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Drug Adherence Rises When Co-Pays Go Down

September 14, 2012 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Reuters Health, by Amy Norton – 9.11.2012

When people with chronic health conditions have lower out-of-pocket costs for medications, they are more likely to actually fill their prescriptions, according to a new research review.

The findings, reported in the Annals of Internal Medicine, sound logical. But they lend some hard numbers to the idea that lower drug costs should improve people’s adherence to their medication regimens.

“It was striking to us,” said lead researcher Meera Viswanathan, of RTI International, a Durham, North Carolina-based research institute.

“If you help people with costs, even a little, it seems to improve adherence,” Viswanathan said in an interview.

She and her colleagues reviewed several dozen U.S. studies on various efforts to improve people’s ability to stick with their prescriptions. A few of those studies focused on insurance coverage – either giving people drug coverage or lowering their out-of-pocket costs for prescriptions.

Some looked at what happened after Medicare prescription coverage took effect in 2006; others looked at cutting out-of-pocket payments for people with private insurance.

Overall, better coverage seemed to help. In a study of nearly 6,000 heart attack patients, for example, those given full drug coverage through their insurer got more prescriptions filled over about a year.

Of patients who were on their usual insurance, 36 percent to 49 percent filled their prescriptions, depending on the medication. Those rates were four to six percentage points higher among people with full drug coverage.

Patients with full coverage also suffered a new complication, like a stroke or second heart attack, at a slightly lower rate: 11 percent, versus just under 13 percent.

But while there is some evidence of actual health benefits, not many studies have followed people long-term to see if the better drug adherence translates into a longer or healthier life.

“There were some encouraging findings,” Viswanathan said. But more research is needed to know what the long-term health effects are, she and her colleagues write.

The results do not mean that better drug coverage is the only way to get people to fill their prescriptions, according to Viswanathan.

The studies in the review found some other tactics to work, too. Education plus “behavioral support” was one.

That goes beyond telling patients about their health problem, and why a particular medication is needed, Viswanathan said. “You would also try to get through the barriers that may keep a patient from taking it,” she said.

If a patient was afraid of side effects, for example, a nurse might discuss that with him or her.

Another measure that seemed effective was “case management.” That means the health provider would try to identify patients at high risk of not using their prescriptions, then follow-up with them – with phone calls, for instance.

It’s not clear, Viswanathan said, how programs like that could be “scaled up” to be widely used in everyday practice, and not just clinical trials.

And the specific fixes might differ depending on the health problem. With high blood pressure, a fairly simple move seemed to boost patients’ adherence to their medication: Giving prescriptions in blister packs rather than bottles, so people could more easily keep track of whether they’d taken their daily dose.

With more complex measures, the question of how to work them into the real world remains. “We need to know, what does it take to implement them into clinical practice?” Viswanathan said.

Figuring out how to get people to stick with their medications is considered a key part of improving healthcare. Studies show that 20 percent to 30 percent of prescriptions are never filled, and half of medications people take for chronic ills are not taken correctly.

All of that is thought to contribute to 125,000 deaths a year, and to cost the U.S. healthcare system as much as $289 billion annually.

Medicine is the best medicine; help patients keep taking it

December 07, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Boston Globe, 12.3.2010

Patients who don’t take their medications are a well-documented problem in medicine. If doctors are to spot patients who might stop complying with prescriptions, it’s vital to have a fuller understanding of why and how it happens.

As many as 40 to 60 percent of those with chronic conditions like high blood pressure, heart failure, or diabetes don’t take their medicines regularly. The reasons vary – some patients never fill their prescriptions; others feel better and stop their drug regimens; in still other cases, side effects or the burden of too many pills discourage patients from refilling their prescriptions. Whatever the motive, failing to take needed drugs leads to worse health and higher spending, as patients land in the hospital for preventable conditions that cost the health care system hundreds of millions of dollars a year.

But a new study this month in the Annals of Internal Medicine, by researchers at Brigham and Women’s Hospital and Harvard Medical School, shines the spotlight on another contributor: Patients not picking up prescriptions that have already been filled.

The analysis, funded by CVS Caremark, looked at over 10 million prescriptions filled over a 3-month span in 2008 and found that 3.3 percent were never picked up. The number seems small, but translates to 110 million abandoned prescriptions per year in the United States. It costs a pharmacy an estimated $5 to $10 to prepare, then return to the shelves, an unclaimed medication, so the authors estimate the problem could be costing more than $500 million a year. CVS Caremark has a clear interest in bringing that number down – but so do patients and doctors.

