Retailers’ new programs target nonadherence
Improving medication adherence in specialty pharmacy could be equivalent to introducing a new blockbuster drug. That’s how Diplomat Specialty Pharmacy president and CEO Phil Hagerman put it at Drug Store News’ Specialty Pharmacy Roundtable two years ago.
And he was only talking about specialty and the disease states it covers. The most commonly cited cost of poor medication adherence comes from a study published in the New England Journal of Medicine, which put it at about $290 billion; the latest drug trend report from pharmacy benefit manager Express Scripts has it pegged at more than $300 billion.
One of the ways retailers are improving medication adherence is medication therapy management. Last month, Rite Aid announced a collaboration with health insurer UnitedHealth Group as part of the Diabetes Control Program, itself a part of UnitedHealth’s Diabetes Prevention and Control Alliance. The collaborative program is now available to residents of Long Island in New York state who are enrolled in UnitedHealthcare’s employer-sponsored health plans. Diabetes patients enrolled in the program are able to connect with Rite Aid pharmacists at 27 stores who are trained in diabetes care and MTM, and offer consultations, education and support. The pharmacists also consult with enrolled patients to evaluate their success adhering to their drug therapies and review their test results for blood pressure, blood glucose and cholesterol.
Also last month, Walgreens announced WellTransitions, a program that creates a coordinated care model involving health systems, hospitals and the retail pharmacy chain to reduce re-admissions and costs, while improving outcomes and adherence. Under the program, Walgreens pharmacists work with hospital staff to oversee medication therapies and provide such services as medication review, whereby pharmacists review prescriptions upon admission to the hospital and after discharge, checking for potential interactions and simplifying regimens; bedside medication delivery, which includes medication education and instruction; medication counseling with patients and caregivers; follow-up calls to discuss patient progress and discuss regimens; and pharmacist support available 24 hours per day. WellTransitions is available at locations in Florida, Maryland and Indiana, and there are plans to roll it out throughout the United States.
CVS Caremark has some new plans for improving adherence as well. Currently, its Maintenance Choice program — which was launched in 2009 and offers patients the choice of picking up their drugs at the store or having them shipped to their homes at no increase in co-pay or payer pricing — covers 10.7 million lives under 880 plans. But during the company’s second-quarter earnings call in August 2012, president and CEO Larry Merlo discussed plans for Maintenance Choice 2.0, a version that will include less restrictive and voluntary plan design options. Maintenance Choice 2.0 is currently in pilot testing and is expected to become more widely available in January 2013.
ReportersNotebook — Chain Pharmacy, 11/5/12
SUPPLIER NEWS — Pharmacy automation manufacturer Kirby Lester has launched a version of one of its tablet counters with streamlined verification software. The company announced the launch of KL1Plus, which it said combines the KL1 tablet counter with the updated software.
“There is absolutely no reason why a pharmacy can’t afford to verify 100% of orders now that the KL1Plus has been developed,” Kirby Lester president and CEO Garry Zage said. “Pharmacies across the country have incorporated the KL1 into their operations. Now, they can use the KL1, plus verification.”
The counter, which is 7 in. wide and weighs 8 lbs., is designed to verify all pharmacy orders so that patients receive the right medication, dosage and quantity each time, allowing the pharmacy technician to scan the bar code on the patient’s prescription label and then scan the label on the corresponding stock bottle to ensure there’s a match.
The Food and Drug Administration has approved a new use for a drug made by Roche division Genentech. The drug maker said that the FDA had approved Actemra (tocilizumab) for adults with moderately to severely active rheumatoid arthritis who have not responded adequately to one or more disease-modifying anti-rheumatic drugs. The drug was already approved for systemic juvenile idiopathic arthritis.
Medical supply company BD has introduced a disposable injection pen that it said was designed for drugs requiring frequent, low-volume injections or variable dosing. The company’s BD Medical division announced the introduction of the Vystra. The company said the pen is designed for ease of use, comfort and reliability, including design features like multidosing, simple dose dialing and correction with audible clicks and large and clear dose markings.
“As more patient care shifts to the outpatient setting, self-injection devices must be able to accommodate the requirements of an ever broader range of drugs and patient profiles,” said Krista Thompson, BD medical VP and global leader for pharmaceutical systems and the self-administration injection systems platform. “With the BD Vystra disposable pen, BD has incorporated several customization options to meet these needs.”
mHealth transforming health care with apps
Whatever dazzling visions science fiction may offer of the widgets of the future, the long, uphill road of technology inevitably leads to the smaller and the simpler. The horse and carriage gave way to the automobile; vacuum tubes gave way to transistors; and computers that took up entire rooms and required intricate climate-control technologies now fit in one’s pocket.
