mHealth apps foster drug adherence
mHealth — the use of mobile technology devices and smartphones for healthcare purposes — is transforming health care as more Americans adopt mobile devices. Smartphone apps are an innovative way to improve adherence and patient behavior because they are constantly accessible, engage and educate patients, and provide a repository for patient-and medication-specific information.
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Consider these facts:¹
- 247 million Americans have downloaded a health app.
- 95 million Americans are using mobile phones as health tools.
- Mobile health, a $1.3 billion industry, is expected to reach $20 billion by 2018.
- 42% of U.S. hospitals are using digital health technology to treat patients.
- Remote patient monitoring using mobile will save the United States $36 billion in healthcare costs by 2018.
Medication-adherence apps can potentially store all of the user’s medical information and provide a more streamlined way to keep patients informed about their disease and care. What’s more, adherence apps can be downloaded for free and can benefit anyone taking prescription medications.
Given that improved medication adherence can greatly reduce total healthcare use and costs as a result of reductions in hospitalization and emergency department use, mHealth has emerged as one of the most significant healthcare tools for the new reform era.²
The Future is mobile
Healthcare apps offer patients easy access to essential pharmacy benefit-related information, including:
- Pharmacy and medical benefit summaries and claims history;
- Drug formularies and drug prior authorization status;
- Drug prices of nearby pharmacies and expected out-of-pocket costs with generic and therapeutic alternatives; and
- Reminders and alerts for prescription drug compliance.
Currently, health-related apps are used primarily for information retrieval, with some mobile devices providing more one-on-one interaction. For example, RxManager, which is offered by Physician’s Plus, provides personal drug utilization information for each patient, including specific money-saving suggestions for better pharmacy benefit use. The app also offers patients a number of features, including:
- Records immunizations and health screenings, and those recommended based on the individual’s profile;
- Tracks health and wellness, including weight, HgA1c, headache log, blood pressure, cholesterol and more (the date and time selector supports multiple-tracker measurements per day); and
- Creates list of questions to ask the doctor. The most effective Web-based platforms:
- Gather, integrate and access drug claim histories and formulary data;
- Deliver personal notifications to patients regarding drugs that require prior authorization;
- Contain personalized messaging to increase the effectiveness of consumer engagement communications; and
- Include reporting applications that measure changes in pharmacy utilization and prescription drug adherence for chronically ill patient populations.
Ultimately, the widespread use of mHealth will save time and money across the healthcare delivery system, simplify pharmacy understanding and utilization, and enhance the effectiveness of medication therapy management.
More providers embracing mHealth technology
Apps are designed to support patient care and enable clinicians, pharmacists and hospital staff to encourage adherence to medications for chronic health conditions, such as diabetes and asthma. This enables hospitals to cut costs and work collaboratively with individuals who are at risk for adverse drug events that lead to hospital readmissions.
For example, Geisinger Health Plan, which developed its Geisinger Monitoring Program that uses remote monitoring technologies to increase interactions between caregivers and patients upon discharge, experienced a 44% reduction in hospital readmissions.³
With access to their medical and pharmacy claim data, patients are able to make better, more well-informed choices that can increase prescription drug adherence, reduce costs associated with emergency care, and improve the overall quality and satisfaction with health care. Apps also can serve as decision-support tools for healthcare providers, allowing them to quickly suggest additional prescription drug purchasing channels, such as mail order and retail discount options available through network pharmacies.
Not all mHealth solutions are created equally. Therefore, look for one that offers robust and flexible mobile technology apps that enable patients to easily interact with healthcare providers and pharmacy benefit managers. The mobile app suite should offer a completely configurable approach to placing mobile decision-support tools in the hands of patients, including medication history and drug lookup, drug savings calculations and plan benefit options, personalized messages, bio-metric trackers and physician office visit preparation applications.
Robert Oscar, R.Ph., is president and CEO of RxEOB, which develops and configures private-label software applications for health plans and PBMs.
- Fay, Terry; This Infographic Shows the Power of Wireless Medical Innovation, Senior Lifestyle; February 2014; http://www.seniorlifestyle.com/infographic-shows-power-wire-less-medical-innovation/; accessed September 29, 2014.
- Oscar, Robert; Smarter Pharmacy Benefits: How Mobile Technology Communications Improve Pharmacy Utilization and Cut Costs; Managed Care Outlook; April 15, 2013; https://www.rxeob.com/secure/pdf/MCO_Smarter_Pharmacy041513.pdf; accessed July 22, 2014.
- Anderson, Chris; Remote monitoring helps Geisinger cut readmissions; Healthcare IT News; February 29, 2012; http://www.healthcareitnews.com/news/remote-monitoring-helps-geisinger-cut-readmissions; accessed July 22, 2014.
