If it can be said that a small ray of light came from the global COVID-19 pandemic, it may be that some inroads were made into changing the way we provide medication access in behavioral healthcare. Unfortunately, changes in access have not gone far enough in ensuring that those receiving care are able and willing to adhere to a medication-assisted treatment plan.

Telehealth services are now utilized at a rate 38 times higher than pre-COVID-19.¹ Additionally, same-day appointments have increased by up to 20%.² But despite these positive moves, non-adherence continues to be one of the most challenging aspects of behavioral health. Up to 56% of those with a serious mental illness are not adhering to therapeutic treatment, according to a 2020 systematic review.³

It is not enough for individuals to find their way to a psychiatrist, they must be able to fill, pay for, and confidently take prescription drugs as directed by their provider. Not taking these medications in a timely manner can lead to serious complications, increased hospitalizations, episodes of violence, a higher risk of suicide and other crises situations.

As access improves, it is imperative to find new solutions to the age-old problem of adherence. Not only that, but we must ensure that people seeking care receive prescription medications as quickly as possible. Too long of a lag between an initial appointment and when someone begins a prescription regimen can lead to poor outcomes similar to those seen in non-adherence.

One encouraging development is the evolution of the care team to include as many clinicians and social support professionals as possible. For prescriptions, this would include a skilled pharmacy partner with the ability to navigate local and individual barriers to medication access. In this article, we will discuss how a connected care team can help to reduce the time between when an individual first sees their provider and when those prescription drugs are in their hands.

Barriers to Timely Adherence

The reality is that, without a dedicated pharmacy partner, psychiatrists have little to no knowledge of or control over when, or even if, a prescription is filled. Nothing ever exists in a vacuum––when individuals fail to fill or take their medications, there is a reason behind it. Traditional barriers to adherence include things like stigma and limited access to providers. Culturally and as individual providers, many have been striving to alleviate these access-driven challenges. When they are successful in bringing people to the office for a diagnosis and direction of care, barriers to accessing and maintaining medication treatment remain.

Some of the common obstacles to medication adherence within the recommended timeframe include:

• Cost. Psychiatric medications can be extremely expensive, even with insurance. And not all behavioral health practitioners accept insurance. This might lead individuals to delay filling medications. Pharmacies can help individuals navigate the complexities of insurance coverage, access financial assistance programs, or look for generic alternatives to help bridge this gap.
• Out-of-network Coverage. Some insurance programs are restrictive in which providers they cover and also which pharmacies are in-network. Out-of-network mental health services often come with higher copayments and deductibles, preauthorization hurdles and limited medication formulary coverage. When people can’t find an in-network pharmacy, they might put off starting treatment, and many wind up in crisis scenarios, or the hospital. An in-network pharmacy partner can help verify which medications are covered, speed up the preauthorization process, and ensure a seamless transition.
• Limited Engagement. The nature of behavioral health issues often means that individuals only stay in a care facility for a short period of time. This brief window may not allow for a comprehensive assessment of the individual’s needs, leading to inadequate planning, fragmented care coordination and limited trust between the care recipient and the care team. By actively engaging with individuals during their short stays and addressing logistical and financial barriers, a pharmacy partner contributes to a proactive strategy for consistently filling medications.

Best Practices to Close the Time Gap

In a mental health crisis, time is essential to the safety of those seeking care. That is why these individuals need every professional on their care team to be engaged in finding solutions to shorten the amount of time it takes to fill prescriptions and begin medicated treatment.

There are several best practices that help accomplish this. Some that I recommend include:

1. Take Time to Ask the Right Questions. Providers need to inquire about medication adherence to identify individuals slipping through the cracks. Never assume that signing a script is the final step. Ask about side effects, costs, the individual’s support system at home and any social factors that may impact their ability to obtain and self-administer a prescription. Taking an interest fosters trust and open communication.
2. Form Strong Partnerships. Establish a collaborative care team involving physicians, liaisons, therapists, pharmacists and care managers to ensure that critical information is shared. This comprehensive approach contributes to a more holistic understanding of the patient’s needs.
3. Foster a Value-Based Mindset. Try to consider how every action can contribute to positive outcomes, affordability, patient experience, and provider satisfaction. This approach aligns with the evolving healthcare landscape and the shift towards value-based reimbursements. Ultimately, by keeping all stakeholders in mind and thinking about each step on the road to the desired result helps care recipients get to their treatment plan faster.
4. Strive for Whole-Person Care. Individuals often present with both behavioral and physical health needs. A holistic care approach takes into account everything someone is going through and the different aspects of support they may need. This approach might involve connecting patients to appropriate resources, providing referrals to nurse navigators, finding a pharmacy partner who will provide customized packaging to accommodate a complicated medication regimen and other creative solutions. When providers address as many barriers to success as possible at the outset, it shortens the time it takes for an individual to get the medications they need and begin to heal.

Conclusion

Psychiatric professionals owe it to the people they serve not to let the advances made in the last few years in telehealth and other resources be the end of the road. Behavioral care recipients often face more challenges than other populations in getting from their provider’s office to the finish line. When barriers in the form of insurance, a lack of understanding due to short stays or cost stop these individuals from filling their prescriptions, it costs everyone within the system time, money and heartache.

Let’s stay curious, and ask the questions that will lead to more proactive solutions, stronger collaborations and a safer and more fulfilling life for the people we are striving to help.

Sources:

1. https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
2. https://www.ncbi.nlm.nih.gov/books/NBK499495/#:~:text=Currently%2C%20approximately%2030%20percent%20of,seen%20a%2020%20percent%20increase.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966860/