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Pharmacies embrace expanding medical role

September 13, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: News & Observer – 9.12.2010

After years of adding everything from groceries to grills to their inventory, drugstore chains are once again emphasizing their pharmacies.

Pharmacists are being asked – and paid by insurance companies – to monitor their customers’ health. That could include counseling them on chronic diseases, making sure they’re taking their medications, and screening for maladies from diabetes to high cholesterol.

While many pharmacists have long done more than dispense pills, this is the first time many have been able to offer such a wide range of medical services – partially because of changes in the way pharmacists are educated, and partially because of legislative changes that have cleared the way for an expanded role.

For pharmaceutical chains, the change is an opportunity to develop new sources of revenue in a highly competitive industry.

For customers, it’s another option for health care, and one that may be less expensive and take less time than a trip to the emergency room or an urgent care clinic.

“I think it’s a mixture of everything that’s going on,” said David Catalano , a Raleigh pharmacist who works for Walgreens . “[Customers] are trying to get some advice as quick as they can from someone they can trust.”

The emphasis on pharmacists makes economic sense for health insurers. Pharmacists have expertise and often have a customer’s entire medical picture, so they can catch prescription overlaps or possible drug interactions. Nor do they command the same fees that a physician does from a health insurer.

The push toward enlisting pharmacists to do more than dispense drugs comes as the nation is trying to lower health care costs. A 2007 study from the New England Healthcare Institute estimated that 13 percent of total health care expenditures – more than $290 billion a year – are made simply because people don’t take their medications as prescribed. Those people have a higher likelihood of winding up in the emergency room or with other complications because they did not follow their doctor’s instructions.

But not everyone is happy with pharmacists treading on turf that was once solely the territory of doctor’s offices and urgent care clinics.

“Store-based health clinics can offer patients an option for episodic care but cannot replace the patient-physician relationship,” said Rebecca Patchin , a doctor from California and board member of the American Medical Association . “Patients deserve timely access to affordable, high-quality care provided by health care professionals that are appropriately and adequately trained. Convenience should never compromise safety.”

‘Closer than my doctor’

Over the past four years, James Evans has come to rely on Prasanna Bafna, a pharmacist near his Durham home, for much of his medical advice.

On Thursday, Evans was at his Rite Aid for an hourlong counseling session with Bafna.

They reviewed Evans’ medications, including drugs for diabetes, high blood pressure and poor circulation.

Though the pharmacist didn’t tell him to make any major changes, Evans said the opportunity to speak with a medical professional for such a length of time is invaluable.

“It’s wonderful,” said Evans, 76, of Durham. “When it’s time for my medicine, it’s right on time. I don’t have to stand there and wait on it. The other pharmacist I used to go to, you’d have to sit and wait for hours. … [Bafna] is closer than my doctor. My doctor is eight or nine miles from here.”

Proponents of the expanded role of pharmacists say that getting customers like Evans to utilize the new services being offered is key to making the system work and lowering health care costs.

Reimbursement rates

In general, pharmacists are not reimbursed as much money as doctors are for immunizations and the like, said Dan Mendelson , CEO of Avalere Health , a health care advisory company in Washington, D.C., and a Duke University adjunct professor.

“Most pharmacies are not allowed to bill for a pharmacy visit,” he said. “They’re allowed to bill for a vaccine, but there’s no routine office visit into the pharmacy that gets paid for by the insurance.”

The insurance companies may choose to reimburse the pharmacists more money or for additional services if there is a shortage of doctors or other circumstances in a particular region, Mendelson added, but “it depends on what the insurance company is trying to accomplish with respect to its network.”

The model is getting a boost from federal legislators. Some changes triggered by the new health care law will take effect later this month, with other changes rolled out in the years to come.

As of this year, laws in all 50 states also allow pharmacists to administer immunizations, something that also clears the way for expanded services.

Some companies are using the additional services simply as another way to get customers through the door, even if some of the services are not yet reimbursed by insurance, Mendelson said.

“It’s really about bringing purchasers into the box,” he said. “That’s what they call it. The box is the four walls in the pharmacy. If you can bring purchasers into the box then you’re doing fine. If a consumer comes in and they buy all kinds of other stuff, you’re doing well.”

Enhanced training

In addition to legislative changes last year, there have also been changes in the pharmacy industry that have helped pharmacists reach this point, said Edith Rosato , senior vice president of pharmacy affairs for the National Association of Chain Drug Stores .

She credits federal plans which began paying pharmacists to counsel Medicare and Medicaid patients in the hopes of improving results. She also said that an academic change was also key Students earning a pharmacy degree must now get a year of training on counseling and interacting with patients.

That set the foundation for the industry to focus more on patient care services, Rosato said.

So far, studies have indicated the services are working.

Raleigh-based Kerr Drug has taken the lead in this state in offering preventive care and has gone so far as to design some stores to focus exclusively on health and wellness. In Asheville, the company partnered with the city and the Mission-St. Joseph’s Health System to see whether pharmacists with expanded roles could help diabetes patients better manage their diseases and save in overall health care costs.

Kerr found that the annual health care costs for the diabetes patients participating in Asheville declined by 9.8 percent per year. One employer had an average reduction of 41 percent in sick days taken by participating patients, which equated to an estimated $18,000 in increased productivity for the company.

