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CMM 36517 MARExecutiveSummary Digital

2020 Medication Access Report
EXECUTIVE SUMMARY

Advisory Board
The Medication Access Report is published by CoverMyMeds in consultation with an advisory board of leaders from across the industry:

Morgan Bojorquez Director, HPS Clinical Integration & Implementation, Humana
Nicole Braccio, Pharm.D. Director of Policy, National Patient Advocate Foundation
Nick Calla SVP, Industry Relations, Orsini Healthcare
Kristina Crockett VP, Product Management, RelayHealth
Hemal Desai President, BestRx
Regina Murphy VP, Product Strategy, RxCrossroads by McKesson
Robert Nace VP, Specialty Industry Relations, OptumRx
Lynne Nowak, M.D. VP, Clinical & Provider Strategy, Express Scripts

Melissa Paige Pharmacy Patient Medication Access Principal Coordinator, University of Virginia Health System
Judy Sorio Director, ePrescribing Services Development, Cerner Corporation
Rebecca Snead, R.Ph. EVP & CEO, National Alliance of State Pharmacy Associations
Brian Stalder Manager of Pharmacy Operations, Blue Cross Blue Shield North Carolina
Lee Ann Stember President & CEO, National Council for Prescription Drug Programs
Eric Weidmann, M.D. Chief Medical Officer, eMDs
Joel White President & CEO, Horizon Government Affairs

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Introduction
Patients face significant healthcare barriers while trying to get the medications they need to live healthy lives.
The 2020 Medication Access Report examines price transparency, prior authorization and complexity of specialty therapies as major areas influencing medication access for patients. Careful consideration of patient circumstances and point-of-view, along with stakeholder perspectives, is critical for development and success of healthcare IT solutions.

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Price Transparency and Consumerism
With many now covered under high-deductible health plans, patients are increasingly exposed to high out-of-pocket costs and are vulnerable to prescription abandonment or medication nonadherence over one third of all Americans are at risk.1
© 2020 CoverMyMeds LLC.

35% of Americans are uninsured or under-insured.1
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Prescription Abandonment

Prescription Abandonment Increases 0.6% For Each Out-Of-Pocket Dollar
Actual Data Model

Out-Of-Pocket Cost

It's estimated that only one third of high-deductible plan members reach their deductible for a given year. Average patients do not reach their deductible until about halfway through the year.2,3
A recent survey of 1,000 patients found that 69 percent have made personal sacrifices during their deductible period to afford prescribed medications one in three patients make this decision once a month or

more frequently.4 For some, this financial strain is too much one third of surveyed patients admitted to going without their medications if too expensive.4
A recent study of brand name medications revealed that as out-of-pocket costs increase,5 prescription abandonment appears to rise exponentially at a rate of ~0.6 percent for every dollar, before leveling off around 69 percent as costs exceed $250.

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When asked to pick the most important factor for making decisions about prescription medications, most surveyed patients prioritized paying the lowest price. As a result, empowering patients to be informed consumers of health may be the most effective strategy for improving medication access.
Prescription decision support (PDS) at the point-of-prescribing and beyond, through tools like real-time benefit check, can supply providers, their care teams and patients with price transparency information and affordability options to make informed healthcare decisions that consider clinical factors and personal circumstances.
For more information about price transparency, consumerism and available healthcare solutions, read our 2020 Report on Prescription Decision Support.
© 2020 CoverMyMeds LLC.

Patient Sentiment4
69% of patients make personal or financial sacrifices to afford their medications
77% of patients think it is important or very important to discuss affordability options with their provider
29% of patients abandon their prescriptions when they can't afford them
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Prior Authorization
Prior authorization (PA) is an ongoing challenge for patients seeking access to prescribed medications.
In fact, it is estimated that seven percent of all prescription claims are rejected due to PA and 37 percent of those prescriptions are abandoned by patients.6 As 5.8 billion prescriptions were dispensed in 2018, PA could be the cause of over 150 million patients7 not getting the medications they need.
© 2020 CoverMyMeds LLC.

