1. Tackling the Adherence Problem: Community Pharmacists Offer Solutions

2. The Adherence Problem
For years, emphasis has been placed on the problem of medication non-adherence
$290 billion a year in direct and indirect costs = 13% of total health care spend
125,000 deaths that result from not taking medication correctly
69% of medication-related hospital admissions due to poor adherence
50% of new statin patients will discontinue medication after 6 months
NEHI. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. 2009
World Health Organization. Adherence to long-term therapies: Evidence for action. 2003
Benner JS, Glynn RJ, Mogun H. Long-term Persistence in Use of Statin Therapy in Elderly Patients. JAMA. 2002;288(4):
*These are actual images sent by participating pharmacies in the Dispose My Meds Program. Patient information has been removed or obscured to comply with all applicable laws protecting personal health information.

3. Impact of Medication-Related Problems
Medication Non-adherence = $290 Billion
↑ costs to health care system
↑ costs to employers and payers
↑ premiums and co-pays to patients and ↓ health outcomes

4. It’s Time to Bring Solutions
Transformation of health care delivery with focus on quality
75% of total health care spending on chronic disease, imperative to improve adherence rates
Medicare, one of the nation's largest payers, has demonstrated its commitment to adherence:
Adherence factored into of the Part D plan ratings program
Pro-rated cost sharing to promote synchronization of refills
Pharmacists have the capability and opportunity to improve adherence that can achieve the ‘triple aim’ of:
Better care
Better health
Lower costs
*These are actual images sent by participating pharmacies in the Dispose My Meds Program. Patient information has been removed or obscured to comply with all applicable laws protecting personal health information.

5. Why Community Pharmacists?
Trusted medication expert
Maximize medication use for optimal outcomes
Most accessible provider in community
Key touch point throughout continuum of care
Last health care professional seen by patient before medications are taken
Gastroenterologist
Cardiologist
Allergist
Dentist
PHARMACIST ER
Primary Care
Physician
Gynecologist
Dermatologist
*These are actual images sent by participating pharmacies in the Dispose My Meds Program. Patient information has been removed or obscured to comply with all applicable laws protecting personal health information.

6. How Can Community Pharmacists Help?
Addressing barriers to medication adherence:
Health Literacy
Translating medication information in a patient-friendly manner
Counseling on interactions, side effects
Cost
Identifying cost-effective alternatives that are clinically appropriate
Generic medications dispensed by independent pharmacies: 72%
Disease State Management
Offering patient care services that help manage chronic diseases through effective medication use
Regimen Complexity
Packaging, refill reminders, reduced dosing frequency
Refill coordination

7. Effective Communication is Key
Independent community pharmacists are a vital link between the patient and the entire health care system
Uniquely positioned to complete the triad of care as they communicate with patients and collaborate with physicians and other health care professionals
Patient
Improved:
Communication
Patient understanding
Medication adherence
Quality of care
Health outcomes
Simplify My Meds is a personalized coordinate refill program that facilitates improved patient adherence by reducing the potential for gaps between refills and creating mechanisms to identify other possible barriers to adherence (cost, complexity, side effects). It also promotes regular dialogue about a patient's entire medication regimen and identifies other potential risks or problems such as a duplicative therapy prescribed during a recent hospitalization. Patients and caregivers appreciate being able to plan for their refills and the extra attention they get from their pharmacy.
Pharmacist
Physician

8. Taking Care of Patients Takes Teamwork
Pharmacists often contact prescribers to make recommendations and improve medication therapy for their patients
Independent community pharmacists consult with physicians or other health care professionals about 7 times daily regarding prescription drug therapy
Approximately 93 percent of independent community pharmacists recommend brand to generic drug changes when appropriate to other health care professionals

9. Patients Are Our Priority
78% of independent community pharmacies indicate they offer at least one disease state management service or medication therapy management
Top five services offered:
Immunizations
Blood pressure monitoring
Diabetes training/education
Smoking cessation
Cholesterol monitoring

10. The Power of MTM Medication Therapy Management (MTM):
Personalized, comprehensive reviews that can:
Optimize the clinical benefits of patients’ medications (prescription and OTC)
Reduce the risk of adverse drug events, drug interactions, and the potential for side effects
Increase patient adherence to prescribed regimens through education and counseling
Identify more cost-effective alternatives
Study comparing MTM interventions found drug costs decreased for those who received service from community pharmacists, decreased somewhat for patients who received service from a call center pharmacist, and were unchanged for those who received MTM via educational mailings.
Winston S, Lin Y. Impact on drug cost and use of Medicare Part D of medication therapy management services delivered in J Am Pharm Assoc. 2009;49(6):813–820.

