Articles on Pharmacy Benefit Management

E-Prescribing Holds Promise for Improving Rx Drug Adherence

Reprinted from the June 30, 2006, issue of DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies.

Electronic prescribing has proven its ability to reduce medication errors and confusion that can result from doctors’ notoriously messy handwritten scripts. PBM and plan medical directors say the technology also has the potential to improve another persistent health care problem: ensuring patients actually take their medications.

E-prescribing can let doctors know if their prescriptions are being filled — knowledge that allows physicians to intervene when necessary. A pilot project using an e-prescribing tool offered by Caremark, Inc. has cut by half non-adherence rates in two classes of drugs, according to medical directors involved in the initiative.

Prescription drug adherence — getting patients to finish their medications in the manner recommended by their doctors — “is a very real problem,” said Jan Berger, M.D., senior vice president and chief medical officer at Caremark. Poor adherence has a financial impact of $100 billion a year in direct health care costs and $50 billion in lost productivity.

“To the patient, there are significant implications — everywhere from the extreme of death, hospitalization, nursing home admissions to not having the energy or feeling good to do the things that you really enjoy doing in life,” Berger told a session of the America’s Health Insurance Plans (AHIP) annual Institute held recently in San Diego.

PBMs and health plans already deploy various pa-tient-focused methods to boost adherence, including the use of automatic phone calls with digital voices to remind at-risk patients about taking their medications. But e-prescribing now offers a way to tackle the problem from the health care provider’s angle.

Historically, one of the most difficult measures of adherence is determining whether the patient filled the first script, Berger said. “A patient comes into my office, I see them for a medical problem, write a prescription [and] I assume they are going to fill it,” she explained. “If it’s an acute condition, I may not see them back for that condition. I never know if they’ve taken the medication.”

Patient-Specific Data Are Key

Caremark’s iScribe e-prescribing tool has the ability to fill in that blank. The technology captures the writing of a prescription, which can then be compared to claims data to see if the script was actually filled.

Recognizing the potential value of this information, Caremark and Horizon Blue Cross Blue Shield of New Jersey in March 2005 launched an adherence pilot project that alerts doctors when their patients have not filled prescriptions.

“We have found an alarming number of patients in the pulmonary/cardiac drug classes are not filling…their prescriptions — 32%,” said Richard Popiel, M.D., chief medical officer at Horizon Blue Cross Blue Shield of New Jersey.

This information has many uses, he added. “It now raises awareness and informs us as to the kind of research that needs to happen as to why patients who have chronic diseases, who should be on chronic meds, are not filling out their prescriptions,” he told the AHIP conference session. The Blues plan is in discussions with Pfizer, Inc., Merck & Co., Inc. and other pharmaceutical firms, as well as with physicians, on how this information may be used to develop interventions to improve Rx compliance, Popiel said. One idea is to develop a screening test for patients to take in the physician’s office, which may determine who is going to be compliant and who is not, he noted.

In addition to gathering data for research, the first phase of the adherence pilot project included 11 general messages that were sent to physicians’ personal data assistants (PDAs) and a Web site, reminding them about the importance of adherence. “The results from that were less than great,” Popiel acknowledged. “A majority of survey respondents did not find the general messages valuable in day-to-day practice.”

A second phase of the project, which captured pa-tient-specific data on Rx fills, had more success. “We know what the claims experience was, and we match the prescriptions with the claims. And we know who did not fill their prescriptions,” he says. The project provided physicians with this information through reports on a Web site and their PDAs.

A formal declaration of non-adherence requires a two-month wait. But Popiel said the pilot project aims to get such information posted quickly. “As soon as we make the connection between the prescription being written and capturing that information through claims, we put that back on the Web. It’s real time, and certainly less than two months.”

Knowledge Leads to Action

When the doctor finds out a prescription has not been filled, “you can go in and find out the details on that and take an action,” Popiel said.

Early data from the pilot suggested this messaging has boosted adherence. There was a 16% improvement in the original 32% non-compliance figure for the initial prescription filled within the pulmonary/cardiac drug classes once doctors received the information on a pa-tient-specific basis, Popiel said. The study examined 153 prescribers, and captured all prescriptions written for asthma and lipid-lowering maintenance drugs. A total of 1,965 prescriptions were captured.

Popiel acknowledged Horizon does not fully understand the reason for the improvement. But he has a hunch: “It’s is just raising awareness in the physician office level, getting office staff to make the outbound call to the patients, and having the physicians make the call.”

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