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Radar On Market Access: Express Scripts Exec Urges Smarter Treatment of HIV

Posted by Leslie Small on Nov 1, 2018

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At the annual Medicaid Health Plans of America conference, Express Scripts Holding Co. Senior Vice President and Chief Medical Officer Steve Miller, M.D., had a simple message for health plan leaders: "You have to think long term if you're going to have better outcomes," AIS Health reported.

One area in which Medicaid is not heeding that call, Miller said, is how it approaches treating and preventing HIV.

While the number of HIV patients is decreasing, the amount spent on treating HIV has risen in recent years — and the culprit is rising drug costs, Miller said. Thus, Medicaid programs and plans are often choosing to cover the least expensive medications, which tend to be multi-tablet regimens, rather than pricier single-tablet therapies, he said.

While that approach may cost less in the near term, patients treated this way are less likely to be adherent to their treatment plans than those who get a single-tablet therapy.

According to Miller, that link between medication adherence and simplified treatment regimens is key, as medication non-adherence can lead to complications that ultimately make patients more expensive to treat.

Commercial health plans, which have less of an issue with finances than Medicaid, almost always choose single-tablet regimens for patients, according to Miller. Medicaid beneficiaries with HIV, on the other hand, are getting single-tablet regimens less than 60% of the time.

"So the reality is we're sub-optimizing that care, and therefore we're actually going to cost ourselves a lot more in the long run," he added.


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Topics: Industry Trends, Payer, Specialty, Provider