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Archive for March, 2011

How Can You Help the Medicine Go Down?

March 30, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: The Wall Street Journal, 3.28.2011 -by Katherine Hobson

Too many people don’t take the drugs they’re supposed to. Tackling that problem could save a lot of money and a lot of lives.

Medication can do great things for people—but only if they take it. And a lot of people aren’t taking it.

Half of patients in the developed world don’t properly take their drugs for chronic conditions, according to the World Health Organization. The additional costs for treating diseases that progress unchecked run into the hundreds of billions of dollars a year. One study estimates nearly 90,000 people die prematurely in the U.S. each year because of poor adherence to high-blood-pressure treatment alone.

So how do you get people to take their medicine? There isn’t one answer, because there isn’t one reason people aren’t sticking to their regimens. Cost, forgetfulness, side effects and doubts about effectiveness can all be factors, among others. And for many people the health-care system isn’t designed to monitor or encourage adherence to drug prescriptions.

But there are plenty of health-care professionals and researchers tackling this issue, and they have some ideas about what can be done and what should be done. Here are some of those ideas.

More Refill Information

Doctors and other health-care providers need “some way of tracking to know if patients are refilling their medications, so we can step in and help people” if they aren’t, says Robert Reid, a physician and researcher at Group Health Cooperative, a Seattle-based nonprofit health-care system that coordinates care and coverage.

Providers like Group Health and Kaiser Permanente, a large managed-care consortium based in Oakland, Calif., can track refills because they manage all aspects of their patients’ care, so all information for each of their patients is collected in one easy-to-access electronic record. Alec Does, a family-medicine physician at Kaiser Permanente Anaheim Hills, says that when he shows patients records indicating they haven’t been consistently filling their prescriptions, “90% of the time, they’ll open up” and start talking about any issues they’re having.

But most people don’t get their care from such comprehensive providers, so their doctors rarely have access to their pharmacy records.

The technology to fix that problem exists, says Valerie Fleishman, executive director of NEHI, a national health-policy research institute based in Cambridge, Mass. “Physicians are sending prescriptions to the pharmacy, so we have the capability to close that feedback loop,” she says. The problem, she says, is that most doctors are paid for specific services, like office visits and medical procedures—not for managing their patients’ health outcomes. So there is no financial incentive for them to take on the cost of tracking prescription refills.

There is no quick fix for this problem, Ms. Fleishman says, but the recently passed health-care overhaul bill includes funding for new models for care and payment that might do a better job of rewarding providers for doing whatever it takes to keep patients healthy.

Get Pharmacists Involved

“Retail pharmacists appear to be able to play a really substantial role in encouraging patients to use their medications better,” says William Shrank, an assistant professor of medicine in the division of pharmacoepidemiology at Brigham and Women’s Hospital in Boston. “They are an underutilized resource.”

At Stamford, Conn.-based customer-communications company Pitney Bowes Inc., on-site pharmacist Antonio Tierno says he talks with patients about their conditions and medications. If a patient is picking up a refill behind schedule, he’ll ask what’s up. “If a person is late, you need to find out why,” he says.

Mr. Tierno says he always asks patients if they know why they’re taking a drug. That conversation can help ensure that patients will take their medication, he says, by making the drug’s benefits clearer to them and by making them feel more involved in their care.

A study by researchers at the Walter Reed Army Medical Center in Washington, D.C., published in the Journal of the American Medical Association, found that a pharmacy-care program for 200 people age 65 and older who were taking at least four medications for chronic conditions boosted adherence to 97% from 61% after six months. Patients were educated about their medications, including usage instructions; medications were dispensed in blister packs that made it easier to keep track of whether they had taken their pills for the day; and pharmacists followed up with patients every two months.

After 12 months, those who continued to get the pharmacy care kept their adherence at about 96%, while adherence among those for whom the program was discontinued dropped to 69%.

Another review of efforts to improve adherence—sponsored by CVS Caremark Corp. and carried out by Dr. Shrank and other researchers from Brigham and Women’s Hospital, Harvard University and CVS—found that nurses talking with patients as they were discharged from the hospital were right behind pharmacists in terms of how often they successfully encouraged patients to take their medications as directed.

Treat Patients as Individuals

Every patient’s story is different—so every solution has to be tailored to the individual.

The first step is to engage the patient with a simple, open-ended question, says Elizabeth Oyekan, area pharmacy director at Kaiser Permanente South Bay Medical Center: What’s getting in the way of picking up your medications?

“That will give you some concrete information, and then you target the solution to the individual patient,” she says. Kaiser has created a set of online tutorials to help doctors and others engage more effectively with patients who are skipping their medications.

If a patient is worried about side effects, a health-care provider might offer a substitute for the medication, or a lower dose. For the forgetful, it could be as easy as using a simple pillbox, or maybe something more technologically advanced, such as text-message reminders or souped-up pillboxes with audio or visual alerts.

If money is the problem, the solution may be generic substitutes, a mail-order program (which not only provides drugs at a lower cost but also helps those who have trouble getting to a pharmacy), or a drug company’s assistance program.

In many cases, though, problems can be addressed only by looking at medication adherence as a behavioral issue with often complex roots, says Alan Christensen, chairman of the psychology department at the University of Iowa. As with diet and exercise, getting people to change their behavior can be difficult.

“There’s more and more interest in how to better motivate and engage patients beyond just simply reminding them or reducing financial barriers or simplifying therapy,” says Dr. Shrank. Multifaceted programs that entail various combinations of those elements and education delivered by health-care professionals have shown promise in studies, but “we don’t have a good sense of what precisely is the right mix,” Dr. Shrank says. And, he says, if that ideal mix turns out to involve a lot of expensive face time, someone will have to figure out how to implement those efforts in a cost-effective way.

