What Payer Trends Can Tell Us About Medication Adherence

Strategies for Market Access Teams

One thing the healthcare ecosystem lacks in the United States is a system of shareable, actionable healthcare data. So where is one possible place pharma can look for insights into patients? The answer is payers and claims.

According to a study by DRG Digital’s Manhattan Research, drugmakers are still mostly focused on reaching payers through traditional, in-person account manager relationships.

Among the pharmacy and therapeutics (P&T) committee members DRG surveyed, 44% would use pharma digital resources more frequently if companies made it easier to find content dedicated to formulary decision-makers. P&T committees at hospitals, government organizations and insurers decide which drugs will make their formulary lists.

So what does this mean for medication adherence and patient outcome trends? How do pharmaceutical companies work with payers?

In a typical value-based contract, the manufacturer and the payer take on a level of risk; if the drug does not perform as expected, the manufacturer likely reimburses the payer for a portion or all the costs.

In this blog post, we’ll take a closer look at how payer trends can reveal insights into the way patients use their medications – and how pharmaceutical companies can use this data to help improve patient outcomes.

The way patients access and adhere to medication is a key factor when determining successful health outcomes. To this end, payers play an important role in providing insights about medication usage – both in terms of how patients are responding to treatments and in terms of how much money is changing hands.

Patient Utilization Trends

One of the most important aspects of monitoring payer trends is getting an accurate picture of patient utilization. Understanding which treatments are being utilized, by whom, and for what length of time can help inform pharmaceutical operations on how best to meet patient needs.

Medical Cost Trends

In addition to patient utilization trends, payer trends can also provide insight into the cost of treatments and medications. This information can be helpful in determining how much the company is spending on certain medications or treatments, as well as what patients are paying out-of-pocket for their care.

Drug Adherence Trends

Finally, payer trends offer valuable information about medication adherence. A comprehensive look at payer data can reveal which medications are being taken as prescribed and which ones aren’t – a key factor in determining the success of any medication regimen. Additionally, it can help a company identify areas where they could improve education and incentivization programs that promote better adherence to medications.

Patient Outcomes & Adjusting Clinical Protocols

By leveraging payer trends, pharmaceutical companies gain invaluable insights into how their investments are impacting patient outcomes – and utilizing data from payers can also reveal issues surrounding cost containment, such as whether or not medications are being prescribed in the most cost-effective manner or if there are any discrepancies between the payment rate and actual costs associated with treatment.

Another way that payers provide insight into medication adherence is through reporting on changes in clinical protocols. By tracking changes in prescribing habits and treatment guidelines, organizations can stay abreast on evolving standards and adjust their strategies accordingly. This type of information can also be used to create incentives for new medications that may be more effective than current treatments and identify areas where additional research or educational initiatives may be necessary.

Finally, drug utilization review (DUR) systems allow organizations to gain further insight into the overall effectiveness of medications by monitoring side effects or contraindications associated with particular drugs. DUR systems essentially flag potential problems before they become widespread issues – helping organizations better understand medications and take preventative steps where necessary.

With the right data from payers, pharmaceutical companies have a powerful tool like H1’s platform at their disposal for evaluating treatments and making adjustments that ultimately lead to more successful outcomes for patients.

For more information about understanding payer and patient utilization trends, request a demo.