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Adherence, Compliance Key with Underinsured

04.10.2009Managed Healthcare Executive

bu Tracey Walker

A recent study by IMS Health Inc. reports prescription drug sales in the United States rose 1.3% in 2008 to $291 billion—compared with a 3.8% increase in 2007, about an 8% increase in 2006 and double-digit percentage sales growth in earlier decades. Patients are opting for cheaper generic versions of their prescription drugs or in severe cases, are choosing to go without necessary treatment because they simply cannot afford the medical expenses.

The issue behind this trend is that a pandemic of underinsured patients continues to spread exponentially as the economic downturn progresses, according to David L. Knowlton, board member of the national nonprofit HealthWell Foundation in Gaithersburg, Md. HealthWell provides financial assistance to patients with chronic or life-threatening illnesses to cover certain out-of-pocket costs.

“Managed care executives have always been interested in quality healthcare in their plans while keeping costs manageable for all involved,” says Knowlton. “The key to accomplishing that is their members’ adherence and compliance with treatment regimens.” The numbers above show the tip of a non-compliance iceberg and reinforce the fierce urgency for reform. It also is the leading edge of more radical drops in compliance if the economy worsens, he says.

According to Knowlton, when individuals find themselves in dire circumstances, there are very few strands for them in the safety net until one is in serious poverty.

“Copayment charities . . . have seen a dramatic surge in applications from the underinsured who need help,” he says. “Ultimately, though, to truly meet people’s needs, healthcare reform must take place and must provide long-term affordability, coverage for all, no exclusions for pre-existing conditions, and low enough copayments for people to afford.”

While managed care executives could lower costs and copayments in their plan designs as an alternative, the current economic realities would seem to push in the opposite direction, says Knowlton.