Real World Health Care Blog

Tag Archives: pharmacy

New Drug Delivery Options that Help the Medicine Go Down

David Sheon

David Sheon

The water cooler talk for us at RWHC is frequently about improving treatment adherence (a patient’s ability and willingness to take his or her medicine consistently, as directed).  OK, so we don’t have the most exciting water cooler discussions.  But this happens to be important – for all of us because when patients stay on treatment, they get better faster.  This is almost universally true, regardless of the therapeutic category.

In some cases, improving adherence not only saves the life of the patient, but it can benefit an entire community.  In HIV, for example, taking antiretrovirals not only helps the patient to manage his or her viral load (the amount of HIV circulating in the blood), but it also lowers that patient’s ability to transmit the virus to someone else.

Sometimes, adherence can be improved by using a different delivery system.  This is the first post in a series on how drug delivery helps adherence.

Remember the first time you took a breath strip that dissolved on your tongue? The technology was invented in the 1970s, but only since July 2012 have pharmaceutical companies been able to win marketing approval to put a drug on the strip.  Two products have been cleared by the FDA.

Zuplenz (ondansetron) oral soluble film is an anti-nausea and vomiting product used by cancer patients who experience nausea and vomiting as a result of receiving chemotherapy and/or radiation as well as for the prevention of postoperative nausea and vomiting.

“We know from market research that patients who are nauseated don’t necessarily like swallowing pills or using suppositories and that sometimes taking pills with water contributes to their nausea,” said John V. Aiken, M. Ed., Vice President, Corporate Operations, Marketing, and Training, Praelia Pharmaceuticals, Inc.  “Since launching the product in December 2012, a number of doctors are telling us that their patients prefer the dissolving strip.”

The second drug now available on an oral dissolving strip is Suboxone (Buprenorphine and Naloxone), from Reckitt Benckiser Pharmaceuticals Inc.  For more information on this product, click here.

If the dosing is standardized and absorption is as good as more typical drug delivery methods, we see only an upside in terms of patient adherence to oral dissolving strips.  Please tell us what you think.  Also, if you know of a new drug delivery option that you’d like to see us cover, let us know!

Walgreens Unveils Solutions to Boost Medication Adherence

How can health professionals enable their patients to take medications more consistently as prescribed?

Personalized counseling from pharmacists and prescription refill reminders are two effective ways now shown to fuel better drug adherence, according to research from Walgreens presented March 15 at the World Congress Summit in Philadelphia.

Walgreens’ community pharmacy programs – in addition to successful intervention models – are equipping patients with powerful tools to self-manage their health.

One finding, for example, revealed that individuals receiving in-person counseling from their pharmacist saw 7.2 percent higher adherence than those with more conventional pharmacy care. Meanwhile, one of Walgreens’ pilot programs demonstrated that patients who receive prescription refill reminders (also called automated refill reminders or ARR) are more likely to consistently take medications for chronic conditions.

“In order to improve medication adherence among patients, providers need to understand the key challenges and contributors to non-adherence, and how to address them,” said Jim Cohn, Walgreen Co. spokesperson. “The research findings demonstrate how programs at the community pharmacy level designed to target common barriers to adherence, such as the challenge of learning a new medication therapy or simple forgetfulness, can significantly improve patient health and outcomes.  Ultimately, these types of pharmacy initiatives can help providers do their part to ensure more people get, stay and live well.”

Walgreens isn’t alone in recommending evidence-based approaches to enhance adherence outcomes. The Medication Adherence Project’s (MAP) 2010 Training Package also offers strategies for both providers and pharmacists that stress individualized patient engagement, with solutions that include writing 90-day instead of 30-day prescriptions, prescribing generics, communicating directly with providers, and more.

Securing increased medication adherence will not only go far in helping patients live longer and healthier, but will deliver considerable savings for the health care system too.

How do we know? Underscoring the benefits of adherence, MAP cites “lower disease-related medical costs” for diabetes and hypercholesterolemia in addition to related “reductions in health care costs.”

