Over the last year, the healthcare ecosystem has tested and pushed past boundaries that wouldn’t budge before. As a society, we’ve found ways to recreate daily life patterns through a pandemic, and the historically inflexible healthcare industry also transformed — medication management included.
Due to relaxed regulations and social distancing measures, patients received longer fills of maintenance medications, visited the pharmacy at different frequencies — and often for different reasons than before— and may have even weathered drug shortages due to supply chain issues.
With new measures and habits in place, and others, such as the federal bills tackling prescription price control, the future of prescription management will likely remain patient-centric — as long as technology and related policies can keep up with the demands of healthcare consumerism.
In this piece, we examine the trends that have shaped the last year in medication management, and the ways pharmacists and providers have adapted to these changes, plus look ahead to solutions currently in motion to further progress on this issue.
For a deeper look into the legislative moves addressing medication access, check out our 2021 Medication Access Report: Legislative and Regulatory edition.
Prescribing and specialty therapy trends
In 2020, overall prescription volume dropped by as much as 12 percent, compared to 2019 baseline levels. As office visits dropped and patients stayed home, some suffering through undiagnosed conditions, new prescriptions plummeted by as much as 37 percent in 2020. On the other hand, continuing prescriptions remained fairly stable, only dipping as low as 8 percent during 2020 — in part due to relaxed or waived medication regulations, for prior authorization (PA) and refill-too-soon orders, which allowed patients access to prescribed medications during office closures.
While 2021 prescription volume has started to show rising trends over 2020, not all specialties are created equal. Prescriptions to treat mental health conditions increased over 2019 levels, with new prescriptions up by as much as 25 percent, though the percentages varied from state to state.
This could be related to how these conditions are diagnosed: Psychiatrists saw the least impact on diagnostic visits during 2020 lockdown months compared to other specialties. This area is also easier to convert from office to telehealth visits, compared to a specialty like rheumatology or dermatology where seeing the patient in-person can make a bigger impact on a provider’s diagnosis or treatment plan.
Another impact area is telehealth. Office visits have returned to normal levels, but telehealth is here to stay, especially if legislation allowing telehealth expansion becomes permanent in many states. Medical claims data from 2020 showed prescribers were less willing to initiate new prescriptions remotely, with as much as a 40 percent difference in prescribing volume for in-office visits over telehealth visits. This could be due to a lack of diagnostics tools or shorter telehealth visits compared to in-office visits.
Providers have experienced these trends differently. While 80 percent of providers in our 2020 survey had positive experiences with telehealth, 40 percent noted an increase in administrative burden.
But no matter how they’re interfacing with patients, providers can benefit from in-workflow technology to make the prescribing process easier. Not only do solutions such as real-time prescription benefit save time by surfacing patient data and even PA requirements, they can also help spark affordability conversations via telehealth while a patient is already engaged with technology. This allows patients visibility into the prescribing and benefit process and can help prevent barriers later on at the pharmacy.
For a broader look into the impact COVID-19 had on the healthcare industry, check out our COVID-19 & Medication Access report.
Prescription reception behavior changes
In our 2019 patient survey, 88 percent of patients surveyed reported receiving their prescriptions from a retail pharmacy, before most pharmacies offered any kind of delivery service. In 2020, many pharmacy chains, payers and PBMs began offering home delivery services — often free of charge. By September 2020, half of patients surveyed reported receiving prescriptions at home during the previous six months.
Forty-one percent of pharmacists surveyed in 2020 said they’ve started prescription home delivery services since the start of COVID-19. As pharmacies continue to expand delivery and partnerships with existing delivery services, these trends are likely to continue, with technological advances to follow.
In a survey with pharmacists, one pharmacist in-charge from Texas said their retail pharmacy started prescription delivery, and offered ideas for both provide patient visibility and to improve pharmacists’ workflow.
“Our delivery process ... is far from perfect. People expect (food delivery) speed in an industry that’s much more complicated, regulated and expensive than food. ... Patients should be able to open an app and see exactly what queue (position) their prescription is in and when it’s due to be returned to stock. They should be able to input their own insurance info via the app. We should be able to push messages through, like if their med is on backorder or if they need a PA.”
Technology to support patient-centric prescription management, such as delivery choice, can help patients feel more in control of their healthcare and manage their information at their own pace. They can update current medications, health issues and any allergies through connected devices. This also helps eliminate some of the administrative work off pharmacists, allowing more time for urgent or complex questions.
The expansion of the one-stop-shop pharmacy
Due to the COVID-19 pandemic:
- 27% of patients rely more on their pharmacist for information regarding their condition and medication
- 18% of patients relied more on their pharmacist to explain benefit and payment options for my medications
- 70% of pharmacists have taken on new job responsibilities
The COVID-19 pandemic made glaringly obvious the pivotal role pharmacies can play in primary care. Over 40,000 pharmacies nationwide have been part of the federal vaccination effort, contributing to the mass distribution of one of the most-desired medications in history.
In addition to vaccination, this effort also revealed to many patients an accessible option for future vaccinations, routine wellness exams and acute illnesses — and within 5 miles of home, for nine out of 10 Americans. Providers within pharmacies are becoming more common and allow patients easy access to their medications.
While most pharmacists themselves can order and administer vaccinations, few states allow pharmacists independent provider status to prescribe medications. More than 40 pieces of legislation are currently pending in states regarding pharmacist provider status, ranging from prescriptive authority to COVID-19 medication administration.
Most states allow collaborative practice agreements, in which a pharmacist and a physician have an agreement to allow pharmacists some patient care authority such as adjusting medications, prescribing and ordering labs. If granted provider status, pharmacists have the potential to improve patient care through expedited PA, medication changes and lab billing and administration, like A1C, in support of value-based arrangements.
In-workflow technology at the pharmacy could further boost time savings and help reduce the administrative workload for the entire patient care team. Pharmacists using a solution that provided real-time PA status updates saw an average 14 percent increase in paid claims than those using standard electronic PA request submission methods.
Patient prescription choice and visibility would have eventually arrived at the level of accessibility and electronic access we’re seeing today — but it’s likely the COVID-19 pandemic accelerated the course. As healthcare consumerism demand increases and the pharmacists’ role on the patient care team grows importance, it’s likely technology, too, will need to keep pace.
Read more about prescription trends in the 2021 Medication Access Report.