The need for these types of clinics will only increase as the population grows older and more people are diagnosed with chronic illnesses such as diabetes, said Rebecca Chater , executive vice president of Kerr Health , a subsidiary of Kerr Drug.

“Look at the number of people who are now moving into Medicare age,” she said. “If you look at medication use in that population, people who are within the Medicare system have 13 different prescriptions on average, with 50 different medications filled each year on average. The opportunity is huge.”

But getting to a point where insurance companies are willing to reimburse for more preventive services and pharmacists are willing to offer them is tricky business, said Jay Campbell , executive director of the N.C. Board of Pharmacy.

“There is a bit of a chicken and the egg aspect,” he said. “Health care being the huge expenditure it is, folks aren’t going to want to spend money until there’s a demonstrated benefit for those services. But private insurers have to start seeing enough of a value to provide the reimbursement.”

‘Cookbook medicine’

Still, some physicians say there are risks to having health care administered by pharmacists instead of doctors.

Linwood Watson , a family medicine doctor with an urgent care clinic called Rex Express Care in Knightdale, said he thinks patients like the new options because they are very transparent. There is a set fee for each service, and no secrets about what things will cost.

“Everyone wants cookbook medicine, but what happens when your body doesn’t read the book?” he said.

Pharmacies respond by saying that they work closely with area doctors to offer referrals to customers who do not have a primary care physician or need further medical expertise.

But with so many options and such a fragmented system, Watson said, he feels patients will have to take more responsibility for their own care in order to ensure continuity.

“If you want to go buy a car, and you want a good deal, you’re going to have to do some research, keep some records and be prepared,” he said. “Are you prepared to do that for your health care?”

Copyright © 2010 McClatchy-Tribune Information Services

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.

Don’t forget to take your meds! The costs of non-adherence are staggering.

March 29, 2010 By: Jason A. Klein Category: Medicine Advice, Medtipster, Prescription News, Prescription Savings

Medtipster Source: www.pharmalive.com; www.vitality.net; www.att.com

Don’t forget to take your meds! The costs of non-adherence are staggering.

Jason A. Klein, Medtipster President

Life is expensive. You work for a living. Your employer offers health insurance. You’re a diabetic. Your doctor prescribes Glucophage (Metformin Hydrochloride). The average monthy cost is roughly $97.00 (or $8.99 for the generic at Rite Aid….Thanks Medtipster.com!).

Now, what happens if you forget to take or refill your medication? That’s easy. Blue Cross & Blue Shield likely saves $97.00. WRONG. The correct answer is: You get sick and the non-adherence to your medication costs on average 100 times more. According to a study published in August by the New England Healthcare Institute, non-adherence costs the U.S. $290 billion in added medical spending each year. Mortality rates are twice as high among diabetes and heart disease patients who don’t take their pills properly, it said.

A Cambridge, Mass.-based startup called Vitality Inc. took note of the New England Healthcare Institute study and is gearing up to offer an extremely innovative solution. Not only that, but they have brought along AT&T, one of the nations largest communications providers, along for the ride. Their solution: A pill bottle cap that keeps track of when and how often it is opened. If not opened according to the pre-programmed clinical specifications, you will be notified via the AT&T network. The cap can also be programmed to notify your spouse, parents, or children. You can run, but you can’t hide! We, at Medtipster, love this innovation. See full press release below:

Vitality GlowCaps Utilize AT&T Wireless Network to Improve Prescription Medication Adherence
CAMBRIDGE, Mass. and DALLAS, March 23 /PRNewswire/ — Vitality, Inc. and AT&T announced today that AT&T will provide the nationwide wireless network connection for Vitality GlowCaps, intelligent pill caps designed to help patients take medications regularly, provide peace of mind for loved ones, and solve the billion-dollar adherence problem for pharmaceutical companies, retail pharmacies, and healthcare providers.
The AT&T-connected GlowCaps fit on standard prescription bottles and use light then sound reminders, which can be followed by a phone call or text message so people don’t miss a dose. Each time the pill bottle is opened adherence data is recorded and securely relayed to Vitality over the AT&T wireless network. This daily adherence information is used to compile periodic progress reports that are sent to patients, caregivers and doctors, and family members.
Using sophisticated pattern recognition, Vitality uncovers the key motivational levers for each individual, and then tailors programs to activate these levers and break through whatever barriers exist. Data generated by GlowCaps can be used to automatically refill prescriptions as pills deplete.
“For the first time in the healthcare industry, we can use minute-by-minute adherence data to motivate healthy behavior,” said David Rose, CEO of Vitality. “The AT&T wireless network enables Vitality to know when people do and don’t take their medication, then send reminder calls, compile progress reports, and refill people’s medications before they run out.”
“GlowCaps offers a very intuitive solution to an ongoing issue in the daily lives of many consumers,” said Glenn Lurie, president, AT&T Emerging Devices and Resale. “We look forward to providing the network connection for GlowCaps, delivering timely wireless data that will assist consumers in sticking with a prescription regimen, keeping them connected with doctors and family members, informed and on schedule.”
Financial terms of the agreement have not been disclosed.
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