Thrifty White’s Tim Weippert on med sync
Last year, Drug Store News covered extensively the results from Thrifty White's successful medication synchronization program. DSN recently checked in with Tim Weippert, Thrifty White EVP pharmacy, to get an update.
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DSN: How has Thrifty White's med sync program progressed in the past year?
Tim Weippert: Over two years ago, we did this [study] with Virginia Commonwealth University and provided the results … where [proportion of days covered] scores were coming in at around 80%. That was the early stages of our medication synchronization program. Now we've been at this program for about three-and-a-half years. We just had some analytics done [on research] that was conducted between August 2013 and August 2014, and basically what we're seeing is those 80% marks are now rising to, in some disease states, over 90% of PDC scores. In a lot of cases, we're seeing average days of therapy where patients are now on this program at 353 days once they're on this program. Those are just phenomenal results, which means that we're getting a little more than 11-out-of-12 fills when the national average is still sitting at four or five.
DSN: What are some of the programs and processes that have come out of the medication synchronization program?
Weippert: There's a lot of talk around comprehensive medication reviews and medication therapy management, and where those are and where they're not in relationship to Centers for Medicare and Medicaid Services needing to see greater results. We now tie all those into this appointment. And we're becoming best-in-class with some of the MTM providers, such as OutcomesMTM and Mirixa, and showing those [completion] rates that are 10%, 11% and 12% that CMS is seeing — we're probably double that or higher today in completion rates. So that's one thing that has just been a tremendous avenue for us, and again it increases the engagement with our patient.
One of the things that we've just initiated here in the last few months is what we call our Thrifty White Care Coordination. That's around discharge counseling and medication reconciliation for patients. We initiated this program and have been piloting it with some of the transitional care facilities on the long-term care side. … We get a pharmacist hooked up with that patient and/or their guardian prior to them leaving the facility, and literally do a complete med [reconciliation] and discharge counseling, making sure that those patients are understanding their medications before they leave and then also making sure they have medications in hand before they leave. Even beyond that, we know that people still don't stay on their meds, so we follow that up with calls three and seven and 30 days after they leave the facility. After that 30 days, then we've got them on our synchronization program, and we're talking with them monthly.
DSN: How many patients are enrolled in Thrifty White's med sync program today, and what is the growth trajectory?
Weippert: We now are a little over 52,000 patients on this program, and that's across our 95 stores. We're still growing on an average of about 400 patients per week on this program. And that's a very steady growth; it continues to grow at that rate. It's just been phenomenal. The stores are doing a great job. Patients are really getting excited about it. The physicians in these communities are really getting excited about it. So it's certainly helping us grow the program.
DSN: What are the benefits to the patient around a robust med sync program?
Weippert: For the patient, it's all [about] value services. No. 1, it's one visit to the pharmacy. That's been huge. Then it's the ability to bring in the other [services] that patients maybe don't think about — it's time for your immunizations or have you considered your flu shot for this time. Or you know, when a CMR does come up because of a Part B plan, we have that opportunity to review all of your medications for the year. We're starting to see where the patients starting to reach out to us and start asking some of these questions. It certainly comes down to them being more healthy. …
I talked about our Thrifty White Care Coordination, which our pharmacists are very involved in. The other big [initiative] that we're pushing is getting our pharmacists involved in going out to their communities to employer groups, service clubs, community groups, chambers of commerces, finding additional patients that we can work with and help. It sort of ties into a new position, which we've added to our company, which we call Health and Wellness Advisors, [who] are assisting our pharmacists in finding those opportunities within our communities.
DSN: What are the numbers?
Weippert: Prescription counts are up. We're seeing nice steady growth of about 4.5% to 5% in prescription counts. [Last years] VCU study showed that we had about 2.8 more refills that came from med sync. This new study now shows that has also increased. That it s now 3.5 additional refills. So subsequently, revenues are impacted and are going up in this process. All the additional services that this now provides because of the program has certainly brought many good new business avenues for us. [And] we believe these medication synchronization results have really helped us get into some networks that we haven't been in the past.
DSN: Why is medication synchronization important in the healthcare landscape?
Weippert: I'm going to give the one simple answer that we use all the time, it's all about the patient. Healthy outcomes. It's about taking care of this patient. In any type of population, we talk about provider status and having the ability as pharmacists to have provider status. This gets us even closer. … It's bringing better health outcomes and what we believe is a resulting reduction in overall healthcare spend. … We're changing the landscape of our pharmacy. We took this paradigm shift about two-and-a-half years ago and now it's actually happened where pharmacy is really something that we do, but it isn't everything that we do. That’s really the final story to all of this. Pharmacy is more than just the pills in the bottle.
