CVS Caremark study: Pharmacy Advisor improved diabetes Rx initiation, adherence rates

WOONSOCKET, R.I. — A CVS Caremark study found that the company's integrated pharmacy-based program — Pharmacy Advisor — increased medication adherence rates and physician initiation of prescriptions for concomitant medications, improving care for diabetes patients and resulting in savings for health plans, the company announced on Monday.

Pharmacy Advisor promotes interactions between diabetes patients and pharmacists, either in face-to-face counseling or on the phone. The study entitled, "An Integrated Pharmacy-Based Program Improved Medication Prescription and Adherence Rates in Diabetes Patients," was published Monday in the January issue of Health Affairs and highlighted the central role pharmacists can play in improving the health of their patients.

"Ensuring adherence and appropriate treatment has long been the domain of primary care providers," stated Troyen A. Brennan, EVP and chief medical officer of CVS Caremark, and lead author for the study. "However, as demands on the time of these providers increase, interventions carried out by pharmacists can complement primary care. Indeed, pharmacists are in the unique position to monitor patient adherence and effectively intervene when indicated." 

Brennan said the study also added insight into the problem of time-limited healthcare interventions. "This study showed that patients stay on their medications while they are actively counseled, but once those pharmacist-patient conversations ended, adherence fell quickly. We need to continue these kinds of interventions to make sure patients benefit from the full beneficial impact of their medications.”

Researchers from Harvard University and Brigham and Women's Hospital assisted the CVS Caremark researchers in the analysis of the pharmacy claims data of benefit members at a large Midwest manufacturing company and focused on interventions with diabetic patients between October 2009 and April 2010. The study included an intervention group of 5,123 people who were proactively counseled by retail and call center pharmacists and a control group of 24,124 patients with diabetes who did not receive specialized counseling. The researchers measured gains in patient adherence and medication initiation rates of concomitant therapies for diabetes, such as statins, angiotensen converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).

The research showed that contacts by pharmacists with the patients and their doctors increased therapy initiation rates by as much as 39% for the full sample and an even higher 68% for the group counseled at retail stores, and increased medication adherence rates by 2.1%. The researchers noted that face-to-face interventions by retail store pharmacists resulted in increasing adherence rates by 3.9%.

The integrated pharmacy-based program featured counseling by pharmacists at 12 retail stores near the manufacturing client's headquarters, and counseling through a pharmacist call center for those identified as having diabetes. CVS Caremark launched Pharmacy Advisor for diabetes in 2009 because the cost and prevalence of that disease continues to rise. The American Diabetes Association estimates the cost of the disease to the U.S. in 2007 at $174 billion.

The study estimated that the employer saved more than $600,000 through healthcare cost avoidance with the intervention group, while expenditures for the counseling totaled $200,000, a return on investment of $3 for every $1 spent on additional counseling. "In a healthcare system eagerly seeking programs that can reduce costs and improve care, such simple, pharmacist-based counseling programs to improve adherence to existing medication regimens and initiate missing therapies should be of great value," the researchers concluded.

The Pharmacy Advisor program is being expanded in 2012 to include counseling for patients with cardiovascular disease, in addition to the more than 12 million members who are part of the diabetes-focused counseling.


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