Medication Adherence – The Next Frontier
Strange as it may seem pharmacy benefit managers and pharmacy retailers have finally awoken to the fact they can increase their profits if patients with chronic conditions like diabetes actually take their medications. Imagine that, patients who take their medications regularly and don’t skip doses will not only achieve better outcomes but the providers of their prescriptions will actually make more money.
This is hardly news for anyone in the diabetes business as we have known for years that therapy non-compliance is a major reason why nearly two-thirds of all patients with diabetes are not properly controlling their diabetes. As Diabetic Investor has stated previously it really doesn’t matter how good a drug or device is if the patient doesn’t take the drug or use the device.
Given the increasingly competitive environment for filling prescriptions PBM’s and pharmacy retailers have latched onto medication adherence as their latest strategy to increase sales. According to an article in today’s Wall Street Journal; “Pharmacy-benefit manager Express Scripts Inc. is unveiling a new program that aims to contact people who fail to take their prescription drugs—before they actually stop.
The company Monday will announce an initiative intended to predict in advance who’s most likely to discontinue a medication regimen, and keep those people on their drugs with interventions such as letters or phone calls. This is an effort to encourage compliance and offer help such as mail-order prescriptions.”
Medication adherence was also a major theme this past Friday when CVS/Caremark (NYSE:CVS) held their analyst day. In his opening remarks company Chairman &CEO Tom Ryan outlined the burden chronic diseases are placing on our economy and healthcare system. He noted that therapy compliance not only increases pharmacy utilization but also lowers healthcare costs. As a pharmacy retailer Mr. Ryan also knows that customers who are therapy complaint also visit their stores more frequently providing CVS with the opportunity to sell them other non-pharmacy related items.
It’s not surprising that all major pharmacy chains are interested in therapy compliance and customers with diabetes. It’s well known that diabetes is growing at epidemic rates and the patient population is getting older. As Mr. Ryan noted during his presentation, there is a direct correlation between therapy compliance and age, or simply put the older a person gets the more compliant they become. Mr. Ryan also knows that the customer with diabetes is worth nearly $4,500 per year in revenues. This is reason why retailers like CVS have designed special programs for their customers with diabetes as they know the high value of the diabetic customer.
Being both retailer and a PBM CVS/Caremark is an interesting example of how companies plan to target patients so they become therapy compliant. Understanding the growing role a pharmacist plays the company using advanced technology has given their pharmacist access to information regarding the patient’s prescription history. For example using this technology the pharmacist is alerted when a patient is behind or has not filled a prescription. This allows the pharmacist to intervene with the patient helping to get the patient back on track.
As outlined in the Wall Street Journal article Express Scripts is using a slightly different approach using predictive analytics to intervene before the patient becomes non-compliant. It is also known that Walgreens (NYSE:WAG) is currently testing the use of the widely successful Asheville Protocol.
While all of these efforts have succeeded to one degree or another there are still some issues which need to be resolved. As successful as the Asheville protocol has been the programs Achilles heel is it’s high cost to implement and maintain. The program’s other drawback is what happens after the patient leaves the pharmacy, or put another way how does the pharmacy keep the patient engaged between pharmacy visits.
The proactive patient consulting model also has some drawbacks. Typically companies like Express Scripts proactively contact the patient on the phone or through the mail. This proactive consultation is designed to answer patient questions and identify issues that could cause the patient to become non-compliant.
As noted earlier both approaches have succeeded to a certain degree however neither approach has succeeded far enough as therapy non-compliance remains a huge issue. Additionally while therapy compliance is critical to better outcomes these programs fail to address other aspects of diabetes management which are just as important as therapy compliance. For example, studies have shown that patients who monitor their glucose levels on a regular basis achieve better outcomes. The same is true for exercise and weight management programs.
Given the cost and complexity of such a comprehensive diabetes management program it’s understandable that companies like CVS and Express Scripts have concentrated their efforts on medication adherence. Another reason for this focus is the companies can easily monitor their return on investment. As CVS noted during their meeting in one program for US Airways therapy compliance for employees with diabetes increased nearly 18%.
The missing link here, you know what’s coming next, is patient education. Adding patient education to a therapy compliance program is like adding peanut butter to jelly. Just as studies have found that patients who monitor their glucose levels regularly achieve better outcomes, other studies have shown that education also increases therapy compliance. The simple fact is patient education is the most successful method to achieve better outcomes and the other simple fact is patient education is an investment that offers the largest overall return on investment.
The bottom line here is that whoever combines patient education with their therapy compliance efforts stands to reap the greatest financial rewards. Therapy compliance is a good first step and Diabetic Investor is pleased to see companies like CVS and Express Scripts expanding their efforts here. Hopefully someone will build on this adding patient education to the mix and truly change the diabetes paradigm forever.
Progress is being made and Diabetic Investor believes we are beginning to move in the right direction, but we cannot stand still as there is still more to be done. As Oliver Wendell Holmes wrote; “I find the great thing in this world is not so much where we stand, as in what direction we are moving: To reach the port of heaven, we must sail sometimes with the wind a d sometimes against it— but we must sail, and not drift, nor lie at anchor.”
