Proactive pharmacy outreach with VBC: Better medication adherence, lower costs

Scott Greenwell, Pharm.D

Senior VP & President, Humana Pharmacy Solutions


Mr. Greenwell manages existing Humana Pharmacy Solutions capabilities while working to develop new initiatives that support improving health outcomes. He has been integral in preparing Humana for the launch of the Medicare Part D benefit, opening Humana’s Mail Order and Specialty Pharmacy offerings and leading creation of Humana Pharmacy Solutions’ clinical program.
MA members affiliated with physicians in value-based agreements filled more prescriptions in 2020 than those with non-value-based prescribers, but they spent less for those medications thanks in large part to the inclusion of generic drugs.

Members with value-based physicians had more than 10% higher utilization than non-value-based members, according to Humana internal data. But with their providers prescribing more generics than higher-priced name-brand medications, they spent an average of 35 cents less per month out-of-pocket, with that spending amounting to $234 for the year. The prevalence of generics in member medication regimens also translated to lower year-over-year cost increases for those with value-based practices, rising 11% compared to 14.5% for non-value-based.1

Physicians in the highest risk arrangements showed more value than the total value population, with costs going up between 5.8% and 8.6% and utilization up only around 2%. Comparatively, non-value-based utilization was up 5.3%.1

Contributors to the difference in use may be non-value-based members who received prescriptions but failed to fill them. Fewer prescriptions being written by non-value based physicians due to them seeing their patients less frequently than value-based physicians also contributed to this number, according to an internal analysis.

Value-based physicians’ ability to successfully manage their patients’ chronic conditions meant their prescriptions collectively were dominated by maintenance medications and resulted in less reliance on costlier specialty drugs—those prescribed to help control complex diseases. That focus on controlling conditions and routinely reinforcing the value of adherence appeared to resonate with members.

Therefore, when it came to specialty medications, those in the value-based cohort used and spent less for prescriptions connected to a number of common chronic conditions than those in the non-value-based cohort. That included medications for diabetes, chronic obstructive pulmonary disease and rheumatoid arthritis.

Why it matters:

Medication, and particularly adherence, is a critical element of patient care strategy and the value-based model.

The use of generics, when appropriate, provides additional value to members and helps curtail rising pharmaceutical spending.

Compliance among Humana’s individual MA membership was 86% or higher in each of four adherence areas factoring into quality ratings from CMS related to diabetes, hypertension and statin use. Members with value-based physicians averaged 2.5% improved adherence in those categories than those with non-value-based physicians.1

The way forward:

Limiting disruptions in treatment is a key to patient safety. Humana and its network providers adapted processes during the pandemic to ensure patients had necessary medications.

Pharmacists allowed for early and extended refills for Humana individual MA members, of whom 1 in 10 at the height of shutdowns in March and April 2020 refilled early.

Several practices expanded their home services to include medication delivery.

Further improving the customer experience through convenience, Humana Pharmacy’s mail order service helps MA members facing pharmacy and pharmaceutical access, such as transportation and social distancing, overcome those hurdles.

The mail order service ranked highest in customer satisfaction in the 2021 J.D. Power U.S. Pharmacy Study for the fourth consecutive year, earning its highest score during that stretch amid the pandemic. The pharmacy received a 906 out of 1,000 in all four of the study’s mail order pharmacy categories: prescription ordering and filling process, cost competitiveness, prescription delivery and customer service experience.