Technologies used in health care have undergone a similar transition, and much of that has happened in the last few years thanks to the spread of mobile technology.
According to published reports, the number of mobile health apps in the Apple Store increased from nearly 3,000 in early 2010 to more than 13,000 in early 2012. But download rates have not kept up with that growth. According to the Pew Internet and American Life Project, which surveyed 2,260 adults in July and August 2011, the percentage of cell phone owners who downloaded apps to their phones increased from 22% in September 2009 to 38% in August 2011. But in September 2010, only 9% of adult cell phone users had an app for helping track or manage their health. At the same time, young and African-American users seem to be bigger users of health apps. Fifteen percent of users ages 18 years to 29 years had health-related apps, compared with 8% of those ages 30 years to 49 years. Meanwhile, 15% of African-American users had them, compared with 11% of Hispanics and 7% of whites. When the question was asked in August 2011 of those who had downloaded an app to a cell phone or tablet, as opposed to all cell phone users, the numbers were much higher, with 29% of respondents reporting that they had downloaded a health-related app.
Increasingly, everything from keeping track of prescriptions and ordering new ones to management of chronic disease states to health information to medication adherence is migrating to consumer’s pockets and purses. In fact, several major developments in the mobile health, or mHealth, app world have happened within the past couple of months.
In September, Chicago-based Leap of Faith Technologies announced that it had received a grant for more than $1 million from the National Institutes of Health to develop its iPhone and Android platform for improving medication adherence. The platform, known as eMedonline, is described as a software-as-service, mobile health platform that would provide opportunities for drug surveillance and research data mining. According to the company, the platform had demonstrated medication adherence levels of 98% and shown “significant” improvements in patient self-efficacy in clinical trials funded by the NIH and private industry.
Apps tailored to patients taking drugs for chronic disease states have seen development as well. The same month that Leap of Faith Technologies made its announcement, Eli Lilly announced the launch of an app to support patients with Type 1 diabetes taking glucagon. The app was described as a mobile tool designed to teach caregivers how to use glucagon, which treats severe hypoglycemia, or low blood sugar, through simulated practice. It also provides information about severe hypoglycemia and Glucagon; visual and audio emergency instructions; tools to keep track of kit locations and alerts for expiration dates; and safety information. “Lilly Diabetes is committed to developing personalized solutions to help people with diabetes achieve their treatment goals and improve their outcomes,” Lilly Diabetes U.S. product brand director for specialty marketing Matt Caffrey said. “The Lilly Glucagon mobile app leverages the power and reach of mobile technology, providing another opportunity to support people living with Type 1 diabetes. Lilly Diabetes is constantly striving to create new and better tools to support the diabetes community in a variety of ways.”
Other apps that appeared in September include health references that provide information about things like drugs and the human body. Mylan released a mobile version of the reference guide to its drugs. The Generic Brand Reference Guide, or GBR, is designed to allow healthcare professionals, patients and pharmacy students to identify branded and generic drugs. The print edition of the GBR had been released as a pocket-sized reference earlier this year. “We are pleased to offer Mylan’s 2012 GBR to healthcare professionals in the United States, including pharmacists, physicians and nurses, and chain and wholesale buyers,” Mylan North America president Tony Mauro said. “The GBR provides a comprehensive and up-to-date list of the generic and brand names for more than 2,000 separate oral and liquid dosage forms, as well as injectable and transdermal products. Mylan is committed to partnering with healthcare providers to optimize their time and together expand access to high-quality medicine.”
The pace of development in mHealth has been enough to prompt calls in Congress for the Food and Drug Administration to step in and regulate it. Last month, Kaiser Health News reported that Rep. Mike Honda, D-Calif., whose district includes Silicon Valley, was preparing to introduce a bill that would set up an Office of Mobile Health within the FDA. The bill, named the Healthcare Innovation and Marketplace Technologies Act, would also call for the writing of a mobile health developer support program at the Department of Health and Human Services and help prevent violations of the Health Insurance Portability and Accountability Act or other privacy regulations by app developers. “Currently, our healthcare system works against small-to-large startup entrepreneurs with a multitude of barriers of entry,” the Kaiser Health News reported Honda as saying. “Why have the principles of Silicon Valley, which I represent — competition, innovation and entrepreneurship — not fully manifested themselves in the healthcare information technology space? This bill gets us closer to that space.”
Research2guidance predicted that the mHealth market could grow to $1.3 billion by the end of this year, from $718 million in 2011.