Patients believe in adherence but don’t act on it
Medication nonadherence costs the U.S. healthcare system about $290 billion per year, according to New England Healthcare Institute. That big and scary number — the kind whose sheer enormity can make one’s eyes glaze over — is now even bigger.
According to the most recent drug trend report by pharmacy benefit manager Express Scripts, patients failing to take their medications as prescribed cost the country $317 billion. Included in that is the $105.8 billion in waste that results from nonadherence among patients with the three most common chronic disease states: diabetes, high cholesterol, and hypertension and heart disease.
The reasons why nonadherence is such a crisis remain unchanged: Patients who don’t take their drugs as prescribed face higher risks of complications. For the top three disease states, that means higher risks of heart attacks, strokes, heart failure, amputations, blindness and kidney disease, among others. But while nonadherence is a serious medical problem, it’s also a social problem that results from a variety of causes, and thus isn’t as simple as a miracle-pill panacea. Fortunately, patients are taking it as seriously as pharmacy retailers, PBMs, prescribers and drug makers. According to a recent survey of 40,000 adult patients taking a medication to treat at least one chronic condition, 90% agreed that taking medications as prescribed was important, while 81% agreed that skipping doses was bad for their health. In addition, respondents ranked taking medications as prescribed as the most important health behavior, above not smoking, eating healthily, getting enough sleep and getting enough exercise.
But just because patients say adherence is important doesn’t mean they themselves are adherent, even if they think they are. The ESI survey found that 85.2% of respondents reported taking their medications as prescribed at least 80% of the time, but other research has indicated adherence rates may be less than 50% in some cases. In another survey, the PBM measured adherence using patients’ medication possession ratio, a measure estimated by dividing the days’ supply of medication that a patient has on hand by the number of days for which it should be available. The least adherent patients in the survey reported perceived medication possession ratios of 90.3%, but their actual MPR was 24.3%.
Meanwhile, in late March, CVS Caremark released results of its own medication adherence studies, with one focusing on state-by-state performance. States were ranked as gold, silver or bronze depending on a mix of adherence measures, including MPR, percent optimal MPR, first-fill persistency rate, generic dispensing rate and mail dispensing rate across the top three disease states, as well as depression, in addition to including various demographic and healthcare access measures. The “State of the States: Adherence Report” was based on a review of CVS Caremark’s pharmacy benefit management claims data.
Walgreens also released its own adherence studies in April, presenting results at the Academy of Managed Care Pharmacy’s annual meeting in San Francisco. The studies focused on three programs, including the Prescription Savings Club, pharmacist-led patient counseling and the Walgreens HIV Centers of Excellence pharmacies. The studies found that Prescription Savings Club members were 77.9% adherent to diabetes medications, compared with 68% among nonmembers. Meanwhile, patients with new statin and thyroid drug prescriptions who received pharmacist-led counseling saw their medication possession rates increase from 44% to 56% in the space of one year, while 62% of HIV patients who went to Walgreens’ HIV Centers for Excellence had adherence rates of 85% or more, compared with 57% of patients using community pharmacies.
ReportersNotebook — Chain Pharmacy, 5/21/12
SUPPLIER NEWS — Watson has announced its intention to acquire Actavis, the company said. Following news reports that the U.S.-based generic drug maker would acquire Switzerland-based Actavis, Watson announced that it would buy the latter for $5.6 billion. News media had reported that the deal would be worth $5.9 billion, while there had been estimates in March that Watson would pay up to $7.3 billion.
“The acquisition of Actavis will create the third-largest global generics company, substantially completing Watson’s expansion as a leading global generics company,” Watson president and CEO Paul Bisaro said.
Watson noted that Actavis operates in more than 40 countries and markets more than 1,000 products around the world, with more than 300 projects in its pipeline and 2011 sales of about $2.5 billion.
The Food and Drug Administration has approved a new drug for treating erectile dysfunction, the agency said. The FDA announced the approval of Vivus’ Stendra (avanafil). “This approval expands the available treatment options to men experiencing erectile dysfunction and enables patients, in consultation with their doctor, to choose the most appropriate treatment for their needs,” FDA Office of Drug Evaluation III deputy director Victoria Kusiak said.
