- Rising costs, fragmented care, and limited intervention strategies have led to poor medication adherence among patients with diabetes. But a new report from the Network for Excellence in Health Innovation (NEHI) says coordinated care and lower costs are among potential solutions to improve diabetes care.
Diabetes impacts nearly 30 million Americans, costing the US $322 billion per year. According to the NEHI study, some form of medication is used to treat four in five Type 2 diabetics, but many prescriptions are ineffective or used incorrectly and may not benefit patients. In fact, a recent report from IMS Health found that nearly half of Medicare diabetic patients fail to meet recommended medication adherence rates.
“It’s possible to use medications in diabetes care far more wisely than we do now, improving patients’ health, producing better care, and lowering costs,” says Susan Dentzer, NEHI’s President and CEO. “The nation needs to address barriers standing in the way of patients’ optimal use of medications, including inadequate education and training of diabetes patients, high out of pocket costs for patients, lack of competition in the market for diabetes drugs, and fragmented care.”
Improving medication use for diabetic patients could save the US roughly $4 billion in Medicare spending per year, according to the IMS Health report.
According to NEHI, challenges in medication use among diabetics include the complexity of the disease, and a lack of communication between clinicians, pharmacists, and payers.
"Achieving the best results with medications for diabetes patients requires thousands of steps every year, not only from patients, but also from clinicians, pharmacists, and payers," the report states. "Success requires a high degree of coordination and support, but many patients experience fragmented and uncoordinated care."
Other challenges include gaps in pharmacy quality goals, a lack of patient self-management education and training, and increasing costs for patients and payers.
"For many patients with diabetes, the high cost of medications is a major contributor to poor adherence," the report states. "Spending on diabetes-related drugs has risen for both patients and payers due to the trend toward intensified treatment, a decade-long trend in higher prices for insulin products, and to date, a lack of a generic insulin equivalent."
NEHI's recommendations for improving medication use for diabetics include tailoring medication strategies, such as Medication Therapy Management (MTM), to patients' needs.
"The Medicare program’s 'Enhanced MTM' pilot program, scheduled for launch in 2017, is a promising strategy that should be rapidly evaluated for best practices that can be scaled up throughout the health care system," the report states.
Cutting patient and payer cost could also improve medication use and medication adherence. Specifically, the report urges stakeholders to help create a competitive market for diabetes medications to keep them affordable.
"Health insurance and prescription drug benefits should be designed to lower copayments and other cost barriers faced by patients, as these depress adherence and lead to avoidable costs," the report states. "Payers should experiment with broader adoption of value-based insurance designs (VBID) that support optimal use of medications and lead to lower health costs."
Additional recommendations include payers and health systems providing pharmacists with patient medication adherence data "to facilitate quick problem resolution," the report states. Additionally, the report calls for to Medicare to "take the lead in allowing pharmacists to bill for identifying and resolving patients' specific drug therapy problems," and for the expansion of collaborative practice agreements.
“I see patients with type 2 diabetes every week and the majority of them are facing an uphill battle. These patients have to manage their blood sugar, eat healthy, and be active," says Kam Capoccia, Pharm. D., BCPS, CDE, chronic disease management expert and Clinical Associate Professor at Western New England University College of Pharmacy. "Most of these patients take multiple medications, several times a day, often in varying doses. The burden of financial difficulties and mental illness combined with a system that doesn’t make it easy for them to navigate and learn how to manage and cope with their chronic conditions results in fragmented care that costs billions of dollars."
In 2014, healthcare spending rates among diabetics with employer-sponsored insurance increased about 6 percent – almost double the spending rate for those without the disease – according to a Health Care Cost Institute study. Increased spending was associated with a rise in prescription drug use and emergency room visits.
Additionally, the HCCI study found that diabetics also sought treatment for multiple other conditions, including mental health issues. Young adults with diabetes were four times as likely to be admitted to the hospital for mental health or substance abuse issues.
Diabetics spend 2.5 times more on out-of-pocket costs per year than non-diabetic policyholders, according to the HCCI study.
"The burden of financial difficulties and mental illness combined with a system that doesn’t make it easy for them to navigate and learn how to manage and cope with their chronic conditions results in fragmented care that costs billions of dollars," Capoccia says.