DAW Prescriptions May Add $7.7 Billion To Healthcare Costs

March 25, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: CVS Caremark – 3.25.2011

Approximately five percent of prescriptions submitted by Pharmacy Benefit Management (PBM) members in a 30-day period during 2009 included a “dispense as written” (DAW) designation. This practice – whereby doctors or patients demand the dispensing of a specific brand-name drug and not a generic alternative – costs the health care system up to $7.7 billion annually, according to a new study by researchers at Harvard University, Brigham and Women’s Hospital. Moreover, these requests reduce the likelihood that patients actually fill new prescriptions for essential chronic conditions.

In a study published this week in the American Journal of Medicine, the researchers demonstrate that DAW designations for prescriptions have important implications for medication adherence. They found that when starting new essential therapy, chronically ill patients with DAW prescriptions were 50 to 60 percent less likely to actually fill the more expensive brand name prescriptions than generics. “Although dispense as written requests would seem to reflect a conscious decision by patients or their physicians to use a specific agent, the increased cost sharing that results for the patient may decrease the likelihood that patients actually fill their prescriptions,” the researchers said.

“This study shows that dispense as written requests are costing the health care system billions,” said William H. Shrank, MD, MSHS, of Brigham and Women’s Hospital and Harvard, and the study’s lead author.  “The further irony is that patients with prescriptions specifying a certain brand seem less likely to fill their initial prescriptions, adding to the medication non-adherence problem.”

“Previous to this study, little was known about the frequency with which doctors and patients request dispense as written prescriptions,” said Troy A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark and a study author. “Those who advocate for dispense as written and argue that the practice provides patients and physicians with greater choice will probably be surprised to learn that the practice increases costs and exacerbates non-adherence.”

The study reviewed 5.6 million prescriptions adjudicated for two million patients from January 1 to January 31, 2009. The review found that 2.7 percent of those prescriptions were designated DAW by doctors, while another two percent were requested DAW by patients.

If existing safe and effective generic alternatives had been provided in place of those brand-specific prescriptions, patients would have saved $1.7 million and health plans would have spent $10.6 million less for the medications.  The researchers said that assuming a similar rate of DAW requests for the more than 3.6 billion prescriptions filled in the U.S. annually, patient costs could be reduced by $1.2 billion and overall health system costs could be reduced by $7.7 billion.

The study is a product of a previously announced three-year collaboration with Harvard University and Brigham and Women’s Hospital to research pharmacy claims data in order to better understand patient behavior, particularly around medication adherence.  Annual excess health care costs due to medication non-adherence in the U.S. have been estimated to be as much as $290 billion annually.

Keep a druggist in your pocket

March 01, 2011 By: Nadia Category: Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: newsobserver.com, 2.28.2011 – by Sue Stock

It’s not enough for America’s big pharmacy chains to be on every corner.

Now they want to be in your pocket, too.

This year the behemoths of the pharmacy industry including Walgreens, CVS, Rite Aid and Target are all ramping up efforts to offer you pharmacy services via your mobile phone.

Want to refill a prescription? No problem.

Check on your medication history? You can do that, too.

Walgreens has even introduced a refill system that allows you to order a prescription refill by using your smart phone camera to take a picture of the bar code on your medication bottle.

The pharmacies say the added features are all about convenience.

“If you look at our national footprint of 7,600 stores throughout the country, our physical stores are within three miles of nearly two-thirds of the U.S. population,” Walgreens spokesman Jim Cohn said. “I think that what we’re doing through our online and our mobile offerings is really extending that convenience to our customers through this channel.”

But, there are other reasons for such companies to explore mobile technology, especially in the super-competitive pharmacy business, said Dan Mendelson, CEO of Avalere Health, a health care advisory company in Washington, and a Duke University adjunct professor.

“What they’re really trying to do is create ‘stickiness’ among their clientele, and they’re also trying to appeal to younger customers who are maybe not going into the pharmacy for other things,” he said. “It’s a marketing strategy and not a whole lot more.”

Still, it seems to be working. Walgreens reports that more than 1 million people have signed up to receive alerts by text message when their refills are ready.

And with that kind of interest from consumers, it should be no surprise that smaller and independent pharmacists are watching closely. Raleigh-based Kerr Drug is exploring mobile technology this year, spokeswoman Diane Eliezer said. Kerr already offers refills through its website.

“We’re just looking for more ways for people to reach us with different devices,” she said. “We’re not going to hesitate to try it when the time is right.”

Here’s a rundown of the different services that are available for consumers:

CVS : Last year, CVS introduced an iPhone app that allows users to refill and transfer prescriptions, view prescription history, access drug information, view the weekly sales ad and use a GPS navigator to locate the nearest store. Users of other devices, including Blackberry and Android phones, can access the same services through the CVS mobile site, m.cvs.com .

Rite Aid : In September, Rite Aid introduced the option for customers to opt in to receive alerts about their prescriptions via text message,e-mail or automated phone call. To opt in, customers should create a profile at www.myriteaid.com and select the appropriate option.

Target: Target has set up a dedicated mobile website, target.com/rx , where users can find a pharmacy, refill or transfer a prescription and enroll in auto refills.

Walgreens: Walgreens has apps for iPhone, Android and Blackberry users that allow customers to find the nearest pharmacy, order refills, access prescription records, view the weekly ad, make a personalized shopping list and even order prints of photos that they take with their mobile phones. The feature through which customers can scan the bar code on their prescription bottles to order refills is only available for iPhone and Android users at this time. More information is available at www.walgreens.com/ mobile .

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