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 2017, The Centers for Disease Control and Prevention estimated that one half of patients in the U.S. stop taking their medications within one year of being prescribed. Additionally, a 2017 study published by the Annals of Internal Medicine relayed that 20–30% of medication prescriptions are never filled, and approximately 50 percent of medications for chronic diseases are not taken as prescribed.
  • Outcomes: Non-adherence negatively impacts patients’ health outcomes. The Annals of Internal Medicine study estimated that prescription non-adherence resulted in approximately 125,000 deaths and at least 10 percent of hospitalizations, costing the U.S. healthcare system $100 to $289 billion a year.
  • Costs: Many prescription drug prices—particularly those designed to treat complex medical conditions—are rising at an exponential rate.

Humana Pharmacy Solutions is the nation’s fourth largest prescription benefits manager by prescription volume, provides pharmacy benefits to almost 11 million members, and manages $26 billion in annual drug spend.

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.
  • Helping hold down costs and improve quality: 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. By simply informing members of generic or lower-cost alternatives and educating them on how to effectively take their medications, we have produced notable savings and success stories:
    • Member out-of-pocket costs reduced by $10 per prescription on average
    • A 17 percent lower incidence of gaps in care for members with diabetes compared to other pharmacies
    • A 1 percent lower adverse-drug-event rate for members (2.8 percent lower than retail pharmacies)
    • 32 percent greater medication adherence than retail pharmacies
  • 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):