Reasons Behind Non-Adherence in Patients

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

When presented with a medication or other health care service, one would naturally assume that the patient who received it would follow through. However, recent reports have shown that many patients actually fail to comply with several health care services, particularly prescription medications, and unfortunately, this has led to an increase in health care costs.

Earlier this month, Express Scripts reported that "non-adherence is a major contributor to skyrocketing health care costs as well as higher rates of hospital and ER visits for patients who do not take their medications." But why exactly are patients leaving their medications in the dust? Well, the report further explained that 69% of non-adherence by patients is a result of certain behaviors such as forgetfulness, procrastination and even confusion; when patients have multiple medications to take, it can be easy to get things mixed up. Additionally, aside from the patient's own behavior, the cost of such medications has also proven to be a cause of non-adherence in 16% of cases. Lastly, 15% of non-adherence is due to clinical side effects, according to the data provided by Express Scripts.

So what can be done to combat this issue? First and foremost, if a medication is too expensive or causes severe side effects, the first plan of action should be to switch it for that particular patient. Or, if there is no alternative, health care providers should work with the patient as closely as they can to make their current situation work. If copayments for mail order prescriptions and if mail order discounts are competitively negotiated by an independent third party like PBIRx, home delivery for medications can offer patients reminders so that they don't lose track of when it's time to take or renew a medication.

To learn more about non-adherence in patients, including how it is directly linked to rising health care costs, check out this article from HealthIT Analytics.

At PBIRx, we understand just how big a role non-adherence plays in health care costs. And as a company whose main priority is to reduce costs wherever possible for our clients, we encourage you to contact us if you're struggling to keep up with the rise in prices for prescription medications so that we can audit your pharmacy benefit plan. For more information, please call (888) 797-2479 or visit us at www.pbirx.com today.

PBIRx Client Testimonials

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Established in 1993 by President and Founder Pat Sirowich, we at PBIRx have been providing solutions for the management of pharmacy benefit plans and health care costs for many years. Since our inception, it has been our goal to create optimal health care outcomes for those we work with, which in part includes minimizing total health care costs. To date, after gaining many valuable experiences and practicing our trade, we are proud to say that we have accomplished just that and continue to do so with each client who comes to us for help.

If you are in need of assistance with your pharmacy benefit plan OR your pharmacy benefit costs are exceeding your budget, PBIRx encourages you to give us a call. Why? Just take a look at what some of our current clients are saying about us:

"Thank you again for all the help and guidance you've given us over the years to keep our prescription drug costs down. This helps us keep more funds in our program budgets to directly benefit our students. I truly appreciate all your hard work."

"Thank you both again for the presentation and all the work you do on behalf of LEARN and the Cooperative. Because of your help and guidance, more dollars can go directly to benefit students and in this economy that really helps."

"You always provide excellent superior service! It worked because of you and I really appreciate it! You're just always on your game, provide the best client services and I would refer anyone to you!!"

"We would like to thank you for all your hard work on our prescription drug plan. We certainly learned a great deal yesterday and we both felt the process you followed was extremely thorough."

"Thank you for the information and for all the work you've done on our behalf. We are very pleased with our drug plan and especially the cost."

"You're terrific! We couldn't ask for more in a partner for our Rx needs."

Our diverse, dedicated staff of actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers, IT personnel and more are truly grateful for the opportunities we have been given to assist with pharmacy costs and hope that we have the chance to help YOU next! 

For more information about our services, including pharmacy benefit consulting and auditing, please visit us at www.pbirx.com or give us a call at (888) RxPBIRx (797-2479) today.

Clinical Technology Intelligence (CTIRx) By PBIRx

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

At PBIRx, we are all about finding ways to minimize healthcare costs by developing cost saving solutions that each of our many clients can benefit from. Aside from our consulting and auditing services, one of the major benefits we offer is our clinical technology intelligence, also known as CTIRx. Through this service, our goal is to promote clinically appropriate prescription drug utilization, which in turn results in positive healthcare outcomes (including pharmacy benefit savings, of course).

To ensure that our clients are paying the appropriate prices for pharmaceutical services, we run their claims through our CTIRx data processor. Then, we carefully analyze the results to determine what steps must be taken next in order to present our clients with the most beneficial clinical savings programs.

But what exactly are we analyzing?

Throughout the process, we complete a monthly analysis of cost and claims for all types of prescription drugs, review physician prescribing practices and manage specialty spend by following along with the steps presented in our specialty drug tool box. Furthermore, we analyze the cost of prescriptions through medical J code and compare that to the pharmacy benefit, and determine how we can alter drug dispensing to further benefit the client.

Since pharmacy benefits are so complex by nature, we have made it our priority to offer providing entities the services they need to ensure that what they are spending accurately reflects the lowest possible prices. For more information about our CTIRx services and how we can help you manage your pharmacy benefit costs, please visit our website or contact us at 1 (888) RxPBIRx (797-2479) today.

The Benefits Of Auditing Your Pharmacy Benefit Plan

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Although you may have a fantastic relationship with your PBM and trust that they are billing the pharmacy claims according to the terms and agreements outlined in your contract, you are only doing yourself an injustice by not having a professional with state of art technology and experts to examine your claims file as compared to contract language and discounts to confirm accuracy of adjudication. After all, it is very easy for things to get lost in translation or during the time that your PBM's personnel manually enters data. 

When you have your pharmacy benefit plan audited by an expert like PBIRx, you can be sure that the financial terms, rebates and guarantees in a PBM contract are met by your Pharmacy Benefit Manager and that any discrepancies are negotiated in your favor.  

As a providing entity, an auditing program such as our own, Audit Rx, will give you control over the terms stated in your contract so that you know exactly what discounts and rebates you should be receiving. And the best part? If you have lost out on savings because your PBM has not acted according to the terms in your contract, when you audit with PBIRx, you can earn those savings right back! We have a proven track record of negotiating extensive recoveries for our clients due to discrepancies in what is stated in a contract vs. the actions taken by the PBM. Through both our Audit Rx program and our 340B compliance audits, you can rest assured that you're not paying a penny more than necessary.

With the new year well underway, are you finally ready to have your plan audited for accuracy? If so, we're ready to help! To learn more about our pharmacy benefit auditing services, visit us on our website or contact us at (888) 797-2479 today!