New Bill Mandates 90% Drug Adherence for Medicare, Pushes AI and Generics

The Secretary of Health and Human Services is now tasked with creating guidelines to get Medicare Part B and D drug adherence up to 90%. This isn't just a suggestion; it's a mandate, and it's pushing hard for the use of artificial intelligence and machine learning to make it happen. The bill, SEC. 1. Establishment of drug adherence guidelines, also emphasizes using generic and biosimilar drugs whenever possible.

Prescription for Change

This bill is all about making sure people take their meds as prescribed. The goal? A 90% adherence rate for all drugs covered under Medicare Part B (typically administered in a clinical setting) and Part D (prescription drugs you pick up at the pharmacy). To get there, the Secretary must incorporate AI and machine learning into the new guidelines. Think algorithms analyzing patient data to predict and prevent non-adherence. For example, a construction worker with a chronic back condition might get personalized reminders or support tailored to their work schedule, while a retiree managing multiple medications might receive assistance in organizing their pills or understanding potential side effects.

Real-World Rollout

So, how might this play out? Imagine a system where your pharmacy app not only reminds you to take your meds but also flags potential interactions or suggests more affordable generic options. Or picture a scenario where a doctor receives an alert if a patient's data suggests they're struggling to stick to their regimen, allowing for timely intervention. The bill specifically defines "Medicare Part B drugs" as those paid for under Part B of Title XVIII of the Social Security Act, and "Medicare Part D drugs" as those covered under section 1860D-2(e) of the same Act.

The Tech and the Targets

While aiming for better adherence is a good thing, the 90% target across the board could be a stretch. Some patients have complex conditions or life circumstances that make perfect adherence really tough. And while AI has huge potential, it's only as good as the data it's fed. There's a risk of built-in biases or overlooking individual needs if the algorithms aren't carefully designed and monitored. The bill is pushing for more generics and biosimilars, which could save money, but it’s crucial that these alternatives are truly equivalent in effectiveness for all patients.

The Bottom Line

This bill is a big step toward leveraging technology to improve medication adherence. It could lead to better health outcomes and potentially lower costs, especially with the push for generics. But hitting that 90% mark and relying heavily on AI requires careful implementation to avoid unintended consequences. It will be important to make sure the tech serves the patients, not the other way around.