Making Progress: How Public and Private Stakeholders Are Collaborating to Improve Care

For nearly 90 percent of people with chronic and complex diseases, prescription drugs are the “first, logical choice for medical intervention.” Unfortunately, up to 50 percent don’t take their medications, and up to one-third don’t even have their prescriptions filled.

This disconnect between patients’ need for prescription drugs and their ability to obtain and take them as prescribed was among the health care challenges that Tom Moriarty, EVP, Chief Policy and External Affairs Officer, and General Counsel for CVS Health discussed at the National Association of Attorneys Generals’ April 2017 Summit.

Moriarty described three important and interrelated health care challenges: chronic disease, the cost of prescription drugs, and a fractured delivery system, and shared some of the ways the private sector is delivering solutions.

Rx Care Can Improve Health, Lower Costs

With nearly 85 percent of our country’s health care dollars going toward caring for Americans with chronic illnesses and complex diseases, it’s critical that all stakeholders work together to find solutions.

The FDA’s drug approval process is one of many examples of potential changes that could make a meaningful impact. At the start of 2017, more than 4,000 generic drugs were pending approval at the FDA. By facilitating a more efficient approval process, the FDA can encourage competition and innovation, which has a downstream impact on patient access and cost.

Market dynamics are also an important piece of the puzzle. New branded products are being launched at high prices, and manufacturers are increasing prices on older drugs as well. The increase in “me-too” drugs coming to market and the decrease in breakthrough therapies are also contributing to higher prices.

And as more consumers enroll in health plans with higher deductibles and copays, high out-of-pocket costs for prescriptions increase the likelihood that they are never filled.

Improving Medication Adherence

Studies have shown that improved medication adherence could save up to nearly $300 billion in unnecessary medical costs each year. And because pharmacies represent the “front door of care,” CVS Health can be a valuable strategic partner to drive higher adherence rates.

“Our research has found that face-to-face personalized counseling and clinically effective interventions are two to three times more effective than other interactions at increasing adherence and improving health outcomes,” said Moriarty. “Clearly, pharmacists are an influential voice in helping patients take their medications as directed.”

In addition to our suite of pharmacy offerings, CVS Health also provides unmatched patient-facing touch points that include retail medical clinics, long-term care services, and infusion care. This puts us in direct contact with health care consumers every day to improve access, affordability and health outcomes.

Addressing the Issues

“There is even greater potential for public and private stakeholders to work together to make additional progress,” said Moriarty, including:

• Creating more competition and lower health care costs by increasing the flow of generics and biosimilars to market.
• Enacting new policies that recognize a changing health care delivery system, including those that empower pharmacists to practice at the top of their license.
• Building better regulatory and payment structures that provide an incentive for care in more cost-effective settings.

“We don’t have all the answers. No single solution will solve all of these marketplace challenges,” said Moriarty. “But every player in the health care system – including pharmacy – has a role to play.”