Supporting proper medication usage

Humana’s integrated approach to healthcare connects all points of care, including the prescription medications that help prevent illness and treat conditions. Humana Pharmacy Solutions® (HPS) works to improve patient safety, care and outcomes while helping manage costs. It also helps provide solutions to some of the healthcare system’s biggest medication-related challenges:

  • Adherence: People often don’t take their medications the way their doctors prescribe. In 2013, The Centers for Disease Control and Prevention estimated that between 20% and 30% of prescriptions are never filled. For people taking medications for chronic conditions, adherence drops after six months.
  • Outcomes: Non-adherence negatively impacts patients’ health outcomes. The Centers for Disease Control and Prevention found in 2013 that roughly 30% to 50% of treatment failures and 125,000 deaths every year are attributed to prescription non-adherence.
  • Costs: Many prescription drug prices—particularly those designed to treat complex medical conditions—are rising at an exponential rate.

Humana Pharmacy Solutions provides pharmacy benefits to more than 8.5 million members, and manages more than 275 million prescriptions a year.

How HPS is making a real difference

There are many common reasons people may not take their medications as their doctors prescribe. These include not understanding the need for their medication or how to take it, or the cost is too high. Sometimes they just forget to take their medications. Humana Pharmacy Solutions tries to help address all of these shortcomings in various ways, depending on an individual’s health plan:

  • Making it easy to fill prescriptions: Humana’s mail-order pharmacy, Humana Pharmacy®, delivers three-month supplies of maintenance medications. When it’s time for a refill, Humana’s pharmacy automatically reminds the member, sending an email. The result is increased medication adherence. A 2012 Humana study found 82% of Humana Medicare members who fill 90-day prescriptions follow their drug regimens, compared to 68% who fill 30-day prescriptions.
  • Helping hold down costs: By simply informing members of generic or lower-cost alternatives, we found that Medicare prescription drug program members and the Medicare program saved $42 million in 2015. The goal of Humana Pharmacy Solutions is to increase members’ understanding of the medications they take and encourage them to choose the most cost-effective, clinically appropriate ones.
  • Helping people who take specialty drugs obtain extra support: Some of the newest specialty drugs target chronic conditions such as multiple sclerosis, hepatitis C, HIV/AIDS and cancer. They also tend to be costly therapies. Humana alerts members that need financial help of potential cost-savings programs that help offset out-of-pocket costs. Such help is available from state discount purchasing programs, the federal government and private sources, and Humana Pharmacy does the paperwork to enroll them in patient assistance programs.
  • Connecting members with chronic conditions to disease management programs: Humana’s integrated care model is especially advantageous to people with chronic conditions. Those who take specialty drugs usually are assigned a nurse or health coach through either Humana Pharmacy or a disease management program, because successful outcomes often require education and behavioral change, not just medications.
  • Acting as a model for patient safety: Humana Pharmacy fills prescriptions robotically, using bar codes and tamper-proof containers. Two pharmacists check every prescription for accuracy. Pharmacists also screen for drug combinations that could cause adverse reactions. The result is a low prescription error rate.
  • Consulting one-on-one with seniors: Humana’s Medication Therapy Management program goes beyond what Medicare requires, with pharmacists consulting at least annually with Medicare Advantage members who have multiple chronic conditions and who take at least eight prescription drugs. Members are screened for missing therapies, duplicate therapies, failure to adhere to their therapies, and the opportunity to switch to less expensive medications (as long as their prescriber agrees):

Examples of medication issues identified and addressed in 2014

Member using less medication than prescribed 103,402
Member not on a needed medication (including over the counter) 78,043
Lower-cost alternatives identified 39,061
Medication not appropriate 47,142
Potential or actual adverse drug combination 5,272

Source: CHI 2014 RxMentor TIP data