Can Mail-Order Pharmacy Improve Medication Adherence?

A pair of studies looking at mail-order pharmacy may shed some light on the question of what method of obtaining medications can yield the best outcomes for patients.

In one study, published online ahead of print in the Journal of General Internal Medicine, Kaiser Permanente Northern California patients who obtained new statin prescriptions via a mail-order pharmacy achieved better cholesterol control in the first 3 to 15 months after initiating therapy compared to those who purchased their statin prescription from a local pharmacy. Lead author Julie Schmittdiel, PhD, and colleages determined that greater adjusted rates of LDL cholesterol control in mail-order pharmacy users were seen across all gender and race-ethnicity groups.

After adjustment for demographic, clinical, and socioeconomic characteristics, as well as for potential unmeasured differences between mail-order and in-person pharmacy users, 85% of patients who used the mail-order pharmacy achieved target cholesterol levels, compared to 74.2% of patients who only used the local Kaiser Permanente pharmacy.

“While the findings of this study should be confirmed in a randomized controlled trial, they provide new evidence that mail-order pharmacy use may be associated with improved care and outcomes for patients for risk factors with cardiovascular disease,” Schmittdiel said. “Though mail order may not be right for all patients, this study shows that it is one possible tool in the broader health care system-level toolbox that can help patients meet their medication needs.”

Indeed, findings from another study published in the July issue of the American Journal of Managed Care suggest that patient choice may play a role in adherence. In comparing adherence rates under voluntary and mandatory mail benefit designs, a group of researchers led by Joshua N. Liberman, PhD, of Geisinger Health System found “mandatory mail appears to cause some members to discontinue therapy prematurely, particularly those without previous mail-service pharmacy experience.”

Liberman and colleagues compared adherence rates in the first year of therapy between voluntary and mandatory mail cohorts composed of individuals who initiated statin, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, platelet aggregation inhibitor, metformin, glitazone, or sulfonylurea therapy at a retail pharmacy between January 1 and March 31, 2009.

They found that although persistence rates were similar through the first 60 days of therapy, the mandatory mail cohort had a notable drop in persistence by day 90 (63.3% vs 56.3%), with a more pronounced drop among those without previous mail-service pharmacy use (50.5%).

“Offering a mail-service pharmacy option is an important benefit design tool that helps to control pharmacy costs and may facilitate medication adherence among those who successfully transition to 90-day-supply prescriptions,” the authors wrote. “However, restricting pharmacy choice by requiring the transfer of prescriptions from retail to mail-service pharmacy causes some members to discontinue therapy early. 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.”

In a blog post that looked at both studies, George Van Antwerp, vice president of the Solutions Strategy Group at Silverlink Communications, wrote that if patients are required to move to a 90-day mail-order prescription, “it's important to have a clear transition path for them so that they (a) understand their benefit; (b) realize how to move; and (c) don't end up simply missing refills or stopping therapy.”