CVS Caremark research highlights methods for improving medication adherence

WOONSOCKET, R.I. Research from CVS Caremark demonstrated the positive impact of various tools available to pharmacy benefit management companies, including automated telephonic messaging, fax alerts to physicians about gaps in care and strategic co-pay waivers for generic medications.

The data, which came from three different studies, was presented at the 22nd Annual Meeting of the Academy of Managed Care Pharmacy.

"Poor medication adherence is frequently at the root of preventable hospitalizations and patient illness and the resulting costs to the U.S. healthcare system have been estimated to be a staggering $300 billion annually," stated Troyen Brennen, M.D., EVP and chief medical officer of CVS Caremark. "These studies show that pharmacy benefit managers can employ a variety of tools to encourage medication adherence and close key therapy gaps, resulting in both improved health outcomes as well as opportunities for cost savings for both the plan sponsor and the member."

One of the CVS Caremark studies examined the effectiveness of interactive voice response (IVR) programs in improving persistency to maintenance medication therapies dispensed via mail-service pharmacy. From October 2008 to February 2009, more than 94,000 commercially insured mail pharmacy users received various combinations of supportive adherence messages delivered by IVR. Results showed that among members who answered the telephonic IVR, the odds of refilling the prescription were up to 70.6% higher than controls. In addition, among members receiving early refill reminders the average first fill persistency rate (FFPR) at mail was 3.5% higher than controls, while the average FFPR was 1.4% higher than controls for members receiving refill reminders after their drug supply was exhausted.

A second study examined the effectiveness of faxed alerts to physicians in resolving potential gaps in therapy in three areas: 1) adding an osteoporosis-preventative agent for women on long-term glucocorticosteroids; 2) adding an ACE inhibitor or ARB for adults with hypertension and diabetes; and 3) adding a lipid-lowering agent for individuals ages 30 years or older with diabetes. During the study period, a total of 337 employers and health plans -- representing more than five million members -- participated in a program that delivered fax alerts to providers when members' pharmacy claims indicated the absence of a recommended therapy in one of the areas outlined above.

In this study, interventions were conducted between Jan. 1 and March 30, 2009, with gap closure rates measured through Sept. 30, 2009. Results showed that gap closure rates among members whose physician received a fax alert, were significantly higher than controls. For those members whose claims triggered an osteoporosis alert, gap closure rates were 8.4 percentage points higher than controls, those who triggered an anti-hypertensive therapy alert had gap closure rates 5.5 percentage points higher and those who triggered a cholesterol management alert had gap closure rates 4.5 percentage points higher.

A third study examined the effectiveness of generic co-pay waiver programs designed to provide incentives for members using brand medications to switch to generics. Members using targeted brands were given a six-month period during which they could change to a recommended generic medication and receive generic co-pay waivers at mail. Members who converted to a generic early in the six-month period received two generic co-pay waivers (i.e., on medication for six months). Members who delayed their generic conversion until the end of the six-month period received one generic co-pay waiver (i.e., on medication for three months). The study focused on members who continued therapy with the generic after using the co-pay waiver(s) and found an overall higher sustained generic dispensing rate (GDR) for members who received two co-pay waivers (GDR of 88.2%) compared with members who received one co-pay waiver (GDR of 71.7%).

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