CVS Caremark study addresses correlation between out-of-pocket co-pay, Rx abandonment
WOONSOCKET, R.I. — There is a direct correlation between the amount of a patient’s out-of-pocket co-pay and prescription abandonment, according to the findings of a CVS Caremark-sponsored study published this week in the Annals of Internal Medicine. The study also found that e-prescriptions are more likely to be abandoned at retail compared with handwritten prescriptions.
The new study by Harvard, Brigham and Women’s Hospital and CVS Caremark researchers found a direct correlation between the amount of a patient’s out-of-pocket co-pay and likely abandonment of the prescription, with patients having a co-pay of $50 almost four times more likely to abandon a prescription at a pharmacy than those paying $10. The study also found that e-prescriptions are 65% more likely to be left abandoned at a retail pharmacy by patients than are handwritten prescriptions.
"Sticker shock is an important driver of prescription abandonment," stated lead author of the study William Shrank of Brigham and Women’s Hospital and Harvard. Shrank said the study also outlined and validated a simple prediction rule that pharmacists can apply to help them assess whether patients are at risk to abandon their prescriptions.
"This research gives us new insight into an area of nonadherence that we did not have before, and shows we have opportunities to change patient behavior," added Larry Merlo, president and COO of CVS Caremark. "We need to be more attentive to reasons why patients may be abandoning prescriptions and work to help them stay on their medications. We continue to be a strong proponent of e-prescribing because we recognize the benefits it can provide, such as improving the accuracy and quality of prescription delivery and reducing paperwork to make pharmacy care more efficient."
Researchers reviewed all prescriptions dispensed at CVS/pharmacy locations between July 1 and Sept. 30, 2008. Of the prescriptions that were abandoned, more than half were never filled at any pharmacy, while some were filled at other pharmacies at a later date. The team concluded that the pharmacy industry would benefit from learning more about prescription abandonment, which the team said is an addressable factor impacting patients’ adherence to their medications.
The researchers said the higher rate of abandonment for e-prescriptions appeared to occur because patients with written prescriptions must proactively brought the request for medications to the pharmacy, while patients with e-prescriptions are not required to take any step to begin the prescription-filling process. In addition, the rate of e-prescription abandonment appeared high because pharmacies are able to track the prescriptions as abandoned versus paper prescriptions that never actually are brought to a pharmacy.
The researchers said that if the 3.27% abandonment rate observed during the study period was applied to the 3.6 billion prescriptions filled at pharmacies in 2008, approximately 110 million prescriptions would be abandoned.
Furthermore, researchers outlined a predictive model for pharmacists to apply to help them recognize likely candidates for abandonment that includes:
- Reviewing the individual’s benefit plan and tiered co-pays. The study said cost is the strongest predictor of abandonment. The data showed a 1.4% prescription abandonment rate for patients with co-pays of $10 or less, a 3.4% rate for patients with co-pays between $30 and $40, and a 4.7% rate for patients with co-pays of $50;
- Understanding past pharmacy behavior. Patients with first-fill prescriptions are three times more likely to abandon prescriptions than those who are refilling their medication;
- Identifying the age of the patient. Younger patients are more likely than older patients to abandon their medications; and
- Reviewing the drug class. The study found that opiates, antiplatelets and statins were the least likely to be abandoned, while insulin and proton-pump inhibitors were more likely to be abandoned.
The study is the work of CVS Caremark’s previously announced three-year collaboration with Harvard University and Brigham and Women’s Hospital to research pharmacy claims data to better understand patient behavior around medication adherence.
Past industry studies showed one-quarter of people receiving prescriptions never filled their first prescriptions, and patients with such chronic diseases as diabetes and coronary artery disease adhere to their ongoing medication regimen about half of the time. Nonadherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. healthcare system estimated at about $300 billion annually.
Pharmacists engage with patients in campaign for improved nutrition
Should retail pharmacists tell their patients to eat a good breakfast?
A mountain of data showing the health benefits of a good breakfast — one that includes high-fiber foods like cereals and grains — point to an unequivocal answer: absolutely.
Studies have proven that eating breakfast is closely linked to healthy body weights, improved mental alertness and physical performance. Plus, people who skip breakfast don’t make up for the missed nutrients later in the day.
And with health and nutrition concerns influencing more household food purchases in the United States, pharmacists are increasingly helping patients learn about better dietary choices while they shop.
As a result, retail pharmacies are equipping pharmacists with additional training and education to encourage discussions with customers about overall nutrition, including the importance of starting the day with breakfast.
