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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.

Meridia Withdrawn from the market place

October 25, 2010 By: PharmaSueAnn Category: Medtipster

Meridia is a drug used to assist with weight loss along with diet and exercise.   Abbott Labs has voluntarily withdrawn Meridia from the U.S. market because of clinical trial data indicating an increased risk of heart attack and stroke.

The myth of the perfect drug

June 28, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News

www.Medtipster.com Source: The Boston Globe – Christoph Westphal, 6/28/2010

If we focus too much on side effects, we might forfeit important new medications

WHEN IT comes to prescription drugs, patients expect benefits but appear intolerant of risks. What would happen in a world that accepts no risks in its pharmaceuticals? We would have very empty medicine cabinets.

Every June, 200 biotech and pharmaceutical CEOs gather in Boston. This year, the deputy commissioner of the Food and Drug Administration spoke to the group on the evolving risk-benefit analysis regarding prescription drugs. Much of the ensuing dialogue with the CEOs centered on society’s changing views of drug benefits and risks.

The first “wonder drug,” aspirin, was synthesized by Bayer in 1897 and marketed in 1899. This extremely rapid path from initial experiments to market is impossible to imagine in today’s world. Now, aspirin has some wonderful properties – it reduces inflammation, prevents blood from clotting, lowers fever, and lessens pain. Millions of Americans take aspirin every year, without a doctor’s prescription. However, side effects kill roughly 10 out of 100,000 men taking aspirin. In fact, it is possible that aspirin would not be approved today by the FDA, so dramatic is the shift in society’s risk-benefit views regarding pharmaceutical products.

That shift spelled the doom a few years ago of another drug with significant benefit, but some risk, namely Vioxx. Merck had shown beneficial effects of Vioxx in severe arthritis in thousands of patients, and the drug was approved. After Vioxx reached the market, however, the risk of death from heart attack, estimated by independent academics to be on the order of 20 to 30 out of 100,000 patients taking the drug, led Merck to remove Vioxx from the market. There are likely patients with severe arthritis who would accept the risk of side effects, in order to benefit from this effective medicine. But these patients no longer are able to make their own risk-benefit calculations. Instead, society has determined on their behalf that this therapeutic option should no longer be available to them.

How dangerous, in comparison to taking aspirin or Vioxx, is driving a car? According to the National Safety Council, the risk of dying in a car accident during one year is about 155 out of 100,000. The death rate of car usage actually appears a good deal higher than the likelihood of death caused by taking Vioxx or aspirin. Nevertheless, no one is arguing that cars should be taken off the market. Instead, society has decided that the benefits of cars outweigh their risks.

As society has shifted to a view that medications should have virtually no risks, the inevitable effect has been to reduce the flow of important new drugs. It is certainly fair to rigorously test any new medication prior to approval. In addition, any new drugs should be monitored for safety and efficacy after they have reached the market.

But society must be careful to weigh the benefits of effective new drugs for diseases that until now have been poorly treated, versus the added risks of the new medications. If we focus too much on the risks of drugs, and do not balance those risks against the benefits, fewer drugs will be approved and reach patients in need. That is a risk in and of itself.

On your next drive, remember that it may be riskier to get in your car than to take the drug Vioxx, which was shown to be highly beneficial to patients with severe arthritis, but has been removed from the market.

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