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Archive for July, 2010

Lack of medication adherence remains widespread problem; Get into your members’ minds and resolve issues

July 23, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Managed Healthcare Executive, by Mari Edlin – 7.22.10

Patients who do not follow their medication regimens cost the U.S. healthcare system an estimated $290 billion a year, or 13% of total healthcare expenditures, according to the New England Healthcare Institute. In addition, those with low levels of medication adherence spend nearly twice as much as those who have better adherence.

Non-adherence is widespread; only about half of all U.S. patients take their medications as prescribed by their physicians, according to the Congressional Budget Office.

The Patient Protection and Affordable Care Act promotes medication adherence indirectly through several provisions including incentives to establish patient-centered medical homes and accountable care organizations as well as innovative payment models, as highlighted in a recent study in the April 28 issue of The New England Journal of Medicine.

Ann Arbor, Mich.-based HealthMedia, a health coaching organization, provides behavioral support intervention digitally. The company’s recent survey found that consumers receiving a tailored cholesterol management guide resulting from personalized responses to questions related to hyperlipidemia—their understanding of the condition, perceived barriers to medication adherence and their attitudes and beliefs—fared better than a control group.

The control group received behavioral advice from one interactive-voice-response telephone call without personalization in addition to a general cholesterol management guide delivered through the mail.

The experimental group also received reminders to refill prescriptions, tips for overcoming adherence barriers and encouragement to follow up with their doctors. Adherence was based on the use of a statin.

The findings indicate that 74.4% of the experimental patients vs. 60.7% of the control group showed six-month prevalence rates. In addition, the experimental group had medication possession rates (MPRs) over 80%, which is considered optimal from a population standpoint, while the MPR for the control group is 38.9%.

CIGNA is trying to ward off non-adherence before it gets out of control. Last year, the insurer developed CoachRx, an interactive Web site that helps members using CIGNA Home Delivery Pharmacy identify their barriers to medication adherence and then provides solutions to stay on track. It is one more program in the health plan’s tool kit for finding gaps in care. Approximately 5,000 customers have used CoachRx services—either through the Web-based portal or the pharmacist consultation hotline—indicating an increase in engagement of 20% month over month.

In addition to having access to a clinical pharmacist, members can schedule automated medication reminders and record their own messages to be relayed by text, phone or email. The program also offers educational materials, discount coupons to offset drug costs and free pill boxes to organize medication, all based on a member self-assessment.

“Many programs are one-size-fits-all, but we realize that it is critical to study how different people react and what drives them,” says Yi Zheng, assistant vice president, pharmacy clinical programs for CIGNA. “If we understand barriers, then we can personalize solutions. The result is an individualized approach around their issues connected to adherence.”

CIGNA utilizes what Zheng calls “onboarding packets” to encourage proper use of a medication when it is first prescribed. They address the drug’s use, treatment goals and possible side effects to help avoid repercussions in the future.

STOP PROCRASTINATING

Express Scripts, a pharmacy benefits manager (PBM) headquartered in St. Louis attributes $106 billion in wasteful spending to non-adherence to therapy. The PBM is segmenting members into personality categories to address specific non-adherence patterns, including “sporadic forgetter,” “active decliner,” and “refill procrastinator.”

Those classified into the sporadic forgetter group, for example, perceive therapy positively but periodically forget to take medications. The active decliner group does not consider therapy effective. The refill procrastinators view therapy positively and will take their medications if they are readily available.

“People often do not respond to things rationally,” says Bob Nease, chief scientist for Express Scripts, “which is why it is important to figure out why people do what they do regarding adherence. However, we need keener instruments to understand behavior and determine how to intervene.”

Nease says that the PBM has developed strategies to address certain kinds of behavior. For refill procrastinators, mail delivery and automatic refills can potentially increase adherence. For active decliners, physician or pharmacist intervention can provide supporting education to encourage them to continue taking medication as prescribed. Adherence reminders, text messages, email and phone calls can help sporadic forgetters.

Express Scripts conducted a randomized trial of 35,000 patients to determine what kinds of messages rang true. The rate of medication possession rose from 7% for patients who received no messages to 8.8% for those who received messages containing references to negative effects of missing doses of prescribed medication, as well as information from someone who could be regarded as a respected source or authority (a chief medical officer, for example).

“The effectiveness of messages is in the wording and in gaining permission to offer advice, which is as important as incentives,” Nease says.

The PBM found that messaging is most effective for high-risk patients.

CVS Caremark, a PBM and retail pharmacy chain based in Woonsocket, R.I., also is studying the motivators behind adherence.

“We want to pinpoint barriers,” says Bari Harlam, senior vice president, member experience.