37% of prescriptions rejected due to PA are abandoned.6
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Providers report spending an average of two business days a week (14.9 hours) completing PA requests and 86 percent claim that the PA burden for their office is high or extremely high.8

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Beyond such access challenges for patients, PA is perceived as a significant administrative burden for healthcare stakeholders across the industry with providers, pharmacists and payers spending thousands of hours to complete requests.
In a recent survey, providers most often cited reduced face-to-face time with their patients as a major consequence of PA.4 When completed by phone and fax, determination for PA requests can delay time-to-therapy leading 91 percent of providers to agree that PA has at least some negative impact on patient outcomes.8
Electronic prior authorization (ePA) remains the most effective solution for such PA-related difficulties. Through real-time transfer of information, ePA streamlines how PA requests

are completed and can improve how quickly determinations are received from health plans.
91% of providers asserted that PA can have a significant or somewhat negative impact on clinical outcomes for patients.8
Despite the benefits offered through ePA, half of PA volume is still completed through outdated phone and fax channels.9 Efforts to improve provider adoption of ePA are important for easing stakeholder burden while improving time-to-therapy for patients.
For more information about PA, ePA and provider adoption, read our 2020 Report on Electronic Prior Authorization.

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Complexity of Specialty Therapies
Specialty medications offer hope to patients with rare or chronic diseases, but their high-cost and complexity create distinct medication access challenges.
Although they only account for 2.2 percent of prescription volume, specialty medications account for 45.4 percent ($218.6 billion) of total pharmacy spending.10,11
© 2020 CoverMyMeds LLC.

2% of prescription volume accounts for 45% of spending
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Utilization of such therapies is increasing at more than twice the rate of traditional medications, so rapid change is needed to streamline inefficiencies and improve patient support services to help patients get the specialty medications they need.
Of more than 500 specialty patients recently surveyed, 60 percent claimed that they had some difficulty in receiving their first dose of specialty therapy and 76 percent reported their personal role in coordinating care as involved or very involved.4
Over a third of these patients spent more than three hours of their personal time coordinating care. Nearly one in ten surveyed patients reported waiting 8 weeks or more to receive their first dose of therapy.4
© 2020 CoverMyMeds LLC.

Patient Challenges

60% of patients had some difficulty receiving their first dose

76% reported their role in coordinating care was involved or very involved

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Patient support services, or hubs, exist to guide patients through the difficulties of specialty access, affordability and adherence. Despite the value they bring, awareness for such programs is low and administrative inefficiencies can still delay time-to-therapy.
According to a recent survey, ~two out of five providers are not aware of such support and four out of five associate

coordinating care for specialty medications with some level of difficulty.4 Technological improvements to the traditional support model are needed to solve for these challenges.
For more information about specialty medications, patient support services and areas for improvement, read our 2020 Report on Specialty Patient Support.

Only 63% of specialty patients are aware of support programs

Only 63% of providers are aware of support programs

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Network Opportunity

As indicated through market research and survey data, rising financial pressures, restricted choice, administrative bottlenecks and limited support are keeping patients from the medications they need to live healthy lives.

Healthcare IT solutions offer strategies to overcome many of the challenges facing patients.
For the entire network to return the most value from new technology, integration and adoption are key.
By promoting awareness and installing operational changes, industry stakeholders can

drive behavioral changes and meaningful use to help more patients.
For more insights into patient challenges and innovative solutions, read the full Medication Access Report, along with three supplemental reports on ePA, PDS and specialty patient support.
go.covermymeds.com/medicationaccessreport

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SOURCES

1. Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2026, Congress of the United States, Congressional Budget Office, 2019
2. Emergence and Impact of Pharmacy Deductibles: Implications for Patients in Commercial Health Plans, IQIVIA Institute, 2015
3. Deductible Relief Day: How rising deductibles are affecting people with employer coverage, Peterson-KFF Health System Tracker, 2019
4. CoverMyMeds Patient and Provider Surveys, 2020
5. Patient Affordability Part Two, Implications for Patient Behavior and Therapy Consumption, IQIVIA Institute, 2018

6. CoverMyMeds data on file, 1, 2020
7. Medicine Use and Spending in the U.S., A Review of 2018 and Outlook to 2023, IQIVIA Institute, 2019
8. 2018 AMA Prior Authorization (PA) Physician Survey, American Medical Association, 2019
9. CoverMyMeds data on file, 2, 2020
10. Medicine Use and Spending in the U.S., A Review of 2018 and Outlook to 2023, IQIVIA Institute, 2019
11. Specialty Drug Spend Soars. Can Formulary Management Bring It Down to Earth?, Managed Care, 2019

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