Did you know it is estimated that about 50% of chronic medications are not taken correctly? Normally, achieving an adherence rate of 80% or greater is needed for optimal therapeutic efficacy. Adherence to medication is affected by numerous factors. After the initial prescription is written and filled, multiple barriers can appear. Medication adherence does not solely fall on the patient, but also the ambulatory healthcare team, including the prescriber, pharmacist, and the health plan.
At iCare, we strive to be an active part of our member’s healthcare team. iCare has a very active and engaged pharmacy department that is always available to help our members and prescribing physicians. The iCare Pharmacy Services Department is comprised of three pharmacists and three knowledgeable support staff. The staff is there to help answer simple benefit question to complex issues in which other members of the healthcare team are involved.
What can the iCare Pharmacy Services Department do for PROVIDERS:
- Initiate drug prior authorizations and appeals.
- Verify the formulary and offer suggestions.
- Complete a medication reconciliation with the member.
- Recommended local pharmacies that may assist members with adherence barriers.
- Work with the member and provider to assure all prescriptions are written for a 90-day supply, if applicable to save the member money and trips to the pharmacy.
- Engage the iCare Care Management team for adherence barriers that focus on socioeconomic issues such as food insecurities and housing.
What can the iCare Pharmacy Services Department do for PATIENTS:
- Recommend local and mail order pharmacies to help with adherence and transportation issues.
- Work with local pharmacies to assure all medications are being filled for a 90-day supply and are synchronized to be filled on the same day.
- Assist patients in refill reminder strategies.
- Work directly with patients and the filling pharmacy to assure medications are filled timely.
- Proactively assure patient will not run out of medication if a prior authorization is needed for their medication.
- Perform an annual comprehensive medication review.
It is important to note that your Medicare patients will receive a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey about their providers. Health systems choosing to participate in the Medicare Shared Savings Program are required to use the CAHPS Survey for Accountable Care Organizations (ACOs). The results of the ACO CAHPS Survey are used for calculating any “shared savings” to be earned by participating ACOs.
Questions on the survey may cover topics such as whether the patient thought the provider explained things in a way that was easy for them to understand. Which begs further questions, like:
- Do you routinely explain details about medications you prescribe, and confirm your patients understand?
- Do you ask if the patient has barriers to getting their prescriptions filled, such as transportation?
- Do you know if patients have stable housing? Storing medications can be a challenge for homeless patients.
- Do you offer ways to help patients stretch their limited incomes, such as longer supplies? iCare Medicare members are eligible 90-day mail order supplies for the same copay as a 30-day supply.
The iCare Pharmacy Services Department understands the challenges Medicare patients face, and strategies to help overcome them. We’re here to help your patients…and you.
If you need additional support, call 800-777-4376 .
Want to know more about CAHPS? Read “What Medical Professionals Need to Know About the CAHPS Survey.”