A Prescription for Success Amid the COVID-19 Crisis

Patient with pill bottle

PBD’s proactive measures ensure members have access to their medications

BUFFALO, N.Y. - June 19, 2020 - The COVID-19 crisis has had a widespread impact on many businesses. Companies in numerous industries have had to adapt and evolve the way they do business to ensure they could continue to meet the rapidly changing needs of their customers.

At the onset of the pandemic in February 2020, Pharmacy Benefit Dimensions (PBD) immediately realized medication-use behaviors would be affected. As a pharmacy benefit manager that administers prescription drug plans for self-funded employer groups and Medicare Part D prescription drug plans, PBD moved quickly to put new policies and procedures in place to ensure its members would have adequate supply and access to their prescribed medications. By establishing these proactive initiatives early, PBD has also helped to mitigate the administrative strain on providers.

“With the shelter in place mandate, we were concerned how members would go about getting their meds,” said Pat Comerford, PBD’s director of customer service and engagement. “We tried to alleviate their concerns. This is a critical time to help our members remain adherent to their medications.”

“All the changes we implemented for COVID have actually increased our member’s medication compliance during a national shutdown,” said PBD President Lynne Reilly.

PBD takes patient adherence rates seriously. These calculations show that members are taking the right drugs, on time and in the proper doses.

During the first quarter of 2020, PBD’s adherence rates for several drug categories were higher (better) than they were at this time last year. See graphic:

97% of High Cholesterol users are > 80% adherent
96% of Blood Pressure users are > 80% adherent
91% of Diabetic patients are > 80% adherent

95% of High Cholesterol users are > 80% adherent
95% of Blood Pressure users are > 80% adherent
89% of Diabetic patients are > 80% adherent

Adherence, also referred to as Mean Possession Ration (MPR), is a measure of how much medication, on average, a member has in their possession at any given time. It is calculated by looking at how many “day’s supply” a prescription is and how often it is being refilled. For example, if a member received a 30-day prescription, and it was filled every 30 days, the member would be 100% adherent. On a national level, the average MPR is 80%.

Medication nonadherence may lead to a worsening in a patient’s condition and increased health care costs.”

“Increased adherence would presumably lower the overall health care costs for members and employer groups,” said Tim Flanagan, PBD’s director of business operations. “This would be due to members receiving overall better care.”

Among the programs PBD initiated during the COVID-19 crisis include:

  • Submission code 13: This is a code the pharmacist enters on a claim prior to submitting it to PBD. When PBD’s system sees that a pharmacist submitted a code of 13, the system eases the early refill edit to allow the patient to fill the medication. By allowing the pharmacist to submit the code themselves, it eliminates a call to the PBD Help Desk by the pharmacist to get an override. This eases the administrative burden on pharmacists and helps them focus on patients. This is just one example of why PBD has a 100% Pharmacist Satisfaction score in 2019

    “It is extremely important to PBD to maintain a high level of medication adherence rates,” Flanagan said. This override allowed us to maintain these adherence rates without inconveniencing the pharmacies. In addition, this early access to refill medications eased the burden for many members throughout the country who may have struggled to make multiple trips to the pharmacy during this pandemic. It has allowed them to have a supply of their medications on hand to ensure they remained adherent.”

  • Prior Authorization (PA) extensions: Some members received 60-day extensions on certain PAs that would have expired in March, April, and May. PAs were extended for those drugs that members have already been on regularly that require periodic renewal.

    “We did not want anyone to discontinue their medications just because they could not get into their provider’s office for a visit to get a new PA for a drug they were already on,” said Stefan Brand, supervising pharmacist, prior authorization. “This measure has allowed our members improved access to their medication.”

  • Drug shortage monitoring: PBD remained in contact with local wholesalers to determine drug shortages or if a drug is out of stock. If a drug is out of stock, PBD helps identify potential alternatives for members. The monitoring process includes keeping records for the calls PBD receives about the drug shortages from pharmacies and members.

    “We never want our members to go without their medications, so we do everything we can to make sure the member is taken care of,” said Janine Osswald, pharmacy help desk specialist, who has been instrumental in spearheading the drug shortage monitoring process.”

PBD has also seen increased utilization in its mail order programs for 90 day-supplies delivered to the home and a continued strong partnership with its sister company, Reliance Rx, has helped ensure members receive critical specialty medications with direct delivery.

Despite the disruption and uncertainty caused by the COVID-19 pandemic, PBD continues to provide its members with the support they need.

“You would think a barrier (COVID-19 quarantine) would cause a little bit of a dip in adherence rates,” Comerford said. “There’s definitely a strong correlation with the programs in place and the proactive measures we’ve implemented. We have definitely improved access for members by limiting some barriers and check points.”