Feature : Promoting Adherence
The Upside of Adherence Programs
Adherence is a current buzzword in the profession. There are a variety of ways pharmacists can address the issue with patients. One is through drug manufacturers support of the pharmacist-patient interaction, or adherence.
The market share model once in play in pharmacy has evaporated over the years as manufacturers have seen benefits from rebates dwindle. The consistent ROI, manufacturers realized, came not from a one-off fill, but from the regular and continued use of a drug — in this case, a patient’s adherence. The result: programs for pharmacies that mean additional prescription revenue and the intangible benefit of increased patient loyalty.
“Historically, a manufacturer’s focus has been mainly aimed at getting the initial script written, but there is only minimal access to patients beyond that. The community pharmacist is well-positioned to observe patients’ adherence and persistence, and intervene when appropriate,” says Karl Steele, president of the American Pharmacy Alliance (APA). Now the focus has expanded to adherence programs, according to Steele.
“People see a value in that down the road — with a person continuing to take a prescription, there will be a savings in the long run,” says QS/1 President Tammy Devine. “From a pharmacy standpoint, this is additional revenue because you are participating in some of the programs. But the biggest revenue is keeping the customer and building the relationship.”
In the case of CarePoints, offered by the LDM Group, a manufacturer will set rules for a letter to print at the point of dispensing, says LDM’s Andrew Charter, VP of retail channel development. The manufacturer wants to build a long-term relationship with the patient, says Charter.
“We know people on CarePoints will fill more prescriptions,” says Charter. “The pharmacy gets a lift from that, with revenue from these prescriptions, as do the manufacturers who promote sponsored compliance messages.”
Data’s Role in Adherence
One roadblock to enrolling in adherence programs is pharmacists’ concern about the use of the pharmacy data. The pharmacy system vendors are automating the data collection process and then sending the data to the adherence programs that are building a prescription history. Or in the case of a real-time program like CarePoints, the vendor is providing an interface between the pharmacy system and LDM. Still, pharmacists have to be comfortable with how the data is being used and the reminders that are sent to their patients.
Some pharmacists don’t want to lose the personal touch in the case of a letter that’s sent out on the pharmacy’s behalf through an outside organization, or there’s concern about the ability of a patient to opt out of receiving such a letter. “Pharmacists should evaluate the program and determine if it benefits their business model,” says Devine.
Others are hesitant to offer a message coming from manufacturers that patients might construe as the pharmacist steering them to a decision on behalf of the drug company. “We tell pharmacies we work with, ‘Let’s do other types of messaging’ to determine the best messaging solution for them and their patients,” says LDM’s Charter. In addition to sponsored CarePoints, LDM can work with a pharmacy to deliver targeted messages that will set rules based on the pharmacy’s goal — for example, to print letters for a flu vaccine if the patient profile indicates the patient hasn’t gotten a flu shot at the pharmacy, or to remind patients about diabetic supplies. Charter says many manufacturers also offer financial assistance for specific drugs, and the CarePoints letters can be personalized to help a patient receive this service.
Charter, who was a VP of pharmacy at a chain before joining LDM, could see firsthand the benefit of an adherence program. “It’s not just the revenue, but I saw the sponsored messaging and the value-adds of the pharmacy promotional information,” he says. “I don’t know of another way to easily get a message to, for example, a male over 65 with a specific chronic condition.”
Extending the Pharmacy Reach
Sharing data to increase adherence is important for two reasons, says PharmacyFirst CEO Michelle Vancura. “The first one is the payers who are paying bills are mandating the downstream networks perform around key areas; if independents don’t provide proactive counseling and contacts to keep their patients complying with their drug therapy, or provide the service through another avenue, patients may be directed away from that independent pharmacy to a chain pharmacy,” she says. “The second reason is business retention; it’s keeping independents viable with more frequent patient visits to their pharmacy, and they remain involved in the care continuum.”
PharmacyFirst’s RxShare is one program that aims to develop and support adherence programs. Manufacturers have shifted their focus and resources to monitoring patients on specific medication regimens, says Vancura. “If we can help keep patients on their medications, that would result in better care and patient outcomes, and it would increase foot traffic through the independent pharmacy and allow them to focus on their role of being a healthcare provider,” she says.
Through RxShare, PharmacyFirst works with APA to aggregate data to improve patient care based on predetermined matrices, such as a patient who’s new to a therapy or who may need information to understand a new diagnosis. Manufacturers, says Vancura, see the benefit to support the communication between pharmacists and patients who fit a demographic that requires engagement.
Vancura says there are technology partners out there getting things done on the pharmacy’s behalf. And, she says, “The services shouldn’t cost the pharmacy anything.”
As adherence gains a foothold in the industry, both QS/1’s Devine and LDM’s Charter see manufacturers sponsoring not just letters and reminders, but full pharmacist-patient interaction as well.
Devine also suggests another opportunity for pharmacist-patient interaction through medication therapy management (MTM) programs, where third parties pay for this service. “I think when third parties see the money that’s being saved on healthcare from an MTM program, it will become a revenue source for the pharmacy for building adherence,” says Devine.
In the case of LDM, Charter envisions adherence programs that pay pharmacists to sit down and talk about the patient’s medication — for example, when there is a new script for a complicated inhaler or an injection.
“It’s going to be not just about a simple printout, but time spent with the patient. There are lots of studies out there that show face-to-face counseling makes a difference,” says Charter. “Manufacturers see the value of the interaction and will develop programs to take advantage of the pharmacist-patient relationship.” CT
Maggie Lockwood is vice president and a contributing editor at ComputerTalk. Please share comments and ideas with her at firstname.lastname@example.org.