The Food and Drug Administration has approved a drug made by GlaxoSmithKline for certain cancer patients. GSK announced the FDA approval of Votrient (pazopanib) for patients with soft tissue sarcoma who have received prior chemotherapy. Soft tissue sarcomas are a group of rare cancers that affect the mesenchymal cells, which give rise to such soft tissues as muscles, nerves, fat and blood vessels. The incidence of STS was 10,980 in 2011, according to the American Cancer Society.
A company that manufactures pharmacy dispensing machines has moved into a new headquarters. RxMedic Systems announced the opening of its new headquarters in Wake Forest, N.C., a suburb of Raleigh. The company said expansion of product lines created the need to move into a new location. “With our recent growth, we had just outgrown our previous location,” VP David Williams said. “Now, we have much more space for both product development and manufacturing.”
E-prescribing spreads like wildfire in retail Rx
Big trends can sometimes take centuries or even millennia to develop. Think about how long it took between the dawn of anatomically modern humans and the adoption of agriculture. Health care is no different, having come a long way since the days of bloodletting and the assorted quackeries that were once considered acceptable medical practices.
But there’s one trend in health care that has happened with astonishing speed, particularly in the United States: the adoption of electronic prescribing. According to the latest numbers from e-prescribing network Surescripts, there were 16,000 office-based prescribers who had adopted e-prescribing in 2006. Within two years, that number climbed to 74,000, but that still represented only 12% of the total. By 2011, however, that number had reached 390,000 — 54% of all prescribers in the country. The numbers from the pharmacy side have increased even faster. In 2008, 46,000 pharmacy retailers, or 76%, were set up for e-prescribing; in 2011, it was 56,900, or 91%. Of those, chains have adopted the technology to the greatest degree, with 98% of chain pharmacies using it, compared with 79% of independents. According to Surescripts, of the 62,461 community pharmacies in the United States, 64% are part of a chain, while 36% are independents.
One case in particular is Walgreens, which in March announced a program with Surescripts whereby it would send immunization records directly from Walgreens and Duane Reade stores, and Take Care Clinics, to primary care providers using Surescripts’ Clinical Interoperability services, with plans to share immunization data with public health authorities starting later this year.
Currently, the percentage of prescriptions transmitted electronically remains relatively small: In 2011, 570 million prescriptions, or 36%, were sent electronically — but compare that with 2008, when that figure was 68 million, or 5%. The reason for the discrepancy, according to Surescripts, is that actual use of e-prescribing tends to lag adoption, with the most recent adopters among prescribers using it less than those who adopted it in earlier years.
At the same time, adoption has been somewhat uneven when examined on a state-by-state level. So far, according to Surescripts, Massachusetts has seen the most comprehensive use of e-prescribing, while such states as Minnesota and Oregon have seen widespread use as well. On the other hand, adoption has been relatively light across Nevada and California, and appears almost nonexistent in all but a few portions of Alaska. Also, while e-prescribing is common in Dallas and Houston, it’s extremely rare, if not absent, in many other Texan counties, with Kansas, Nebraska and South Dakota showing similar patterns.
One major reason why e-prescribing has seen such dramatic growth is government incentives under the Medicare Improvements for Patients and Providers Act of 2008. According to a report released in February by the Centers for Medicare and Medicaid Services, nearly $271 million was paid to physicians as part of the eRx Incentive Program in 2010, an 83% increase over 2009, the first year of the program, when the program paid out $148 million. The payments went to 65,857 individual professionals and 18,713 practices. The CMS report also found that almost 700,000 professionals were qualified to participate in the eRx Incentive Program in 2010, compared with close to 669,700 in 2009.
At press time, CMS didn’t have complete data for 2011, but it found that by 2011, 160,959 eligible professionals, or 26.3% of those eligible, had submitted data for the eRx measure through claims.