Solving the Puzzle of Medication Adherence in Specialty Pharmacy

Medication nonadherence is a prevalent problem in the US population, especially for the elderly, leading to worsened clinical outcomes and greater resource utilization.

One economic report estimates the cost of all nonadherence in the United States to be $290 billion per year. In 2010, the estimated cost of nonadherence for patients with diabetes, hypertension, and dyslipidemia was $105.8 billion, or $453 per adult.

Optimizing pharmacotherapy and medication adherence is the shared goal of all medication therapy management (MTM) services, although the designs and methods vary. Existing literature shows that these programs generally are successful at improving medication adherence, thereby improving economic and clinical outcomes for patients with chronic diseases.

Comprehensive Medication Management and Adherence

A study published January 2016 in the Journal of Managed Care & Specialty Pharmacy looked at the impact of a particular form of MTM: comprehensive medication management (CMM).

CMM is a system of face-to-face services aimed at improving clinical outcomes by personally managing drug therapies for patients with chronic disease.

The CMM standard of care is to ensure that each medication is (1) appropriate for the individual; (2) effective for the medical condition; (3) safe in light of comorbidities and other medications taken; and (4) able to be taken by the individual as prescribed. CMM includes an individual care plan and follow-up to assess patient outcomes.

Therapeutic Classes and Chronic Conditions

This study looked at 4 classes of chronic disease medications: oral diabetes medications, statins, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), and beta-blockers. These therapeutic classes of drugs are used to treat diabetes, cardiovascular disease (hypertension and congestive heart failure), and hypercholesterolemic disorders.

Sample and Data Set

Researchers used pharmacy claims data for continuously enrolled employees of a large Midwest integrated health system, from 2007 to 2011, focusing on individuals with the chronic diseases of interest. The sample for oral diabetes medications included 477 individuals (CMM N = 159; non-CMM N = 318); 1556 for statins (CMM N = 242; non-CMM N = 1314); 1064 for ACEIs/ARBs (CMM N = 160; non-CMM N = 904); and 943 for beta-blockers (CMM N = 123; non-CMM N = 820).

Improving Drug Adherence in Specialty Pharmacy

Retrospective analysis compared medication adherence in CMM and control groups, measured by proportion of days covered (PDC). Within 365 days of initial service, CMM groups had consistently higher and statistically significant medication adherence across all therapeutic categories compared with control groups (P<.05). The biggest difference between CMM and non-CMM cohorts was measured for ACEIs/ARBs (77.48% versus 66.36%; P<.001), and the smallest difference was observed for statins (73.45% versus 65.06%; P<.001).

Using multivariate models to analyze PDC, the beneficial effects of CMM on medication compliance were statistically significant for all therapeutic classes except oral diabetes medications.

Logistic regression showed that compared to the control groups, 3 of 4 CMM groups (statins, ACEIs/ARBs, and beta-blockers) had a greater probability of reaching the 80% PDC cut-point metric, defined as high adherence.

Enhanced Medication Adherence for Chronic Diseases

Face-to-face CMM services lead to statistically significant improvements in medication adherence across many chronic disease groups; in particular, diabetes, cardiovascular disease, and hypercholesterolemic disorders.