Research focuses on why prescriptions are often filled but not picked up at the pharmacy (typically forgetfulness and financial barriers), why patients prematurely stop taking medications, which medications show the highest level of non-adherence, and the relationship between behavioral science and adherence.

“We have found that the most successful communications are those that are sensitive, prevention-oriented, appeal not just to members but also to their sense of control, and utilize the most effective channel,” Harlam says. “No one communication delivery system is right for everyone.”

FINDING GAPS IN CARE

Exploring medication adherence, Prime Therapeutics, a PBM located in St. Paul, Minn., studied the adherence rate between 30-day prescriptions acquired at a local pharmacy with 90-day supply either through retail or mail and found that those receiving the three-month supply were 40% less likely to have adherence problems. Patients were on medications for hypertension, diabetes and high cholesterol and were followed for a year and a half.

“The extended supply was definitely the determining factor rather than the channel of delivery,” says Pat Gleason, director of clinical outcomes assessment for the PBM. He calls the 90-day supply an “easy, low-cost way” to help keep patients with chronic conditions on their medications. The study shows that extended-supply patients have an adherence rate from seven to 10 percentage points higher, depending on the type of medication and the follow-up period.

On the other hand, Express Scripts promotes its mail service, which increases adherence up to eight percentage points, as the most effective intervention program to reduce non-adherence.

Flu shot in the mail? Microneedles may make that possible, or just buy it at a drug store

July 19, 2010 By: Nadia Category: H1N1 News, HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Associated Press (AP) – by RANDOLPH E. SCHMID – 7.18.2010

WASHINGTON (AP) – One day your annual flu shot could come in the mail.

At least that’s the hope of researchers developing a new method of vaccine delivery that people could even use at home: a patch with microneedles.

Microneedles?

That’s right, tiny little needles so small you don’t even feel them. Attached to a patch like a Band-Aid, the little needles barely penetrate the skin before they dissolve and release their vaccine.

Researchers led by Mark Prausnitz of Georgia Institute of Technology reported their research on microneedles in Sunday’s edition of Nature Medicine.

The business side of the patch feels like fine sandpaper, he said. In tests of microneedles without vaccine, people rated the discomfort at one-tenth to one-twentieth that of getting a standard injection, he said. Nearly everyone said it was painless.

Some medications are already delivered by patches, such as nicotine patches for people trying to quit smoking. That’s simply absorbed through the skin. But attempts to develop patches with the flu vaccine absorbed through the skin have not been successful so far.

In the Georgia Tech work, the vaccine is still injected. But the needles are so small that they don’t hurt and it doesn’t take any special training to use this kind of patch.

So two problems are solved right away — fear of needles, and disposal of leftover hypodermic needles.

“The goal has been a means to administer the vaccine that is patient friendly,” Mark R. Prausnitz of Georgia Tech said in a telephone interview.

That means “not only not hurting or looking scary, but that patients could self-administer,” he said, and people would be more likely to get the flu vaccine.

By developing needles that dissolve, there are no leftover sharp needles, especially important for people who might give themselves the vaccine at home, he said.

The patch, which has been tested on mice, was developed in collaboration by researchers at Georgia Tech and Emory University, Prausnitz said. The work was supported by the National Institutes of Health. The researchers are now seeking funds to begin tests in people and, if all goes well, the patch could be in use in five years, he said.

Flu vaccination is recommended for nearly everyone, every year, and that’s a big burden on the public health network, Prausnitz noted. Many people don’t get the shot because it’s inconvenient, but if they could get in mail or at the pharmacy they might do so, he said.

The patch is placed on the skin and left for 5 minutes to 15 minutes, he said. It can remain longer without doing any damage, he said. In tests on mice, the miocroneedles delivered a correct dose of the flu vaccine.

The little needles are 650 microns (three-hundredths of an inch) in length and there are 100 on the patch used in the mouse study.

Asked if the term “microneedle” might still frighten some folks averse to shots, Prausnitz said he was confident that marketers would come up with a better term before any sales began.

Excellus Blue Cross Blue Shield study estimates e-prescriptions could save money and lives

July 16, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: The Post Standard – by Charley Hannagan – 7.14.2010

A study released Tuesday estimates that 35 deaths a year could be prevented in Upstate New York if more doctors sent prescriptions electronically to pharmacies.

Yet, less than a quarter of the doctors nationally, and in Upstate, e-prescribe.

The study by Excellus BlueCross Blue Shield shows that 24.3 percent of doctors and 20.6 percent of physicians assistants in Upstate electronically send prescriptions to pharmacies, called e-prescriptions. In Central New York, the number drops to 21.8 percent of doctors and 17.3 percent of physician assistants.