11. Ounce of Prevention Worth a Pound of Cure
The Asheville Project: Community-based, pharmacist-directed, medication therapy management (MTM) program provided for several employers in Asheville, N.C.
Assessment of the clinical and financial outcomes of a long-term, pharmacist-driven MTM program for patients with hypertension and/or dyslipidemia found:
Clinical improvements sustained as long as 6 yrs
Approximate threefold increase in cardiovascular (CV) medication use but CV-related medical expenses decreased by 46.5%
Savings due to lower CV-related medical costs exceeded blood pressure/lipid medication and program costs by 12.6%
Bunting BA, Smith BH, Sutherland SE. The Ashville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc. 2008; 48 (1):23–31

12. Don’t be Penny Wise and a Pound Foolish
The Minnesota Experience: Objectives
Provide medication therapy management (MTM) services to patients
Measure clinical effects associated with provision of MTM services
Measure percentage of patients achieving clinical goals for high blood pressure and high cholesterol compared to control group not receiving MTM services
Compare patients’ total health expenditures for the year before and after receiving MTM services
Isetts BJ, Schondelmeyer SW, Artz MB. Clinical and economic outcomes of medication therapy management services: The Minnesota experience. J Am Pharm Assoc. 2008; 48 (2):203–211

13. Getting the Biggest Bang for Your Buck
Results from the Minnesota Experience:
Clinical Benefit: MTM intervention group had a higher percentage of patients meeting goals for hypertension and cholesterol management vs. control group
Hypertension (71% vs. 59%)
Cholesterol (52% vs. 30%)
Economic Benefit:
Per person total health expenditures decreased from $11,965 to $8,197
Overall reduction in total annual health expenditures exceeded cost of providing MTM by more than 12 : 1
Isetts BJ, Schondelmeyer SW, Artz MB. Clinical and economic outcomes of medication therapy management services: The Minnesota experience. J Am Pharm Assoc. 2008; 48 (2):203–211

14. Spend a Little—Save a Lot
Studies have found that increased pharmacy spending (due to increased adherence) resulted in significantly fewer hospitalizations and significantly lower health care costs – these savings are increased for patients over age 65.
Benefit-to-Cost Ratios:
Congestive Heart Failure: 8.4:1
Diabetes: 6.7:1
High Blood Pressure: 10.1:1
High Cholesterol: 3.1:1
Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs 2011;30(1):91-99.

15. Spend a Little – Save a Lot
More trips here can mean
Greater prescription medication access and proper utilization can reduce health care costs, such as hospitalizations
Congressional Budget Office estimates that a 1 percent increase in the number of prescriptions filled by beneficiaries would cause Medicare’s spending on medical services to fall by roughly one-fifth of 1 percent.
Fewer visits there
Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services. Congressional Budget Office. November 2012

16. Not Rocket Science, Just Keep It Simple
Complex regimens with multiple prescriptions negatively impact patient adherence
Patients who make visits to a variety of pharmacies (mix of chains, mail order, independents) and those who fill fewer medications per visit (less refill consolidation) are substantially less adherent to their prescribed therapy
Medication use and prescription filling for patients with multiple chronic conditions can be complex, and strategies to reduce this complexity may help improve medication adherence
Choudhry NK, Fischer MA, Avorn J, Liberman JN, Schneeweiss S, et al. The implications of therapeutic complexity on adherence to cardiovascular medications. Arch Intern Med 2011;171(9):

17. There’s No Place Like (a Pharmacy) Home
Adherence improvement can begin with increasing refill consolidation at individual pharmacies
Having a “pharmacy home” to serve as a central medication information hub can simplify access, improve safety and ultimately adherence
Choudhry NK, Fischer MA, Avorn J, Liberman JN, Schneeweiss S, et al. The implications of therapeutic complexity on adherence to cardiovascular medications. Arch Intern Med 2011;171(9):
*These are actual images sent by participating pharmacies in the Dispose My Meds Program. Patient information has been removed or obscured to comply with all applicable laws protecting personal health information.

18. Simplify My Meds
Adherence can be improved when patients coordinate refills (“refill synchronization”) at a single pharmacy
Nearly 600 community pharmacies participating
Facilitates improved adherence by:
Reducing the potential for gaps between refills
Reducing medication-related hospital readmits
Providing mechanisms to identify non-adherence
*These are actual images sent by participating pharmacies in the Dispose My Meds Program. Patient information has been removed or obscured to comply with all applicable laws protecting personal health information.

19. Win-Win-Win
Community pharmacists are best positioned to positively influence patient medication adherence that will:
Improve care with high-touch, face-to-face counseling
Keep patients healthier in their communities
Lower overall health care costs by reviewing medications for the most cost-effective therapies, and reducing or preventing hospitalizations in the long run
*These are actual images sent by participating pharmacies in the Dispose My Meds Program. Patient information has been removed or obscured to comply with all applicable laws protecting personal health information.