Strategies to increase medication access during COVID outbreak aren't helping patients most in need

A pharmacist consulting with a patient holding medication
Recent policy changes by pharmacy benefit managers have helped some patients get their medications but that doesn’t mean it is helping everyone equally, according to AllazoHealth CEO Cliff Jones. (Getty/Steve Debenport)

During the COVID-19 outbreak, certain patient populations are at a higher risk of not taking their medications as prescribed, which could have major health implications.

The coronavirus pandemic is widening disparities in medication adherence between patient populations, an analysis from startup AllazoHealth shows.

New York City-based AllazoHealth supports 10 million patients on medication adherence programs. The predictive analytics company developed a tool to assess patients’ risk of medication non-adherence and identifies the most effective intervention strategies for individual patients. AllazoHealth works with health plans, pharmaceutical companies, pharmacies, and pharmacy benefit managers.

Using artificial intelligence, AllazoHealth has identified the patient groups that need the most outreach to stay adherent to their maintenance medications during the COVID-19 outbreak. 

In the past few weeks, major healthcare organizations have made accommodations to allow patients access to their prescription medications. For example, CVS Health is offering 90-day maintenance medication prescriptions for insured and Medicare members, and CVS Caremark is working with all its prescription benefit management clients to waive early refill limits on 30-day prescription maintenance medications.

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These changes in medication access can have an unintended impact on health care utilization, medication adherence and use patterns, AllazoHealth CEO Clifford Jones told FierceHealthcare.

As COVID-19 has rapidly spread in the U.S., there's been a surge in early medication refills, likely motivated by patients’ fears of being unable to access their medications for an undetermined period, according to AllazoHealth.

At the same time, news reports have warned of potential drug shortages of COVID-19 and non-COVID-19 therapies due to increases in pharmaceutical demand and supply chain disruptions.

Between March 14 and March 21, the percentage of prescriptions filled more than a week before their due date more than doubled, increasing 18% in just one week, the company's analysis shows. The percentage of prescriptions filled more than 8 days early went from around 17% to 35%.

Medication adherence improves when patients refill their maintenance medications early, Jones said.

"It's good that patients are preparing for COVID and getting their fills early. But if patients continue to get their fills early, and each fill is early every time, this could result in some patients having a lot of supply. It could get to the point where this increased demand could result in shortages due to these policies," he said.

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AllazoHealth uses AI to predict patient risk scores for medication non-adherence to help health plans and pharmacies more effectively target those patients for interventions. The company analyzed how this surge in refills would impact both higher-risk and lower-risk patient populations.

Fewer patients are filling their prescriptions late since the spread of COVID-19, and that's true among both higher-risk and lower-risk populations, the company said.

But there are widening disparities. More low-risk patients made positive changes in their behavior: the percentage of low-risk patients who filled late dropped from 43% pre-COVID to 29% post-COVID outbreak, a 33% decrease.

Among high-risk patients, 49% are still filling prescriptions late, a drop of only 13% from 57% before the COVID-19 outbreak, AllazoHealth's analysis shows.

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The gap between high-risk patients and low-risk patients filling their medications late has increased to 20% from 14%.

"More lower-risk patients are taking advantage of these policy changes and changing their behavior," Jones said. "Overall we're seeing an increase in people getting their medications but that doesn’t mean it is helping everyone equally."

While there are competing demands driven by the pandemic, health plans and pharmacies need to engage these high-risk patients who need more support as these patients are less likely to take action on their own, Jones said.

Health plans also need to shift the types of interventions and messaging they use for individual patients, he noted.

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"Patients have a lot going on at this time. Organizations need to make sure they are not mass targeting patients with messages that are only relevant to some of them," he said.

Data and AI can help to identify the types of engagement that work most effectively with individual patients. Engagement strategies include helping patients sign up for a home delivery service or converting their next fill to a longer days-supply, which could help to improve adherence.

The COVID-19 outbreak is causing major disruptions to patients' lives and driving behavior change, Jones noted, and organizations will have to adjust their medication adherence programs to account for those changes.

"The traditional ways of looking at year over year data are not going to apply effectively. There's been a drastic shift in behavior due to COVID and in order to determine who needs support, the regular metrics are going to be a little wonky," Jones said.