There is no question that the COVID-19 pandemic has changed the way healthcare is delivered. Not only are patients more cautious about where they get care and who they come in contact with, but they are more aware of how much they are spending on healthcare services. Additionally, drastic swings in the media’s handling of the pandemic and more lenient health plan policies have caused shifts in prescribing patterns this year – including everything from types of medications being prescribed, to volumes of prescription orders, to how the medications are being delivered to patients.
A Shift in Patient Sentiment, Safety, and Willingness to Pay
As pandemic restrictions hit nearly every corner of the globe, entire industries were devastated overnight. A side-effect of the sweeping shutdowns was pervasive job loss and fear. America hit its highest levels of unemployment in decades, and is still facing an unemployment rate of more than 10% (Bureau of Labor Statistics, 2020). The combination of unemployment and uncertainty about the future contributed to our economy taking a nosedive, with hundreds of companies filing for bankruptcy protection, and many more closing for good. People across the country faced financial hardships, and became more cost-conscious than ever before. The Bureau of Economic Analysis released data that showed a massive 18% decrease in consumer healthcare spending in particular across the first half of this year (Bureau of Economic Analysis, 2020). Billions of dollars stopped flowing into our healthcare system nearly overnight, and people were thinking more critically about how they allocated their money toward care. PwC released a report and took this research one step further. They discovered that 22% of people surveyed were planning to adjust their prescription drug spending this year, with upwards of 29% of respondents saying they are looking to ‘stretch’ their medications by skipping doses to save money (PwC Health Research Institute, 2020). To put it simply, people are beginning to put their health at risk in order to save money in the near-term.
Not only are patients rethinking their healthcare budgets this year, especially when it comes to prescription drug spending, but they are also reassessing care delivery altogether. At the height of the pandemic, ambulatory and outpatient visits dropped nearly 60% compared to baseline levels (and are still below normal levels). With lockdowns keeping people at home, most elective visits were cancelled. However, as the country began to open up, patients were, and still are, afraid of going into the doctor’s office to receive care. Personal safety and fear of infection have been prevalent themes in recent reports. In a recent Gallup survey for example, more than 40% of those surveyed were ‘very concerned’ to go to a doctor’s office because of the safety risk (Gallup, 2020). This has led to a drastic shift toward virtual care, which many expect is here to stay.
Shifts in Prescribing Trends This Year
While cost and safety concerns have caused decreases in patient volumes since the height of the pandemic, prescription volumes have followed a much different path.
Data from Arrive Health (formerly RxRevu) client health systems shows significant increases in certain medication class orders earlier this year. For example, orders for chloroquine and hydroxychloroquine spiked by 125% and 90% respectively in March of this year. These jumps in prescription orders in our data align with more widely publicized reports from the New York Times, which claim that nationwide publicity of these medications have caused spikes in requests, even though there was limited evidence to support their effectiveness. As seen in Figure 1 below, orders for these medications leveled off across the rest of the half, which aligned with a 77% decrease in media mentions of these drugs on certain news networks (CNN, 2020). Albuterol, a medication meant to help with shortness of breath, also saw an increase in orders of around 50%, likely due to its ability to treat COVID-19 symptoms.
Beyond medications that were publicized to treat symptoms of COVID-19, many other medications saw spikes earlier this year. Again looking at Arrive Health client data, we saw 5% to 15% increases in anxiolytic, hypnotic sleep, antihyperglycemic, and antihypertensive therapies. Data from Express Scripts showed increases of 34.1% in anti-anxiety medication orders, 18.6% increases in antidepressant medication orders, 14.8% increase in sleep medication orders (Express Scripts, 2020), but the modest increases we saw were interesting nonetheless. While we can’t say definitively that these drug orders spiked – as some news sites have – because of increased patient diagnoses that would trigger the prescriptions orders, there are a few likely reasons why orders of these medications increased in March of this year. For example, both the CDC and AARP recommended ‘stockpiling’ or requesting early refills of prescriptions to prevent unnecessary physician visits during the height of the pandemic. Further, many health plans lifted restrictions on filling prescriptions early and 90-day fills. Lastly millions of American’s may have requested medications because they were, unfortunately, likely to lose their employer insurance coverage (HealthcareDive, 2020). Research is still being conducted about the how the pandemic is impacting those that face anxiety and depression, but it would be difficult to align early drug spikes with increased prevalence of these conditions.
Looking at the month of June on Figure 2 below helps paint a clearer picture, since we saw a second dramatic increase in prescription orders for anxiolytic, hypnotic sleep, antidepressant, antihyperglycemic, and antihypertensive therapies. This rebound in orders could be attributed to a three-month refill cycle which started in March, and is rearing its head in June. This shift to a three-month fulfillment option is supported by data published in a recent International Business Times article which stated that there was an 18% increase in three-month prescription orders between mid-March and mid-April (IBTimes, 2020). Additional data points to a 21% increase in mail-order drugs compared to last year (Wall Street Journal, 2020), likely due to the aforementioned safety concerns about going into a doctor’s office or pharmacy.
What These Shifts Might Mean and What is Our New Normal
As Americans become accustomed to various types of telehealth as a means of care, healthcare professionals and technology companies are looking for ways to innovate, while improving the patient and provider experience. Most telehealth companies are working quickly to streamline EHR integrations, medication ordering processes, and patient data capture. Further, patients and physicians are looking for simple-to-use tools to better communicate with one another. One positive side-effect of the pandemic is a shift in providers’ willingness to adopt telehealth as a means of delivering effective care. In a recent survey, most physicians said that they were comfortable prescribing routine medications for non-severe problems over common telemedicine platforms (GoodRx, 2020). By integrated the prescribing process into the new telehealth workflow, providers can be assured they are ordering medications in a safe and secure way.
Healthcare analysts expect COVID-19 to be present for many more months, which means a number of things are likely to hold true this year:
- First, telehealth is here to stay. Patients will be required to speak with their doctors remotely, and many will continue to be hesitant to visit physician’s offices due to safety concerns. This means that prescribing will continue from a distance, and patients and providers will need to work together to understand the nuances of care delivery in a remote world.
- Second, millions of Americans have faced or are going to face economic hardships. While unemployment might be improving, the fear of job loss, a volatile stock market, and the need to recover from a tumultuous 2020 is causing many to think twice about how they spend – and save – their money. As prescription drug costs continue to rise, pricing information is going to be requested more and more by patients. Tools like Arrive Health’s Real-Time Prescription Benefit solution SwiftRx Direct, which is able to provide patient-specific coverage and cost information at the point-of-care, will help patients and providers make more informed decisions about which medications are covered, and which are the most cost-effective.
- Finally, since COVID-19 is such a new infection, treatments are going to be introduced by companies looking to change the world or make a quick buck. However, the media, patients, and providers need to consider whether these treatments have gone through the appropriate clinical trials, and if there is sufficient evidence to warrant mass distribution. Our society needs to rely on data and research to understand this disease and how to treat it. Rushing to conclusions about treatments will cause more harm than good.
The team at Arrive Health will continue to monitor the effects of COVID-19 on nationwide prescribing trends and will be steadfast in our commitment to health systems, EHRs, and PBMs to deliver the right drugs, at the right cost, in real-time.