Pharmacies today face significant challenges, from ever-increasing competition with retailers to quality performance measures to high costs of care and beyond. Like any business, pharmacies must maintain a healthy revenue stream to remain competitive and grow over time.
However, doing so is easier said than done—especially with pharmacy reimbursements directly tied to quality performance metrics, such as adherence to medications for diabetes, high blood pressure, and high cholesterol. This is why many pharmacies have implemented adherence programs to boost compliance, improve health outcomes, and increase profits. Let’s talk about adherence programs and how they drive revenue:
Adherence Programs: How Do They Increase Pharmacy Revenue?
Medication adherence programs are designed to address issues with non-adherence and encourage patients to take their medications as prescribed. With around half of patients not complying with their prescribed drug regimens, the need for strategic and comprehensive adherence programs is more apparent than ever before.
Although not all medication adherence programs are created equal, the most successful ones can significantly increase pharmacy revenue and improve individual health outcomes. In fact, the Consumer Health Information Corporation reports that pharmacies can double their sales in just two years by increasing patient adherence.
Wondering how that’s possible? Well-executed medication adherence programs help increase pharmacy revenue in a few key ways:
Increasing Drug Refills Increases Pharmacy Revenue
Think about it this way: Although many pharmacies offer other profitable services (e.g., immunizations and medication management), their primary moneymaker is still filling and billing. When patients don’t refill their medications, pharmacies lose out on revenue. Implementing an adherence program is an optimal way to proactively intervene and encourage patients to take and fill their medications as prescribed, increasing positive health outcomes and, in turn, pharmacy revenue.
Improving Quality Performance Improves Reimbursement
In recent years, pharmacy reimbursements have been directly tied to quality performance. The Centers for Medicare and Medicaid Services (CMS) Part C and Part D Star Ratings include five pharmacy performance measures, three of which are triple-weighted and specific to medication adherence:
- Medication Adherence for Diabetes Medications
- Medication Adherence for Hypertension (RAS Antagonists)
- Medication Adherence for Cholesterol (Statins)
Plus, certain quality measures impact each other. For example, the Medication Adherence for Cholesterol (Statins) measure overlaps with another Part D measure, Statin Use in Persons with Diabetes (SUPD). As such, pharmacies are financially incentivized to improve medication adherence, therefore increasing revenue and improving individual health outcomes.
Using Smart Data to Improve Adherence Program Effectiveness
With all that said, medication adherence programs are only as effective as the strategy and technology behind them. That’s why more and more pharmacies are using artificial intelligence (AI) to optimize their adherence programs.
Modern healthcare AI solutions—like AllazoHealth’s AI Engine—pull smart data from various sources, including prescription and medical data, historical program data, social determinants of health (SDOH), and consumer behaviors. This data then allows for an individualized, targeted approach, with the ability to predict and prioritize interventions based on each patient’s level of risk and likelihood of being influenced.
AI can further personalize interventions by determining the optimal channel, messaging, and timing for each patient, ensuring messages are delivered with the greatest impact. AI-powered interventions are both more efficient and more cost-effective, ultimately helping pharmacies become more profitable while boosting medication adherence in the process.
Looking to improve the efficiency and effectiveness of your pharmacy’s adherence program? Schedule a demo for a firsthand look at AllazoHealth’s AI technology.