Retail News Breaks Archives
NACDS, NCPA: Mail order falls short on adherence
August 18th, 2011
ALEXANDRIA, Va. – The National Association of Chain Drug Stores and the National Community Pharmacists Association gave their take on two recent studies about mail order pharmacy and medication adherence.
In a statement issued Thursday, NACDS and NCPA criticized the findings of a study released earlier this month by the Journal of Medical Economics (JME), which concluded that medication adherence improved for Medicare Part D beneficiaries who received their prescriptions via mail service.
However, the two retail pharmacy groups said a study by researchers from CVS Caremark Corp., Harvard University, Brigham and Women's Hospital, published in the July issue of the American Journal of Managed Care (AJMC), found that mail order pharmacy can curtail optimal adherence when it's made mandatory for prescription drug benefit plan members.
"The AJMC study effectively counters the claims in a study published in the JME regarding the uses of mail order versus community pharmacies. Amid these studies, it is safe to say that we have at least one important takeaway lesson: The best way to promote proper adherence to medication and better health outcomes is by ensuring patients’ access to the pharmacy of their choice," NACDS chief executive officer Steve Anderson and NCPA CEO B. Douglas Hoey said in the statement. "Despite repeated financial and other inducements encouraging mail order in Medicare Part D and other health plans, the vast majority of patients opt to continue to rely on their local, community pharmacist to help meet their health needs."
The JME study, conducted by Prescription Solutions by OptumRx, revealed that Part D patients using mail-order pharmacy for oral anti-diabetic medications had statistically better adherence than those using retail pharmacies, at 49.7% vs. 42.8%, respectively. In the study, adherence with oral anti-diabetic medications such as metformin, sulfonylureas and thioglitazones was measured by "proportion of days covered" during the calendar year, according to OptumRx.
Yet NACDS and NCPA said medication adherence is more about measuring behavior. "It's important to remember that adherence is about more than simply mailing a 90-day supply of prescription medication to a patient. Possession of prescription drugs alone is not the only factor in measuring adherence," the groups stated. "For the full patient health picture, one must take into account whether that medication was actually taken as prescribed, if the patient had an adverse reaction, or if the prescriber stopped or changed the dosage of that medication based on the patient’s need.
"If any of these factors occur, it not only impacts adherence, but also cost. If a medication is not used properly, then the potential for cost-savings is lost if additional medication, medical tests or even catastrophic and emergency care are needed by a patient, further disrupting patients' lives and driving up health care costs," they added.
The AJMC study compared medication adherence rates under voluntary mail service and mandatory mail order pharmacy benefit plans. Researchers concluded that while mail service can help control prescription drug costs, compelling patients to use mail order over retail pharmacy outlets can reduce adherence.
"Restricting pharmacy choice by requiring the transfer of prescriptions from retail to mail-service pharmacy causes some members to discontinue therapy early," researchers said in the AJMC report. "When members choose to eschew therapy rather than switch to a lower-cost alternative, the unintended consequence is a reduction in medication adherence and the potential for increased medical expenses."
Saying that "drug costs cannot be viewed in a vacuum," NACDS and NCPA pointed out that community pharmacists provide counseling, medication therapy management and other services "that must be considered in any comprehensive cost-benefit analysis."
The groups added, "There is no substitute for the pharmacist-patient face-to-face relationship. Community pharmacy services help to improve patient health and lower overall health care costs. Maintaining patient choice of how to obtain prescription medications is essential."