The Impact of Primary Medication Nonadherence in Specialty Pharmacy

Nonadherence carries significant implications for stakeholders throughout the specialty space.

There is not a lot of information about primary medication nonadherence (PMN), but it could have a huge impact on patients, as discussed by a speaker at the Academy of Managed Care Pharmacy Nexus 2015 meeting, held in Orlando, Florida, October 26-29.

PMN is when a new prescription is written for a medication or for a medication a patient has received before and a certain amount of time passes and the patient fails to pick up the medication during that time period, explained Rebekah Hanson, PharmD, BCPS, BCACP, clinical pharmacist at the University of Illinois at Chicago.

“When you think about the potential impact this could have on patients, if the patient doesn’t start on medication … well, the outcome is going to be very poor in those circumstances,” Dr Hanson said.

Literature has put PMN at anywhere from 5% to 30% of patients, but it is really underrepresented in the literature and there is more information on secondary medication nonadherence (SMN).

SMN is likely easier to measure since it’s a matter of persistency, taking the medication on time, etc, she said.

The most common way of identifying PMN is by running e-prescribing data and claims data.

There are some efforts to look at orders entered into electronic medical records at the point of entry and then the pickup data at the pharmacy, but there are limitations including: some prescriptions are still written; there are technical glitches; some patients receive samples, which means there is no way to know they started on therapy; some patients pay in cash; and it may be a duplicate prescriptions.

According to Dr Hanson, there are also a number of reasons for PMN:

• Cost of the drug
• Concern for side effects
• Treatment change
• Perceived need
• Patient forgot or didn’t know

There are also issues that are specific to specialty pharmacy, which hasn’t really been studied, but there have been studies about why patients might delay treatment:

• Cost and copay/co-insurance
• Patient perceptions: they don’t believe the disease is severe enough or they don’t believe in the efficacy of the drug
• Fear of side effects or a fear of injections

There are interventions that can be used and the earlier they are initiated the better the outcome, Dr Hanson said.

Although these interventions haven’t been studied in specialty pharmacy, she said that many specialty pharmacy services already implement interventions like postcard reminders, telephone reminders, and automated outreach as standard care.