Pharmacists take on medication adherence

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In March, retail pharmacy giant Walgreen Co. started hiring pharmacists specifically tasked with addressing medication non-adherence.

The new role, described as a health outcomes pharmacist, entails having the pharmacists call customers with diabetes, hypertension and high cholesterol who have been historically non-adherent to their drugs, find out why and get them on their regimen if called for.

Research estimates that patients failing to take their medications or failing to take them as prescribed costs the U.S. healthcare industry $100 billion to $300 billion annually.

Deerfield, Ill.-based Walgreen and outpatient clinics run by health systems are investing in pharmacists to try to tackle the issue, often called medication non-adherence. What the other major drug chain is doing in this regard remains unclear; CVS Health didn’t respond to multiple requests for comment.

Pharmacies at Walgreens stores use an internal electronic platform to track medication refill history of customers to determine if they struggle with non-adherence.

Customers with diabetes, hypertension and high cholesterol were targeted because value-based payment contracts that Walgreen has with commercial payers have quality metrics related to those patient populations, said Rina Shah, group vice president of pharmacy operations at Walgreen. The pharmacists will also reach out to customers in value-based payment arrangements that the health plans have targeted as vulnerable to non-adherence. For some payment programs, Walgreen can experience lower payments on prescriptions if customers report poor outcomes on quality measures related to medication adherence such as low refill rates, said Mike Umbleby, divisional vice president of clinical performance at Walgreen.

“Our reimbursement model has definitely shifted to not only include dispensing of medications but if our patients are adherent to therapy,” Shah said. “There is a financial incentive to our patients staying healthy.”

The number of Walgreen’s health outcomes pharmacists has grown from 75 in March to over 200 as of late November with pharmacists reaching out to patients in all 50 states.

There are several things the pharmacists will do to try to improve a patient’s adherence to their prescriptions. If transportation to the pharmacy is a concern, the pharmacist can get them enrolled in Walgreen’s delivery program. Another tactic is to change the customer’s supply from monthly refills to 90-day refills, requiring fewer trips to the pharmacy. Medication synchronization may be another solution, which allows a customer to pick up all their medications at the same time.

The cost of their drugs is another reason frequently cited by customers as to why they aren’t taking their medications. Pharmacists check to see if lower cost alternatives are available and work with their healthcare provider to get the prescription changed if necessary.

Data so far shows customers who had an intervention from a health outcomes pharmacist had a on-time refill rate nearly 8.7% higher than patients who didn’t receive the same intervention. “We are excited about this program, these are real patients that are going through something, and it’s our responsibility to help them so we can leave them better than when we found them,” Shah said.

While Walgreens doesn’t now get data from health plans or providers that could help identify even more patients at risk for non-adherence, Umbleby said the company is in talks with some organizations to do so.

But Indu Lew, chief pharmacy officer at RWJBarnabas Health, said the 11-hospital health system doesn’t find it necessary to partner with retail pharmacies on data to address medication adherence.

RWJBarnabas uses software that shows prescription refill history by assessing patient’s insurance claims history.

“We can partner with our payers” rather than retail chains, Lew said.

“Just because a medication was refilled doesn’t mean the patient is taking it, so we are going to make a big assumption that because medications were refilled they are being taken,” she added.

The five pharmacists that RWJBarnabas has integrated into a few of its clinics often focus on medication adherence. Alyssa Gallipani, an ambulatory-care pharmacist who works at two RWJBarnabas primary-care clinics, said it’s the No. 1 focus area during her shifts.

“We always focus on medication adherence because at the end of the day if they (the patients) aren’t taking the medication we aren’t going to achieve the ultimate goal” of better outcomes, she said.

Physicians in the clinics refer patients to the pharmacists if they think the patient may be at-risk of non-adherence or are already non-adherent to their drugs. Pharmacists may also be asked to visit with patients if their disease states are out of control.

Motivational interviewing is a key tactic to understand if a patient isn’t adherent to their medications and why, said Ammie Patel, an ambulatory-care pharmacist who also works at two RWJBarnabas primary-care clinics. She asks open-ended questions so the patient is forced to respond with more than “yes” or “no” answers.

In one instance, her questions led her to understand why a patient wasn’t taking his medications as prescribed. She asked him about his job, discovering he often traveled internationally. He didn’t like carrying all his medications with him in a large pill box so sometimes he wouldn’t bring them. And because of frequent travel, taking medications on time was a challenge. She ordered him a smaller pill box that could fit better in his luggage as well as helped him set reminders on his phone to take his medications. His hemoglobin A1C levels have declined from 10.4% to 7.4%.

“It was a simple solution, but no one had asked him about his schedule,” Patel said.

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