The past several years have been dramatic for the pharmaceutical industry as the number of specialty therapies on the market continue to rise- in 2020 alone, specialty therapies accounted for more than 52% of total pharmacy spend. But these shifts in care seem to mean costs are also increasing, for both manufacturers and their patients.
Doubling down on this mounting financial burden, the COVID-19 pandemic created additional affordability barriers for patients who lost their jobs and health insurance. Legislation suggests both state and federal government have taken notice, as a larger curtain has seemingly been pulled back on various healthcare affordability and access barriers like never before.
The changes to the healthcare landscape as a result of the Covid-19 pandemic have been unprecedented, but one thing is certain: a digital transformation of healthcare and pharmaceuticals seems to be needed now more than ever before.
Unlock the CareMetx solutions that can help patients access medication faster.
Legislation Spotlights a Need for Real-Time Healthcare Technology
While the tide has long been turning in favor of empowering today’s patients, the pandemic immediately brought access and affordability to the front and center of conversation in both state legislatures and at the Centers for Medicare & Medicaid Services (CMS). More specifically, these conversations have revolved around how smarter, more practical technology solutions need to serve as the industry’s first step.
eBV and ePA
Consider California, where the Patient Choice and Transparency Act is currently making its way through the state legislature. This act would require real-time patient eligibility information, including electronic benefits verification (eBV) to be available to prescribers. A similar bill went into effect in Tennessee on July 1, 2021, and others are expected to pass in Colorado, Massachusetts, New York, Ohio and Pennsylvania.
Many states- including Arizona, Florida, Georgia, Maine, Maryland, and New Jersey- are also beginning to mandate the use of electronic prior authorizations (ePA). And as of March 2021, the Centers for Medicare & Medicaid Services also officially require all Medicare Part D insurers to accept ePA transactions.
The move toward automated technology solutions like eBV and ePA is a positive one for patient access, helping patients get life-saving medications faster. Now, providers and manufacturers need a patient support hub that keeps up. CareMetx provides exactly this- real-time benefit information and best-practice workflows for eBV and ePA – all within the HCP portal or embedded into providers’ systems.
Adjustment to Remote Care Presents New Opportunities
The US saw 30% growth in the number of medical apps downloaded during the COVID-19 pandemic,3 as people seem to be adjusting further to receiving and participating in healthcare remotely- and digital therapeutics (DTx) are also becoming more popular. DTx helps patients manage specific medical conditions, from diabetes and cardiovascular disease to chronic kidney disease and pediatric disorders. It can improve patient adherence and patient outcomes4 by involving patients more in their care and truly making them a part of their own team.
CareMetx has always believed in the value of such technology-enabled clinical support in the overall patient experience. This support could come in the form of simple, patient-centered measures such as those CareMetx already seeks to digitally provide, such as:
- Disease and Product Education
- Therapy Administration Reviews
- Ongoing Clinical Monitoring
- Patient Status Updates
- Adverse Event Recognition, Reporting and Reconciliation
These patient support platforms are a great response to this trend toward what appears to be patients’ desire for more involvement in their own care. CareMetx also offers technology-enabled reminders and educational resources for patients and caregivers that put the focus on behavioral modification, helping to improve adherence for remote therapies.
Financial Shifts Create Affordability Barriers
Rising healthcare costs are no secret. From 2010 to 2020, family premiums increased 55% and employer deductibles increased 111%, while wage growth increased only 27%.7 Plus, specialty therapies have always carried a higher price tag than traditional retail medications.
Not only that, recent financial trends are creating what seems like a perfect storm for greater affordability barriers for today’s patients.
Drug Shortages and Shifts in Care
Several factors are contributing to an additional rise in the price of specialty therapies specifically. Drug shortages, which were already high, were exacerbated by the COVID-19 pandemic. The FDA reported 43 new drug shortages and 86 ongoing from previous years, including neuromuscular blocking agents, anticoagulants and dialysis agents.8
There has also been a shift in pharmaceutical-led care toward biologic and biosimilar therapies and personalized plans, which cost more to create. All of this means higher prices for manufacturers and patients, and more scrutiny from payers. That’s why CareMetx is dedicated to helping manufacturers align their interests with payers by supporting innovative, value-based models.
On top of these rising costs, the pandemic created an economic crisis we’re just beginning to recover from. Including dependents, as many as 15 million Americans may have lost health insurance during 2020.9 Unemployment peaked at 14.7%, and while the economy is recovering, it is still higher than pre-pandemic levels.10
Taken together, these rising costs present serious affordability issues for patients. As a result, some patients may never fill prescriptions in the first place. Others may delay doctor’s appointments, skip or reduce doses to “stretch out” prescriptions or make trade-offs with basic needs like paying bills. That’s why CareMetx offers affordability solutions like end-to-end copay and PAP administration, specialized Bridge Dispensing Programs, and virtual copay cards with electronic claim adjudication and settlement.
As the industry recovers from an unprecedented year, the staying power of current trends remains to be seen. One thing is certain: CareMetx is here to help you get the most from your patient support hub, with continuous updates, hyper-automation, and innovations that meet the needs of today’s patients and manufacturers alike.
Take a quick assessment to reveal more CareMetx solutions that can help you make the wait history.
1 CVS Health, Drug Trend Report 2020, April 2021. Available at https://cvshealth.com/news-and-insights/articles/drug-trend-report-2020-new-drugs-and-new-indications-drive-specialty.
2 The Commonwealth Fund, The Impact of the COVID-19 Pandemic on Outpatient Visits. Available at https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits.
3 Statista, Growth in the Number of Medical Apps Downloaded, October 2020. Available at https://www.statista.com/statistics/1181413/medical-app-downloads-growth-during-covid-pandemic-by-country.
4 T. Kamat, Digital Therapeutics Can Improve Medication Adherence in Diabetes. J Family Med Prim Care. 2020 Nov; 9(11): 5806–5807.
5 OncLive, In-Home Infusions Could Bridge Disparities in Cancer Care. Available at https://www.onclive.com/view/in-home-infusions-could-continue-to-bridge-disparities-in-cancer-care.
6 Penn Medicine, Home Infusions and Home-Based Chemo. Available at https://www.pennmedicine.org/updates/blogs/penn-physician-blog/2020/june/infusion-therapy-and-home-based-chemo-the-innovation-of-penn-cancer-care-at-home.
7 Kaiser Family Foundation, 2020 Employer Health Benefits Survey, October 2020. Available at https://www.kff.org/report-section/ehbs-2020-section-1-cost-of-health-insurance.
8 US Food & Drug Administration, Drug Shortages for Calendar Year 2020. Available at https://www.fda.gov/media/150409/download.
9 The Commonwealth Fund, How Many Americans Have Lost Jobs with Employer Health Coverage? October 2020. Available at https://www.commonwealthfund.org/publications/issue-briefs/2020/oct/how-many-lost-jobs-employer-coverage-pandemic.
10 Bureau of Labor Statistics, The Employment Situation, July 2021. Available at https://www.bls.gov/news.release/pdf/empsit.pdf.