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Industry aims to prevent primary nonadherence

BY Alaric DeArment

While medication nonadherence is a perennial problem that costs the healthcare system $290 billion per year, one of the least explored facets of it is primary nonadherence, when patients receive new prescriptions on paper or electronically and never drop them off or pick them up. But some researchers hope to change that.


The study, conducted by Kaiser Permanente Colorado and the University of Colorado, and published in the Journal of General Internal Medicine, found 11% of diabetes patients failed to pick up or fill their new prescriptions. But this study took place in an integrated healthcare system with extensive use of electronic health records; studies in nonintegrated health systems have found general rates of primary nonadherence to be as high as 22%, though the higher rate could be because of lack of data sharing between different organizations and pharmacy claims databases.


What makes an issue like primary nonadherence particularly significant in diabetes is the scope of the disease. According to the Centers for Disease Control and Prevention, 26 million Americans have Type 1 and Type 2 diabetes, and Type 2 diabetes — once called adult-onset diabetes — has grown rapidly among children.


Earlier this year, the National Association of Chain Drug Stores Foundation announced plans to fund two studies on primary nonadherence in response to the lack of available scholarship on it — a recent analysis by the NACDS Foundation and the Rand Corp. found that out of 4,600 peer-reviewed studies on nonadherence, only three addressed primary nonadherence. The studies, to be conducted by research teams from Harvard University and the University of Mississippi, will focus on various interventions for addressing primary nonadherence at the community pharmacy level in order to determine which are the most effective. Preliminary results are expected to appear in July, with the rest expected within two years.


“The reason we want to focus on primary medication nonadherence in the community is because of the large preponderance of patients who don’t have a health plan that’s integrated,” NACDS Foundation president Edith Rosato told Drug Store News. “We feel that community pharmacists can have a tremendous impact on helping patients become more adherent.”


Still, retail pharmacies already are finding ways to address the problem. Last month, Rite Aid joined forces with UnitedHealth Group’s Diabetes Prevention and Control Alliance to launch a program for diabetes patients at select stores in New York and Washington. Under the program, trained pharmacists will consult quarterly with enrolled patients to evaluate their medication adherence and review their test results for blood pressure, blood glucose and cholesterol. “By participating in the Diabetes Prevention and Control Alliance, Rite Aid is able to offer participating patients the benefit of one-on-one counseling from a Rite Aid pharmacist specifically trained in diabetes care and medication therapy management,” Rite Aid EVP pharmacy Robert Thompson said. “This type of care has been proven to better manage diabetes and improve overall health, lowering healthcare costs in the long run.”

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Novo Nordisk educates diabetics with e-books

BY Alaric DeArment

BAGSVAERD, Denmark — Danish drug maker Novo Nordisk has launched a five-
volume series of e-books designed to help patients work with their healthcare providers to better manage their diabetes.


The series is part of the Cornerstones4Care patient-support program launched earlier this year, and the books will be available at such e-book sites as iBooks, Reader Store, the Nook Book Store and Free-eBooks.net toward the end of this year.


“With an increasing demand for e-books, we saw an opportunity to share our existing diabetes education book series in a new and innovative format that meets the changing technology needs of today’s patient,” Novo Nordisk corporate VP diabetes marketing Camille Lee said.

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New drugs offer hope for better diabetes treatment

BY Alaric DeArment

The recent film “Contagion” depicts the world descending to chaos due to the spread of an extremely deadly virus. But in reality, one of the most serious epidemics doesn’t come from an infectious agent but from people’s life choices.


Diabetes currently affects 26 million people in the United States, with Type 2 diabetes making up the bulk of the epidemic and expected to exact tremendous costs to the U.S. economy as it expands over the next several decades. But while healthier lifestyles ultimately are the best way to combat the Type 2 diabetes epidemic, a number of companies are developing drugs to treat it.


Among these is dapagliflozin, a treatment developed by Bristol-Myers Squibb and AstraZeneca. “Physicians are enthusiastic about this drug’s novel mechanism of action — the drug promotes urinary excretion of excess glucose — because it carries a very low risk of hypoglycemia, even when used in combination with other antidiabetic drugs, and causes modest amounts of weight loss,” said Decision Resources analyst Christine Helliwell, noting that hypoglycemia often is a limiting side effect of diabetes drugs. 


But whether the drug will receive approval remains in doubt, as a Food and Drug Administration advisory committee recommended against its approval in July, raising the possibility that the FDA might decline to approve it. However, this wouldn’t be the end of the road, as there may still be steps that BMS and AstraZeneca can take to win approval.


Novo Nordisk is developing the long-acting insulin analogue degludec, which Helliwell said may be more suitable for elderly or fragile patients due to its lower risk of hypoglycemia. Meanwhile, Bydureon (exenatide), a long-acting version of the Type 2 diabetes drug Byetta — made by Eli Lilly, Amylin Pharmaceuticals and Alkermes — is expected to do well.


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