CVS Caremark convenes first-ever national forum on nonadherence

Panel examines findings from first half of research partnership

WASHINGTON — CVS Caremark and a panel of health experts explored research findings and the problem of medication nonadherence Thursday morning during CVS Caremark’s first-ever national forum on medication nonadherence at the National Press Club in Washington, D.C.

More specifically, the two-hour webcast forum brought together health experts to discuss the body of published medical studies for the first half of CVS Caremark’s three-year research partnership with Harvard Medical School and Brigham and Women’s Hospital, and uncover actionable steps to battle nonadherence.

Presenters and panelists included: Troyen Brennan, EVP and chief medical officer for CVS Caremark; William Shrank of Brigham and Women’s Hospital and Harvard Medical School; Valerie Fleishman, executive director at the New England Healthcare Institute; Sally Greenberg, executive director of the National Consumers League; Punam Anand Keller, the Charles Henry Jones Third Century professor of management at the Tuck School of Business at Dartmouth College; and Scott Smith, senior service fellow for the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality.

Nonadherence to prescribed medications is a significant drain on the U.S. healthcare system — an estimated $300 billion annually in preventable hospitalizations and patient illness.

“Studies, through the years, have shown that has many as 25% of people who get a prescription because they have visited a doctor with a medical-related problem don’t bother to fill that prescription. It is an issue that our industry has been aware of for years. Other studies have shown that up to 50% of the people who are chronically ill and need medications stop taking their medications within a year. Since 75% of the nation’s healthcare costs are spent on treatment of the chronically ill, it is an issue we should be very concerned about,” said Helena Foulkes, EVP, chief healthcare strategy and marketing officer for CVS Caremark, who moderated the discussion.

Against this backdrop, CVS Caremark embarked on a journey to better understand this issue and the reasons behind the lack of adherence.

“Our goal is to help our partners find creative solutions to lower the cost of health care in the United States. People who are ill benefit from good medication habits because it is good for their health. In addition, if we can increase rates of adherence, our healthcare system can save billions,” Foulkes told attendees before handing the stage to presenters and panelists Brennan and Shrank.

During the discussion, Shrank highlighted some of the key findings of the research to date and told attendees that researchers have been working to get a sense of the predictors of whether or not a patient will abandon prescriptions. A key predictor: cost.

“When medications cost over $50 a prescription, there was four to five times greater rate of abandonment. This may not come as a great surprise, but this really highlights this notion of sticker shock,” Shrank said. “When they go the pharmacy and they are faced with really high prices, they not infrequently walk away and don’t purchase their medications.”

Researchers also found that patients are more likely to abandon prescriptions if they are lower-income, it’s a new prescription and if they have an e-prescription, as it eliminates a patient-oriented step.

“Using those predictors, we are able to create a very simple prediction that pharmacists can use in pharmacy practice to identify who is at risk for abandoning their prescription,” Shrank said.

Emerging from the discussion were several key recommendations called for by the research team:

  • Developing tools through continued research that will allow pharmacists to predict and target those patients who are at risk for nonadherence and prescription abandonment so pharmacists can proactively intervene to improve their care;

  • Working with pharmacists and other healthcare providers to simplify pharmacy care for those with the most complex therapies by utilizing a "pharmacy home" concept where one healthcare professional works with the rest of the medical team to manage and synchronize a patient's medication therapy;

  • Improving pharmacist and healthcare provider communications with patients to enhance adherence through individualized counseling;

  • Researching the use of financial or other incentives to encourage adherence because immediate, positive reinforcement for the right behavior can be a powerful motivator to change behavior;

  • Developing a personalized medication approach, such as through pharmacogenomics or individualized counseling with pharmacists, to best deliver pharmacy care; and

  • Studying social networks and connections to see how they can be utilized to improve medication use by individuals seeking help and advice from family and friends.

“Those are the directions [in which] we are headed, but we’re also — and [this is] partially why we are here today — [looking to] make this much more of a national goal. … We think it is really important to communicate the importance of staying on medications. In particular, we think that is one of the key solutions to a healthier system that works much better and is much more cost-effective. Along with that, … we’ll show how important the pharmacist can be in terms of advising patients and how we can integrate that with the medical home. Obviously, through e-prescribing and communications at the time of e-prescribing, we can get there, but we need to develop more holistic connections,” Brennan said during the panel discussion. “We also want to prompt legislative efforts that are going to promote education for both providers and for patients about the importance of adherence. Last, ... we really want to leverage our investments in innovative technologies and make that information available. This is a research approach for us, and the key thing behind a research approach is that you share the insights that you have.”

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