“As the category leader, Kellogg Company’s integrated shopper insights team helps our customers better understand what shoppers are looking for and how they shop the category,” says Doug VanDeVelde, SVP marketing and innovation of ready-to-eat cereal for Kellogg. “We also have a number of efforts under way to remind consumers of the significant benefits of cereal. For example, at www.loveyourcereal.com, we share important nutrition information and address some common consumer questions about ready-to-eat cereal.”
Price-conscious consumers are also looking for discounts, as well as products that offer good nutrition — and at just 50 cents a serving, including milk, cereal provides convenient, affordable nutrition for families.
In fact, ready-to-eat cereal is growing approximately three percent per year and is the third largest center-of-the-store category.
Moreover, cereal provides important nutrition for people at all life stages. Cereal helps children get valuable nutrients they might otherwise miss. For women of childbearing age, cereal provides necessary iron, calcium, fiber and folic acid. And the nutrient density of cereal helps elderly people get necessary nutrients for relatively few calories, which is important as calorie needs decline, but nutrients needs do not.
With healthier food selections, nutritional information and in-store pharmacists, supermarket pharmacies are fertile ground for a more integrated approach to health and wellness.
“If there’s an actual dietitian or a nutritionist in the store, more and more we’re seeing the pharmacist create in-store programs with the dietitian,” said Cathy Polley, VP health and wellness for the Food Marketing Institute and executive director of the FMI Foundation. “They’re collaborating to make sure they understand each other’s world a little better and give the consumer a healthier lifestyle and more fulfilling shopping experience.”
For example, when a person with diabetes or high cholesterol arrives to fill a prescription, the pharmacist can suggest programs, cooking classes or tours led by the dietitian that may complement a patient’s medication.
In addition, Polley told Drug Store News, “Many of the grocery manufacturers these days also have products that they are displaying in and around the pharmacy, like fiber bars and different types of cereal. That really lends itself to pharmacists being able to make that nutrition discussion part of their counseling about the medication.”
There is strong evidence that diets higher in fiber help reduce the risk of a number of health issues, such as heart disease, obesity, diabetes and certain cancers, yet 90 percent of American adults and children aren’t getting enough fiber in their diets. Kellogg is also helping consumers with this important need. The majority of its cereals are at least a good source of fiber (3 grams), and about half also include a half serving (8 grams) of whole grains.
Together, pharmacists, retailers and manufacturers are helping educate consumers about important nutritional options, as well as the benefits breakfast brings to the table. And with more than 80 cereal choices, Kellogg provides consumers with nutritious, convenient and affordable breakfast options that help meet their taste preferences and nutrition needs.
Return to Taking Back Breakfast
NCPA’s new chief likely to shift focus to the Hill
ALEXANDRIA, Va. — The natural affinity that has sprung up between independent pharmacy and the generic drug industry — both viewed as underdogs in the relentless fight for market position and profits: one versus powerful chain and big-box retailers, the other versus the far more entrenched and well-funded branded drug industry — was never more fully realized than it was at the end of October, when the National Community Pharmacists Association introduced its new top manager to its members at the group’s annual meeting.
The NCPA’s new EVP and CEO is Kathleen Jaeger, formerly head of the Generic Pharmaceutical Association. Jaeger, a coolly competent industry spearhead and Washington insider, will bring a markedly different leadership style to the independent pharmacy group than that of her predecessor, the able Bruce Roberts, who retired in June. Both are pharmacists; Jaeger, like Roberts, is steeped in the allure of community pharmacy and is the daughter of an independent pharmacist, as well as a pharmacist by training. But where Roberts brought passion borne of long experience operating his own pharmacies to his role as the face of independent pharmacy, Jaeger likely will put a different stamp on the NCPA.
A lawyer as well as a pharmacist by training, Jaeger has the kind of inside-the-Beltway contacts and legal credentials that the organization may need at this stage of its long existence. Before taking command of the GPhA eight years ago, she honed her Washington chops by chairing the Food and Drug Practice for the McKenna and Cuneo law firm and for Kirkpatrick and Lockhart.
While at the GPhA, she worked hard to win respect and visibility for generic drugs and their manufacturers among the public and on Capitol Hill. And that’s exactly the kind of advocacy that the NCPA needs—particularly in this unsettled time of rapid change and uncertainty as the massive reforms coming to the U.S. healthcare system begin to work their way through every facet of professional practice, including pharmacy.
It’s no secret that independent community pharmacies have been hit particularly hard by this brutal recession—not to mention by the longer-term challenges that preceded it, like the steady erosion of pharmacy profit margins. But their role still is a critical one, especially in rural areas where big chains don’t tread. And that’s to say nothing of their economic importance as the small, locally owned businesses that every economy needs in order to thrive.
Jaeger’s experience at the GPhA and as a second-generation pharmacist is a big asset for the NCPA, and if she can replicate her GPhA successes there, then independent pharmacies across the country are likely to benefit as well.