The New England Health Institute (NEHI) also provides compelling evidence in its October 2012 Issue Brief that reducing medication non-adherence, which contributes to hospital readmissions, helps lower hospitalizations and saves on associated expenses, noting: “One study found that one-third of adverse drug events resulting in a hospital admission were related to non-adherence. The aggregate cost of hospital admissions related to medication adherence has been estimated to be roughly $100 billion per year and estimates of the share of hospital admissions related to non-adherence are as high as 10 percent.”

Successful strategies generating increased medication adherence are clearly worth pursuing and replicating, both to strengthen the quality of health services and to lower the cost of care.

Now we want to hear from you. As a medical professional, what approaches do you incorporate to encourage patients to properly take their meds? If you’re a patient, what has worked for you?

Express Scripts Provides Roadmap to Improve Health Care, Reduce Costs and Streamline Delivery of the Medicine Patients Need

You might be in a “utilization management program” and not know what that means or why it matters to your health. Offered by a variety of employers across industries, utilization management programs are designed to help patients evaluate their health care options and make decisions about the type of services they receive.

So how do these programs impact the delivery of specialty medications for cancer, HIV, inflammatory conditions, multiple sclerosis, and more?

MedAdNews.com reports that a new study from Express Scripts demonstrates how such programs can increase efficiency by ensuring that more patients who need safe, affordable and effective medications can access them.

As spending on specialty drugs continues to increase (18.4 percent in 2012, up from 17.1 percent in 2011), finding the most effective ways to improve the delivery of patient care, reduce cost and eliminate waste is more important than ever. Combining innovations from CuraScript and Accredo, Express Scripts draws upon Health Decision Science – which integrates behavioral science, clinical science, and actionable data – as a springboard to achieve just that.

Building upon this scientific, results-driven approach, Express Scripts provides care targeted to specific areas of patient need through Accredo’s Therapeutic Research Centers as part of its Specialty Benefit Services. Here, a broad array of health care providers integrate pharmacy and medical data to offer what Express Scripts describes as comprehensive patient care that strengthens coordination of services, boosts transparency, and produces solutions.

“It’s really about appropriateness and the right thing for a patient who really deserves safe and effective and affordable medication and ruling out waste. What our plans are most interested in is continuing to be able to afford to provide a benefit. This again was a great example of by doing the right thing that patients were able to save a significant amount of money and again preserve affordability,” said Glen Stettin, M.D., senior VP, clinical research and new solutions at Express Scripts.

Does your employer use a multiple cost management program for specialty drugs? If so, what type? If not, do you think your employer should? What might be some advantages or disadvantages?

Categories: Access to Care

Why Aren’t Patients Taking Their Medication?

It’s a question with which many in the health care community grapple. In some cases, it’s a matter of affordability, as the high cost of certain therapies makes it difficult to pay for needed drugs AND to pay for essentials like rent or the mortgage, utilities and food. Even with medical insurance, the copays for these expensive therapies put them well out of reach for many Americans.

In other cases, it’s a matter of easy access to refills – a problem being solved, in part, by mail-order pharmacies. This was especially the case among 44,000 hypertension patients recently studied by Kaiser Permanente. Research found that making prescription refills more affordable and easier to access might reduce disparities in medicine-taking behaviors among racial and ethnic groups.

The study authors noted that as early as the first refill, some patients are forgoing their hypertension medication. The result? According to the CDC, hypertension can lead to heart attacks, strokes and deaths related to cardiovascular disease. The impact is devastating to communities of color, particularly among African Americans, where males have the highest hypertension death rates of any other racial, ethnic or gender group.

The research found that both mail-order pharmacy enrollment and lower copayments were associated with a significantly lower likelihood of being non-adherent.

Said the study authors, “Our findings suggest that while racial and ethnic differences in medication adherence persist – even in settings with high-quality care – interventions such as targeted copay reductions and mail order pharmacy incentives have the potential to reduce disparities in blood pressure.”

If you’re in the health care field, what ideas have you seen put in action that work to improve treatment compliance? As a patient, have you ever stopped taking your medication due to high cost or hassles getting refills? And have you turned to mail-order pharmacies or copay assistance programs for help?

Categories: Cost-Savings