Across the U.S., rising rates of chronic illness, obesity and mental health concerns have made it clear that our healthcare system must evolve. As reported by the Centers for Disease Control and Prevention, currently 42% of adults are obese, 60% live with at least one chronic condition and 40% live with two or more. Life expectancy now lags behind other developed nations by six years and, finally, nearly one in five adults experience mental health challenges.
These trends, combined with the highest pharmacy drug cost in our history, places immense stress on both patients and employers looking to provide the best healthcare coverage for their employees.
Within this landscape lies an opportunity for growth. Employers and their employees will continue to face unpredictable and often unsustainable drug costs, but we are not without options.
Identifying solutions that reduce unnecessary prescriptions, enhance medication effectiveness and improve overall health outcomes is not just possible but essential.
A more effective pharmacy strategy takes shape with a few critical considerations:
Use data strategically. Claims, pricing, clinical data, patient reported outcomes and utilization management data are all powerful clues about what’s working and what isn’t. Prescribing medication is just one piece of the puzzle; understanding whether patients adhere to treatment, tolerate medications well or experience meaningful benefits is just as critical.
Asking the right questions is important. For example, does the patient use the medication properly? Does the patient tolerate the drug well? Is the price worth the outcome? Is there a way to test the patient to ensure the drug is actually working? All these factors must be evaluated and used to determine if pharmacy benefits are improving health rather than adding unnecessary cost or complexity.
It’s important to remember that healthcare is a multibillion-dollar industry, and the money of healthcare is earned through utilization not outcomes. It’s not that physicians, pharmacists and healthcare organizations don’t care about outcomes; rather, they are rarely held financially accountable for them — and in any system, what gets rewarded, or paid for, ultimately receives the most attention.
Empower employees to take an active role in their health. While many health factors, such as age, gender, family history and genetics, cannot be changed, others can. We must encourage employees to do their part and be active participants in their health. Exercising regularly, not smoking, eating a diet rich in nutrients and taking medications as prescribed can make a difference in managing chronic conditions. Employers must be sensitive and empathetic to these variables and must support these efforts with empathy, resources and education that meet employees where they are.
Reduce waste in our healthcare system. An estimated $935 billion is wasted in the healthcare industry annually, with $170 billion due to pharmacy-related waste.
A significant portion of this healthcare waste is hidden in medications that are purchased and utilized but fail to deliver the intended clinical outcomes. Considerable effort is spent managing prescribing through prior authorization and step therapy, as well as negotiating drug prices.
However, once a patient starts a medication, there is often the inherent assumption it is going to work for them even though, according to clinical trial data — which is gathered in a controlled environment — nearly all drugs only help a percent of the patients who take them. Thus, we are left with high costs and low efficacy. Deploying solutions that monitor efficacy while streamlining costs can help ensure spending aligns with real, measurable outcomes.
Healthcare costs may feel daunting, but accepting the status quo is not our only option. By prioritizing data-driven decisions, supporting employees in their health journeys and eliminating inefficiencies, we can make progressive changes that manage drug costs responsibly while ensuring medications truly improve the lives of those who need them.
If we commit to higher standards for cost and efficacy, we can strengthen the health of our country, our companies and the employees who power them — and create a future where better health is not just a goal but an achievable reality.
Chris Antypas is lead pharmacy consultant at The MJ Companies.
