Importance of Compliance Performance by Patients

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

As crucial as it is for Pharmacy Benefit Managers to comply with the terms and guarantees outlined in a pharmacy benefit contract, it is equally as important for patients to comply with the care and treatments they are getting. Since treatments for disease states like asthma, diabetes and multiple sclerosis can vary depending on the severity of an individual's condition, patients who receive services must be aware of exactly what is required on their end in order to reap the rewards and benefits that treatment brings.

Since some treatments are long term, it can be easy for patients to stray away from their plans. For example, for a disease state such as Type 2 Diabetes, treatments may require complete lifestyle changes where all aspects of their daily routines require close monitoring; individuals with Type 2 Diabetes are encouraged to follow a certain diet, exercise regularly and monitor their blood sugar - and that's in addition to being compliant with their medication and/or insulin therapy. 

Similarly, some treatments for relapsing cases of Multiple Sclerosis involve several doses of medication, which requires patients to follow a tight schedule. Furthermore, many MS treatments involve rehabilitation services, whose length may depend on the severity of the disease. But although treatments can be quite lengthy and rigid, it is absolutely necessary for patients to comply with their plans, since avoiding medication or other available services will result in higher costs for both the plan and the members.

As most treatments available, those for disease states like diabetes, asthma and MS come at a cost. According to the American Diabetes Association, patients living with diabetes acquire about $7,900 in medical charges each year. While health insurance takes away some of the burden for those who have access to it, the cost of treatment is another contributing factor to why people are not compliant with their programs. Although compliance is hard to track, there are several metrics that can be used to determine if the increase in pharmacy benefit PMPM and overall medical spend is connected to a change in compliance on a quarterly basis.

At PBIRx, we recognize the importance of compliance performance by both patients and their PBM and have developed proprietary medication therapy programs and algorithms for many disease states. Our consultants can analyze your plan and provide a courtesy proposal outlining our cost saving services. For more information on how we can help, please visit us on our website or contact us at (888) 797-2479.