Improving access to care: Q&A with Upsher-Smith’s Rusty Field
Drug Store News caught up with Upsher-Smith chief commercial officer Rusty Field to discuss topiramate extended-release capsules, its new authorized generic to Qudexy XR.
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DSN: In July, Upsher-Smith took the unusual step of launching topiramate extended-release capsules, the authorized version of Qudexy XR, almost immediately after the release of the branded version. President and CEO Mark Evenstad has described the move as a way to get this new anti-epileptic medication into the hands of clinicians and patients faster and more affordably, but please describe what, in your own words, led to the decision.
Rusty Field: The current system of getting medication to patients is very complex, and physician decisions to treat with a certain antiepileptic drug, or AED, do not always translate into the patient getting the drug, due to issues of access and cost. This motivated Upsher-Smith to implement a unique business model designed to improve access to effective treatments and reduce healthcare costs.
One example of this is our immediate introduction of an authorized generic to Qudexy XR. An authorized generic, or AG, is a means for Upsher-Smith to provide widespread and affordable access to our extended-release topiramate. This benefits the patient and the payer.
DSN: Given the generally lower pricing structure for authorized generics, what impact does Upsher-Smith expect the move to have on projected top-line sales and bottom-line profitability for Qudexy XR?
Field: Reducing the cost and supporting enhanced accessibility will, we anticipate, result in higher use and support profitability.
DSN: What do you anticipate will be the main avenues for distribution of topiramate? Can you describe the strategy being employed to market both versions of the drug simultaneously?
Field: When clinicians write Qudexy XR, their patients should typically receive the authorized generic, topiramate extended-release capsules from Upsher-Smith, at the pharmacy. It will be available to many covered patients at a generic co-pay. The authorized generic is available to retail pharmacies nationwide.
DSN: Is Upsher-Smith working with a partner on the distribution and/or manufacturing of the authorized generic, or in-house with its own branded generic and generic division? If so, do you have separate sales forces calling on doctors and/or pharmaceutical retail buyers and wholesalers?
Field: The authorized generic is manufactured and distributed by Upsher-Smith. We let customers know that the authorized generic is manufactured using the same materials and process by the same company. Of course, our brand team is responsible for getting the news out to prescribers, and our generic team is responsible for getting the authorized generic established in the market, including support from our award-winning sales teams.
DSN: Have you had any feedback from the epilepsy community, or from advocacy organizations or government, in response to the company's move to provide immediate access to both versions of the medication?
Field: We have had some very positive early feedback:
- Twenty-four hours post launch, a physician asked a representative to lunch in order to hear more about our multifaceted program.
- One physician said “I would like to shake your CEO's hand and thank him for trying to positively impact health care.”
DSN: What sets Qudexy XR apart from older antiepileptics? How large is the market for these products in the United States?
Field: Topiramate is a well-known, effective agent for the treatment of a variety of seizure disorders, but many patients experience challenging cognitive side effects while taking the immediate-release formulation of the drug. Upsher-Smith conducted a global phase 3 clinical trial which showed that Qudexy XR, a once-daily extended-release formulation of topiramate, is efficacious across a range of seizure types and patient severity. This extended-release formulation appears to be a new delivery system of a very effective compound. By improving the delivery method, we hope to improve tolerability, which may lead to better seizure control in patients.
Other points of differentiation include:
- Qudexy XR and its AG is indicated as initial monotherapy in patients 10 years of age and older with partial-onset seizures (POS) or primary generalized tonic-clonic seizures. It is also approved as adjunctive therapy in patients 2 years of age and older with POS, primary generalized tonic-clonic seizures or seizures associated with Lennox-Gastaut syndrome.
- All strengths of Qudexy XR and its AG may be swallowed whole or administered by carefully opening the capsule and sprinkling the entire contents on a spoonful of soft food. This makes it the only approved extended-release topiramate product for patients who experience challenges swallowing whole capsules or tablets.
DSN: Is there a competing generic already in the marketplace with 180-day exclusivity?
Field: Beside our own product, there are no other generic equivalents to Qudexy XR on the market.
DSN: Some 200,000 new cases of epilepsy are now diagnosed each year, which indicates a growth rate of roughly 10% each year in cases of the disease. What do you think is driving that increase?
Field: According to the Epilepsy Foundation, children under the age of 2 years and adults over 65 years are more likely to develop epilepsy than any other age group. This is explained in part by changes that occur in the brains of people early and late in life. The rise in the incidence of epilepsy in adults as they age is due to changes in the brain caused by tumors, strokes and other brain abnormalities.