Inflammatory conditions and multiple sclerosis (MS) are complex specialty conditions with no cure. And yet rising costs, side effects and comorbidities complicate adherence to required therapy.
Express Scripts research found that participation in Patient Assistance Programs (PAP) help to increase medication adherence for patients with an inflammatory condition or multiple sclerosis. Our previous study showed similar positive results for oral oncology drugs.
PAPs provide eligible patients with financial assistance for medications that would otherwise be cost-prohibitive. Without these critical programs, the cost impact of specialty medications may lead some patients to delay or forego treatment. For example, another recent study found a startlingly low uptake of patients beginning treatment in the first six months after diagnosis primarily due to the cost of treatment. In that study, patients who received financial assistance started treatment within 58 days of diagnosis, compared to 108 days without assistance.
Most Costly Therapy Classes
According to our Drug Trend Report, inflammatory conditions and multiple sclerosis represent the two most costly specialty therapy classes, when ranked by per-member-per-year spend.
When combined with oncology, these three classes represent more than half of the nation’s spend on specialty medications.
Express Scripts identified a subset of patients taking medication to treat inflammatory conditions and MS during 2014 and 2015.
The study compared medication adherence rates of those who enrolled in a PAP in 2015 to adherence rates of those who did not enroll over the same time period. Additionally, multivariate models were used to assess the impact of PAP enrollment on adherence controlling for elements such as: demographics, prior adherence, and average household income via census data – creating rigorous research results.
Patients with inflammatory conditions enrolled in a PAP saw a 7% improvement in adherence, compared to patients not enrolled in a PAP. MS patients enrolled in a PAP experienced a 9% improvement in adherence, while patients not enrolled in a PAP experienced a decrease in adherence rate by as much as 2%.
Our results show that enrollment in a PAP, alongside receiving specialized clinical care does help improve adherence and close the financial gap for patients in need.
Specialized Care from Accredo
Accredo specialty pharmacy connects payers and patients with the copay assistance they need. In fact, 98% of specialty drugs at Accredo have a copay assistance program available for patients. Last year alone we helped secure $364 million in total assistance and continue to lead the industry in this space.
In addition to receiving financial assistance, Accredo patients benefit from specialized care from our 14 condition-specific Therapeutic Resource Centers. Our clinical model, centered around the TRCs, allows us to provide patients with the additional resources they need to manage their condition, including:
- Access to 500 specialty pharmacists on the phone and through video conference
- 550 field-based infusion nurses who meet patients face-to-face in their homes
- Nutrition counseling and social worker support
- Therapy management programs to protect patient health and safety
- Complete coordination of care between the medical benefit, pharmacy benefit and physicians
- Safe, prompt delivery of medications, including extensive training on administration of the medication
For patients with MS, this results in 66% fewer ER visits and 23% lower annual medical costs. Patients with inflammatory conditions achieve 23% fewer MD office visits, 9% fewer hospitalizations and a 16% higher overall adherence to their therapy.
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