Maria Castellucci December
14, 2019 01:00 AM
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 four 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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