PHARMACY

CVS study: Targeted interventions versus broad adherence education proves more effective

BY Antoinette Alexander

WOONSOCKET, R.I. — Adherence interventions targeted to nonadherent patients proved more effective in improving medication adherence when compared with broad interventions that cast a wide net to encompass all medication takers, according to new research sponsored by CVS Caremark.

According to the study, entitled "Targeting Cardiovascular Medication Adherence Interventions,” more than one-third of adherence interventions targeted to nonadherent patients resulted in improved medication adherence, compared with 18% of broad interventions.

The study was conducted by researchers at Harvard University, Brigham and Women’s Hospital and CVS Caremark and was published in the May/June issue of the Journal of the American Pharmacists Association.

“While medication nonadherence is widely recognized as a major public health issue that impacts patient health and contributes to rising healthcare costs, there has not been a clear consensus about how best to influence patient behavior and support appropriate medication use," said Sarah Cutrona, a former research associate at Brigham and Women’s Hospital. "These results suggest that broad interventions, which aim to prevent nonadherence by educating and motivating all patients, were the least effective. Without the benefit of identifying patients and their specific barriers to adherence, these types of interventions may be too general to motivate individual patients to change their medication taking behavior."

The researchers reviewed nearly 60 peer-reviewed articles about randomized controlled trials for three types of interventions to improve medication adherence for cardiovascular disease or diabetes. These interventions included: broad interventions targeting all patients, focused interventions targeting nonadherent patients and dynamic interventions initially administered to all patients but then targeted to nonadherent patients based on real-time adherence information. Results found that dynamic interventions (32%) and focused interventions (25%) were more likely to show impact on adherence as compared with broad interventions (18%).

"This study is part of our ongoing research collaboration with Harvard and Brigham and Women’s Hospital to better understand the factors that impact mediation adherence," said Troyen Brennan, EVP and chief medical officer of CVS Caremark, who heads the research initiative that conducted the study. "As a pharmacy innovation company, we believe these results can be useful in helping to develop and better target adherence interventions so they are relevant for the patient and enable them to make better choices about their medications and achieve positive health outcomes."

The researchers concluded that targeting patients who are nonadherent to their cardiovascular medications may lead to better adherence, but more research is needed to determine how best to identify and intervene with nonadherent patients. The accuracy, cost and reproducibility of methods for identifying target populations should be a central consideration in future studies, especially in an environment where resources are limited and healthcare professionals and payers need to identify the most cost-effective and impactful ways to intervene and affect positive behavior change.

To view the entire article, click here.


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PHARMACY

Patients with ulcerative colitis respond to Simponi, study finds

BY Alaric DeArment

SAN DIEGO — Findings from a new study indicate that more than half of the patients with ulcerative colitis who received subcutaneous injections of a drug used to treat autoimmune disorders responded to the treatment.

Johnson & Johnson subsidiary Janssen Research and Development announced results of a phase-3 trial of Simponi (golimumab) in ulcerative colitis patients whose condition had previously failed to improve with or who were intolerant to conventional drugs.

In one treatment group, patients received 200 mg of the drug subcutaneously at week zero and 100 mg at week two, while in another they received 400 mg at week zero and 200 mg at week two. A third group received placebo. Results indicated that 51.8% of patients in the first group responded to treatment after six weeks, compared with 55% in the second group and 29.7% in the placebo group.

"Therapeutic options for patients living with moderate to severe forms of ulcerative colitis who have failed or become intolerant to conventional treatments are quite limited today, which is particularly challenging in managing a disease that primarily affects a younger, active patient population," study investigator and University of California San Diego School of Medicine professor William Sandborn said.


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NCPA addresses adverse consequences regarding latest FUL guidance

BY Michael Johnsen

ARLINGTON, Va. — The National Community Pharmacists Association on Monday drafted a letter to the Center for Medicaid and CHIP Services regarding the latest federal upper limit guidelines that the association characterizes as "getting worse with regard to the negative economic impact [to community pharmacies], not better."

"As we have communicated to you with all the lists that have been released, the implementation of these lists will be economically devastating for independent community pharmacies," the letter opens. "That means that patient care will suffer if access to pharmacy services is decreased because pharmacies have to close or shorten their hours."

According to NCPA’s evaluation, the total number of products with a FUL increased from 935 to 959 between January and February, while the percentage of products with a FUL below a small independent community pharmacy’s actual acquisition cost increased from 40% to 40.6% of all products. For those products with a FUL above AAC, the average gain increased from 41 cents per product to 42.6 cents per product, but the average loss for products with a FUL below AAC increased from 30 cents to 31.4 cents per product.

The average loss per product has increased steadily between July 2011 and February 2012, NCPA stated. "The loss of these revenues would be devastating for independent pharmacies that disproportionately rely on Medicaid revenues and serve Medicaid patients. Moreover, in analyzing the FULs of some of the top Medicaid multiple-source drugs, it is clear that there continues to be rampant volatility in the FULs from month to month, and significant losses to pharmacies on some popular products," the association noted.

NCPA recommends to the agency that a final regulation be issued "so all parties know how to calculate [the average manufacturer price], collect several months of data to calculate draft FULs based on the final regulation and then determine whether such volatility remains in the calculations after all players know the ‘rules of the road.’"

For a PDF of the letter, click here.

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