapest pharmacies nearby. Doctors can have this data at their fingertips, within a few seconds, at the point of care, integrated into their existing workflow. These technology solutions can also track prescriptions to make sure they are picked up and refilled on a regular basis, to gain new insight into which patients are at risk for adverse events due to medication non-adherence.

For years, insurers and patients have just accepted that the price they are getting is the best or the only price. These amounts are usually set by pharmacy benefit managers (PBMs), who promise to offer discounts. But the truth is that PBM “discounts” have always included heavy padding, in the form of ingredient spreads and per prescription fees. In fact, while PBMs are typically paying manufacturers 96 percent off the Average Wholesale Price (AWP) —the “sticker price” for drugs —the prices they charge insurers and employers are between 70 percent and 85 percent off the AWP. PBMs are skimming 10-25 percent off each prescription.

Insurers and employers have had little recourse, both because they did not know the true price of prescription drugs, and because they did not have a way to easily shop around between competing pharmacies to get the best price on every medication. So, new prescription pricing technology solutions should bypass pharmacy benefit managers and other middlemen to deliver true savings—rather than simply “bake-in” inflated pricing before offering discounts.

Previous attempts to solve this problem have been decidedly low-tech. Some patients have looked to Canadian or other foreign, mail-order pharmacies to try to lower drug costs. However, these transactions are usually outside the doctor-patient relationship, and may cause more harm than good to the patient – either by exposing him or her to dangerous drug formulations or by causing rifts in care continuity. Some newer solutions fail to address the price-gouging schemes of PBMs and discount card marketing companies.

Patients, doctors and insurers need something truly disruptive. Technology solutions that provide the lowest price to both patients and insurers, by negotiating the best cash prices across huge pharmacy networks, then delivering those prices at the point of care.

But that’s just the beginning. Technology tools that are truly integrated into the EHR can feed data back to insurers and providers about when or whether that prescription was picked up. There should be a digital “chain of custody” that follows each prescription to keep both the doctor and the insurer informed on drug fills, refills and cadence to ensure medication adherence. This gives the clinician the opportunity to intervene if necessary to help prevent an adverse event or avoidable hospital readmission.

Doctors and patients, together, must come to the best decision about the right drug for their condition and price must be a part of that equation. We need technology solutions that enable doctors to find the best price on any drug, at local pharmacies that are convenient to the patient. Tools exist to address these concerns. The key is for the next generation of EHRs, or even just the next release, to embed these tools into their existing systems. By doing so, we can avoid disrupting doctors’ workflow, and can ensure that all e-prescribing information is captured in the patient record.

A benefit to all stakeholders
Health IT solutions are typically geared towards one healthcare user: hospitals, doctors, patients, insurers or employers. Drug price transparency technology, on the other hand, is one of those rare innovations that will benefit each of those audiences. Doctors and patients, together, will be able to make the best decisions about medication management, at the point of care, during the prescribing process. Hospitals will enjoy better population health management through better medication adherence. Insurers and employers will be able to wring more value from each healthcare dollar.

EHRs are in a unique position to easily add functionality that will make it easier for doctors to do their jobs, by keeping patients healthier through better medication adherence. As EHRs strive to play a growing role in improving outcomes and lowering costs, taking on medication adherence and drug price transparency should be considered “low-hanging fruit.” When it comes to prescription drugs, we can deploy easy-to-use tools to lift the curtain on drug prices, and on whether patients are really taking their drugs properly once they leave their appointment.