E-prescribing is important to keep patients safe, prevent prescription forgeries, save money and make the system more efficient, said Dr. Arthur Vercillo, of Excellus.

“You can try and write as neatly as possible on a prescription form, but the call-backs (from pharmacists seeking clarification) still come in,” he said.

The study estimates that if all doctors sent e-prescriptions, and acted on the alerts provided about drug interactions, it would prevent 35 deaths, 161 permanent disabilities, 391 emergency room visits and 449 hospitalizations.

If doctors followed the generic prescription recommendations that pop up when they e-prescribe just 1 percent of the time, it could cut health care spending in Upstate by $64 million, Vercillo said.

The federal government is encouraging doctors to computerize patient medical records to make the system more efficient. E-prescribing is one part of that.

The federal government offers incentives to doctors to e-prescribe.

Excellus also offers an incentive to doctors to e-prescribe as a part of a package of incentives, Vercillo said.

Yet only about 25 percent of doctors nationally e-prescribe even though 85 percent of the pharmacies nationwide can accept e-prescriptions, according to Excellus.

Among other advantages are it allows doctors to retrieve a patient’s prescription history, it prevents forgeries and patients from going to many different doctors for the same prescription and it allows doctors to see a patient’s insurance coverage for drugs.

Local pharmacies leery of Caterpillar Rx policy

July 09, 2010 By: Nadia Category: Free Prescriptions, HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Winston-Salem Journal, 7.9.2010

A group of independent local pharmacies supports Caterpillar Inc. opening a plant in Winston-Salem, but not if it costs them customers.

That’s why they are appealing to city and county officials to make equal prescription-drug access to potential Caterpillar employees a part of any incentive package with the company.

The pharmacies are concerned about a preferred prescription-drug agreement that Caterpillar has with Walgreens and Wal-Mart.

The agreement, which runs through 2011, provides for lower or no co-pays for Caterpillar employees who fill their prescriptions with Walgreens and Wal-Mart. Employees pay more if they fill their prescriptions through an online or mail-order pharmacy, other chains or independent pharmacies.

“With Caterpillar’s policy, if one of our customers gets hired by Caterpillar, we could lose them,” said Dave Marley, the president and chief executive of Marley Drug in Winston-Salem.

“This, combined with the fact that our own tax dollars were used to entice Caterpillar, and it becomes wholly unacceptable.”

Caterpillar has named Winston-Salem as one of three finalists, along with Montgomery, Ala., and Spartanburg, S.C., for a proposed $426 million manufacturing plant with 510 company and contract employees.

Last week, Winston-Salem and Forsyth County offered Caterpillar a combined $23.4 million in incentives. Caterpillar plans to make a decision in August.

Marley said that the pharmacies are “willing to accept the exact same reimbursement terms given by Walgreens and Wal-Mart.”

“We feel there is no way this would be negotiated after the fact, so if there is going to be a change in Caterpillar’s policy, it has to be raised now and discussed now,” Marley said.

Also making the request are Andrews Pharmacy, East Winston Pharmacy, Gateway Pharmacy, Jonestown Pharmacy, Lewisville Drug, Medicap Pharmacy on Liberty Street and Medicap Pharmacy on Reynolda Road.

Mayor Allen Joines said the city “will bring this concern to the company’s attention if we are lucky enough to be negotiating a contract.”

At cathealthbenefits.cat.com, Caterpillar said the “direct contracts with Wal-Mart and Walgreens use a transparent cost-plus pricing methodology that is intended to eliminate unnecessary and hidden costs in the prescription-drug supply chain.”

Caterpillar did amend its policy to allow independent pharmacies to participate at the Walgreens and Wal-Mart tier in rural areas that don’t have easy access to those stores.

A small percentage of employers have adopted similar policies regarding prescription drugs, said Steve Graybill, a senior consultant for Mercer, a human-resources consulting company.

David Howard, a spokesman for R.J. Reynolds Tobacco Co., said that in 2009, the manufacturer opened up its health-care plan to give employees access to more than 59,000 pharmacies, including national chains and many local pharmacies. Before that, Reynolds provided most medical care for its employees through company-sponsored clinics such as Winston-Salem Health Care.

The bulk of local Reynolds employees have still chosen to use Winston-Salem Health Care and its pharmacy for years, Howard said. “Employees have the option to go outside of network for health care and prescriptions, but they will have higher out-of-pocket costs,” Howard said.

Media General Inc., the parent company of the Winston-Salem Journal, has a contract with Medco, a mail-order pharmacy that provides discounts for employees, but employees can fill prescriptions elsewhere, as well.

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