The problem could worsen as technology evolves: Prescriptions sent electronically were 65 percent more likely to be left behind, probably because they bypass the step of having the patients hand- deliver a slip to the pharmacist. As electronic prescribing continues to take hold nationwide, insurers should be vigilant that prescription fill rates may reflect compliance less accurately than with traditional prescriptions.

Not surprisingly, prescriptions with $40 to $50 copays were the most likely to be abandoned. According to William Shrank, the study’s main author, this means that during economically hard times “even insured patients are experiencing sticker shock, and walking away from the pharmacy, without filling essential medications.”

Doctors are unlikely to know their patients’ copays for drugs, but taking the time to talk about drug costs would help them identify those who might never pick up their prescriptions. Down the road, those extra minutes of chat time at the office become multiple dollars saved at the hospital bedside.

Steep Co-Pays May Cause Some to Abandon Prescriptions

November 17, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News

www.Medtipster.com Source: HealthDay, 11.15.2010 – By Serena Gordon

In these tough economic times, even people with health insurance are leaving prescription medications at the pharmacy because of high co-payments.

This costs the pharmacy between $5 and $10 in processing per prescription, and across the United States that adds up to about $500 million in additional health care costs annually, according to Dr. William Shrank, an assistant professor of medicine at Harvard Medical School and lead author of a new study.

“A little over 3 percent of prescriptions that are delivered to the pharmacy aren’t getting picked up,” said Shrank. “And, in more than half of those cases, the prescription wasn’t refilled anywhere else during the next six months.”

Results of the study are published in the Nov. 16 issue of the Annals of Internal Medicine.

Shrank and his colleagues reviewed data on the prescriptions bottled for insured patients of CVS Caremark, a pharmacy benefits manager and national retail pharmacy chain. CVS Caremark funded the study.

The study period ran from July 1, 2008 through Sept. 30, 2008. More than 10.3 million prescriptions were filled for 5.2 million patients. The patients’ average age was 47 years, and 60 percent were female, according to the study. The average family income in their neighborhoods was $61,762.

Of the more than 10 million prescriptions, 3.27 percent were abandoned.

Cost appeared to be the biggest driver in whether or not someone would leave a prescription, according to the study.

If a co-pay was $50 or over, people were 4.5 times more likely to abandon the prescription, Shrank said, adding that it’s “imperative to talk to your doctor and pharmacist to try to identify less expensive options, rather than abandoning an expensive medication and going without.”

Drugs with a co-pay of less than $10 were abandoned just 1.4 percent of the time, according to the study. People were also a lot less likely to leave generic medications at the pharmacy counter, according to Shrank.

The medications most frequently abandoned were cough, cold, allergy, asthma and skin medications, those used on an as-needed basis. Insulin prescriptions were abandoned 2.2 percent of the time, but Douglas Warda, director of pharmacy for ambulatory services at the University of Chicago Medical Center, said this might be a cost issue, but it could also be that some people are afraid to inject insulin.

The study also found that antipsychotic medications were abandoned 2.3 percent of the time.

Drugs least likely to be abandoned included opiate medications for pain, blood pressure medications, birth control pills or hormone replacement therapy, and blood-thinning medications, according to the study.

Young people between the ages of 18 and 34 were the most likely to forgo their prescriptions, and new users of medications were 2.74 times more likely to leave their drugs behind.

Prescription orders that were delivered to the pharmacy electronically — via the computer — were 64 percent more likely to be abandoned than prescriptions walked into the pharmacy.

“We’re definitely not saying that e-prescribing is bad; it’s great, but there appear to be some unintended consequences,” said Shrank.

There was no way to tell if people never tried to pick up their prescriptions, or if they went to retrieve them but chose to leave them behind because of the cost.

Warda said he believes that more patients might pick up their medications if the instructions from their physicians were clearer. For example, prescriptions for proton pump inhibitors were left at the pharmacy 2.6 percent of the time. These medications reduce the amount of acid in the stomach and can help prevent heartburn or more serious problems. “If the physician message is, ‘You need to take these medications for two to three months and it will reduce your pain and help your body heal,’ fewer people might abandon these medications,” he said.

Plus, if cost is an issue for you, bring it up with your doctor ahead of time, he added. “Don’t get blindsided at the pharmacy. Always ask your physician if there’s a generic option, or if there’s something cheaper that might work just as well. Sometimes people are embarrassed to say anything, but it’s better to ask and get a medication you can afford.

“If you get to the pharmacy, and you can’t afford the medication, follow up with your doctor or ask the pharmacist if there’s a cheaper alternative,” suggested Warda.

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