Partial-Fill Strategies: Do They Work?

Data presented by Gary Rice of Diplomat Specialty Pharmacy at the 2013 Academy of Managed Care Pharmacy Nexus meeting suggest that partial-fill strategies for specialty pharmaceuticals produce a sizable decrease in total spend.

Using split-fill or partial-fill strategies to manage oral oncology medications is quickly becoming one of the most popular methods to control costs within many health plans. Yet the benefits of handling high-priced oral oncolytics in this manner go beyond cost savings—with these types of initiatives, patients are likely to avoid serious adverse events associated with biologics earlier in the treatment process. As an article in Specialty Pharmacy Times noted, “Many oral chemotherapy patients stop taking their medication long before the monthly supply is depleted, typically due to intolerable side effects or lack of therapeutic benefit.”

Gary Rice, RPh, MS, MBA, vice president, Clinical Services at Diplomat Specialty Pharmacy, presented Diplomat’s experience with partial fill during a presentation at the 2013 Academy of Managed Care Pharmacy Nexus meeting (October 15-18, San Antonio, Texas). Diplomat has used partial-fill strategies for oral oncolytics and hepatitis C therapies, as drugs to treat these conditions are associated with high discontinuation rates, poor response, adverse effects, and noncompliance. The program at Diplomat was conducted from January 1 to September 30, 2012, and consisted of a limit on the initial 1 or 2 fills to a 14-day supply of medications in the aforementioned disease states. To support the patients enrolled in the program (only 3.4% [n = 58] of all prescriptions dispensed for targeted therapies were dispensed as partial fill), Diplomat provided patients with additional touch points to determine how they were responding to medication after the 14-day period.

In addition to an “onboarding” call on Day 1, patients received a refill reminder call 7 to 10 days prior to refill. During this call, patients were given adherence counseling, which consisted of educational information about product side effects, patient assistance programs associated with the therapy, use of compliance tools, and other therapy-specific materials. If a patient did not refill his or her prescription in 10 to 15 days after the first expected refill, the patient received a “rescue call,” during which a decision was made to discontinue or continue treatment. If the patient had questions about financial assistance, side effect management, or needed therapy reinforcement, Diplomat provided support for those issues at that time.

According to Rice, 59% of patients stayed on therapy after initial partial fill, 41% of patients discontinued therapy after the first 2 partial fills, 20% of patients discontinued therapy after 1 partial fill, and 2% of patients switched therapy after initial partial fill. Overall, almost 60% of patients stayed on therapy, noted Rice, and the “patient experience was much better,” he noted.

From a health plan perspective, the partial-fill program was a huge success. Nearly $187,000, or 19% of the total spend, was saved by using this type of benefit design. In response to an audience question about payment by the patient, Rice noted that the program works even better when the drug payments are prorated—in other words, patient acceptance of partial fill is much better when the patient only pays for half of the full cost of the prescription. Expecting the patient to pay for a full month’s worth of medication when he or she is only receiving the first half of treatment during the first pharmacy visit could be counterproductive, Rice noted. And, as Rice noted on his last slide, “The best way to make sure that patients experience the optimal therapy outcome is to help ensure their adherence to their prescribed regimen.”

Bonus: What’s on Gary Rice’s iPhone?

It can be difficult for a patient to figure out which free medication adherence programs are of value when he or she is weeding through all of the health care applications available online. When we asked Gary Rice of Diplomat Specialty Pharmacy which free medication adherence apps for patients were the best ones, he listed the following:

• HealthAssist by WellCare Today, LLC
• MyMeds (requires registration)
• MedAdhIR
• mobiHealth Wallet