The Problem – Medication Noncompliance

·         20% of all persons who received prescriptions for chronic medical conditions fail to have them filled

·         Of those patients who fill their prescriptions, 50% do not take the drugs as prescribed, or

         discontinue their treatment within the first year

·         Noncompliance rate is even higher for mental health disorders, reaching 75-80% by some accounts

·         Negative outcomes as a result of noncompliance raises healthcare and employer costs by more

         than $100 billion annually

·         One of the major barriers to compliance is the cost of medications

The Challenge

Two situations make it difficult for patients to comply with the prescription therapy physicians prescribe. 

1.       Many patients cannot afford their medications, especially for chronic conditions

2.       An increasing number of patients who do have insurance must pay cash for their prescriptions.

PRC Program Highlights:

·         Average savings is 26% off of the usual & customary retail price

§         Brands average 15%

§         Generics average 46%, can exceed 75% on some drugs

§         Costs for medications will vary by geographic location, type of prescription and pharmacy

          utilized 

·         All people who pay cash for their prescription drugs are eligible for the benefit

§         Uninsured

§         Underinsured

§         Those with high deductible plans, this benefit allows their deductible to go farther

·         May be used an individual or by any member of the cardholder’s immediate family

·         Accepted at more than 50,000 pharmacies nationwide, including:

§         Kroger affiliates

§         Albertson’s affiliates

§         Longs Drugs

§         Rite Aid

§         Costco

§         Kmart

§         Medicine Shoppe

§         Also many local pharmacies participate, check the pharmacy locator at

          www.PhysiciansRxCare.com for participating pharmacies in your area

·         Ideal for individuals to use in purchasing drugs not covered by their health plan formulary

§         Even people with insurance might want to use the benefit to save money on drugs for

          preventive care or lifestyle enhancement which may not be covered under their plans, such

          as those to ward of baldness or mood elevators, just to name a couple.

·         May provide more attractive pricing for seniors who are disappointed with their Medicare discount

         cards

§         According to the CMS, Medicare discount cards have averaged approximately 21%

·         Statistics of the uninsured:

§         Nationally, a surprising 32 percent of the uninsured have household incomes that exceed

           $50,000 per year

§         The fastest growing uninsured income segment nationally is households with incomes that

          exceed $75,000 per year.

§         El Paso County, with an estimated 2003 population of 547,567, is now the second largest

          county in Colorado, based on State’s Preliminary Population Forecasts.

 o    In 1999, an estimated 16.8 percent, or 84,844 people were uninsured in El  Paso

       County (State of the States, 2001). 

 o    Various other estimates have ranged from 11.2% to 30.1% depending on who is

       counted and how “uninsured” is defined.

 o    According to the Colorado Health Institute’s recent “Profile of the Uninsured in

       Colorado”, El Paso County has a low rate of 11% compared to the state average of

      16.7%; http://www.coloradohealthinstitute.org/Documents/Profile_of_the_Uninsured.pdf

EPCMS Pilot Program Findings

§         37% of card users are 0-49 years old

§         30% are 50-64 years old

§         32% are Medicare eligible, 65+ years old

Key differentiators of the Physician’s Rx Care program are:

·         No eligibility requirements or enrollment fees to access a card

·         Coverage for all drugs, not simply those manufactured by specific pharmaceutical companies

·         Portability: program and card make possible immediate portable health coverage for the uninsured 

·         Program can be tailored to include distinctive local offerings that communities have achieved such

          as over-the-counter products, vision, dental, and other services. 

·         Feedback to EPCMS giving member physicians valuable information for helping their patients pay

          the lowest amount for their prescribed medications, thus improving patient compliance and hence

          outcomes.

§    To assess pharmacy performance, Pharma Futures, Inc. analyzes aggregated pharmacy data

      for the EPCMS PRC program to determine the “preferred” pharmacies – those that provide the

     best discounts - and reports this information routinely to EPCMS for dissemination to their

     members.

§    Also reported are the:

·     Average cost  and % usage of generics, brands with generic alternatives and single

      source brand drugs

·     % and $ savings realized by card holders

How does the card work?

The program is very simple:

1.       A patient obtains a card from their health care provider or community organization.

2.       The patient calls the toll free number on the card (1-866-652-4325) to activate it.  

3.       They will provide their name, address and a phone number (any dependents will be enrolled

          as they use the card)

·         Activation streamlines the pharmacy encounter for the patient.

·         The card will work without activation.

4.       The patient signs the back of the card and locates a participating pharmacy by:

·         Looking on the back of the card flyer

·         Calling the toll-free call center number on the card and speaking with a  customer

         care representative

·         Visiting www.PhysiciansRxCare.com and using the pharmacy locator feature

5.       The patient presents the card to the pharmacist, along with the written prescription, to

         receive their medications at the eligible discounted rate.