A new study finds that patients with complex therapies are struggling to stay on their medication regimens, according to CVS Caremark Corp.


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CVS: Rx adherence tough in complex therapies

January 10th, 2011

WOONSOCKET, R.I. – A new study finds that patients with complex therapies are struggling to stay on their medication regimens, according to CVS Caremark Corp.

The company said Monday that the study, conducted by researchers from Harvard Medical School, Brigham and Women's Hospital and CVS Caremark, found that patients with chronic heart disease are likely to have multiple doctors and take nearly a dozen medications filled in at least two different pharmacies — making it difficult for many patients to keep their medications straight.

The study, published Monday in the Archives of Internal Medicine, concluded that the health care system must find ways to help patients simplify, synchronize, centralize and organize their medication management.

Among the potential solutions is the creation of a "pharmacy home" to coordinate pharmacy care from a single point of contact and improve medication adherence.

"Consolidating prescriptions in a single pharmacy home may help improve health care quality similar to the intended effects of a patient-centered medical home," the researchers said. In addition, the researchers said there is a need to synchronize medication regimens for patients because "those who make numerous trips to the pharmacy to pick up their medications, or fill prescriptions at different pharmacies, may have difficulty taking their medications as prescribed."

"The complexity that typical patients with heart disease face when trying to manage their medication treatment regimens is nothing short of dramatic," explained Niteesh Choudhry, M.D., Ph.D., of Harvard and Brigham and Women's Hospital, and the lead author of the study. "While the treatment of chronic disease is extremely complex, our results clearly demonstrate filling prescriptions at many different pharmacies on many different occasions makes it even harder for these patients to take their medicine as directed by their doctors."

"Some people might look at these results and say it is not surprising that patients who have multiple doctors and take medications purchased from multiple pharmacies are less likely to be adherent," stated Larry Merlo, president and chief operating officer of CVS Caremark. "But these findings show that the health care system needs to do a much better job helping these patients consolidate and manage their pharmacy care if we are intent on improving their health outcomes."

The study reviewed pharmacy claims from the CVS Caremark pharmacy benefit management (PBM) book of business for 1.83 million patients taking statins and 1.48 million patients taking angiotensen converting enzyme inhibitors (ACE inhibitors) or rennin angiotensen receptor blockers (ARBs) between June 1, 2006, and May 30, 2007. The researchers selected those medications for review because they are the most widely sold drugs for the treatment of cardiovascular disease, the condition that imposes the greatest clinical and economic burden in the United States and abroad.

During a three-month period, patients filled prescriptions for an average of 11 medications representing an average of six drug classes, according to the researchers.

"More striking, during this 90-day time frame, 10% of these patients filled prescriptions for 23 or more medications ... and 11 or more different drug classes, had prescriptions written by four or more prescribers, filled these prescriptions at two pharmacies and made 11 or more visits to those pharmacies," researchers noted.

Among solutions discussed in the study were the following:

• Creating a centralized pharmacy home, similar to the concept of a medical home, in which a patient's pharmacy care is evaluated and renewals and refills are better synchronized and managed. Researchers said this could include providing financial incentives for patients to fill prescriptions at a single pharmacy, so that a single health care professional has a full view of the patient's needs and care.

• Encouraging programs that reduce complexity of filling and taking medications by streamlining the number of trips it takes to fill their prescriptions through programs like 90-day versus 30-day prescriptions and coordination through mail-order pharmacies.

• Experimenting with programs and technologies that may make it easier for patients to better organize their medications.

The therapeutic complexity study is part of the CVS Caremark research effort aimed at better understanding how consumers interact with their health care providers so that they stay adherent to their medications. The study is the work of CVS Caremark's previously announced three-year collaboration with Harvard University and Brigham and Women's Hospital to research pharmacy claims data to better understand patient behavior around medication adherence.

Last week, CVS Caremark reported that a new study found that patients who take medications as doctors direct may save the health care system as much as $7,800 per patient annually.

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