Expert Interview: Medication Adherence Amid COVID-19

Hi, this is Gabrielle Ientile with Drug Topics®. Today I'm going to be talking to Heidi Polek, strategic program manager at doctor first, about chronic conditions and medication adherence amid COVID-19. Before we get into our topic, here's the latest news from DrugTopics.com.

The National Community Pharmacists Association (NCPA) is pressuring the Trump administration to eliminate pharmacy DIR fees that inflate drug costs for seniors and negatively impact independent community pharmacies.

In a letter to President Trump, NCPA CEO B. Douglas Hoey explained the viability of independent pharmacies, especially given the amplified instability of pharmacies amid the COVID-19 pandemic depends on DIR reform. Hoey cited media reports warning that drug pricing may be addressed with executive orders from the Trump administration seeking to know Next, the Safe Harbor protections for rebates paid by manufacturers to the PBMs owned by large insurance companies.

NCPA therefore stressed the necessity of DIR fee reform and effectively lowering prescription costs and protecting independent community pharmacies, which serve some of the nation's vulnerable populations on the basis of healthcare access. NCPA also clarified that in the end, it will be the patient who will be hurt the most. And that's the latest news from DrugTopics.com.

Now, here's my interview with Heidi Polek.

Drug Topics®: Before we get into our topic today, can you give an introduction of yourself and your background in pharmacy?

Polek: I'm a registered pharmacist of almost 31 years, 30 years and counting. I spent the majority of that in community pharmacy and have recently transitioned to work for DrFirst 3 years ago in healthcare IT.

Drug Topics®: So can you talk about what we currently know about the prevalence of chronic health conditions in COVID-19 patients in the New York City area?

Polek: What we're seeing, unfortunately, not only in New York City, but really all across the country and the world, is that those that have been impacted most by COVID do have comorbid conditions such as heart disease, and diabetes, as well as respiratory conditions.

Drug Topics®: Can you explain the medical adherence rates that we were seeing prior to the pandemic and the consequences of non-adherence?

Polek: Sure, so, before the pandemic, we were seeing adherence rates at sadly about only 50% for patients with chronic conditions. And as you can understand, obtaining your medications became a little bit more difficult. So we are expecting to see some reduction in that adherence, although it was interesting to see that the Journal of Allergy and Immunology actually showed an increase in adherence the months of January through March to respiratory medications, so I think those people that were experiencing respiratory conditions kind of had the foresight to go out and make sure that they got their respiratory meds so that they would not be as impacted by COVID. We're still monitoring adherence today as it relates to the pandemic and we can just keep our fingers crossed that we don't see too much of a dip.

Drug Topics®: What changes are pharmacies having to adjust to related to medication adherence amid COVID-19, And what are some of the ramifications?

Polek: Pharmacies have had to change their business model since COVID-19. It's very much a patient-facing business and patients just are not being able to make the trip in. So pharmacies are reaching out telephonically, they're using video chatting, all kinds of tools that DrFirst has that can help them reach out to patients. They're delivering medications more. Insurance companies have given patients greater access to their medications. They're really doing a lot of hands on with their patients to make sure that they're getting their medication.

Drug Topics®: With many losing their jobs or out of work during this time is non-adherence also being related to being able to afford medications?

Polek: Even in good times, patients, sadly could not always afford their medications. And what is really great is that DrFirst has a tool that helps patients understand patients, pharmacies and doctors actually understand the cost of medications. And we're able to work with them to make sure that they can find an affordable alternative. Speaking with your doctor or pharmacist can help you find additional sources. Outside of manufacturer coupons, here are charitable organizations that help pay for medications, and even drug manufacturers, so we're using those sources probably more than we were before.

Drug Topics®: And are pharmacy seeing a lot of their clones with immunocompromising conditions avoiding going to their pharmacy?

Polek: In addition to patients with those conditions, I think overall, they're just seeing a reduction from everybody. I think we're all concerned whether we have a medical condition or not, we're making less trips out and about. And so as I stated earlier, pharmacies have changed their business model. They've increased delivery and many organizations that may have charged for delivery in the past have made delivery free, they’re probably doing it more often and mail ordering it to patients, so they have definitely changed their business to bring the pharmacy to the patient.

Drug Topics®: And can you expand on some of the services that DrFirst provides?

Polek: Sure, we have a wealth of programs that we can help both at the prescriber level as well as the pharmacy level. We have a tool that sends notifications to patients to educate them about the prescription that they're about ready to fail. It offers adherence information. It offers cost saving information. We have our telehealth and secure texting platforms, all of which can be used to really educate patients, keep them in contact with people who can help them and really drive that adherence to medication.

Drug Topics®: And how do you see DrFirst being different from other telehealth services that we're currently seeing?

Polek: Our platform for telehealth is actually really an all in one type platform. We have secure messaging, we allow for document sharing, which is extremely important in this time. In addition to telehealth, it is very patient friendly, there is no app to download on the patient side; that can be a little cumbersome for elderly citizens who may be experiencing issues the time. So we're just user friendly. We have a really robust company behind it. A lot of hands on people here to help you with any solution you're looking for.

We can actually service any patient whether you have diabetes or not, whether you have extensive medical conditions are not, our platforms are here to really help anybody across the care continuum. We can even engage caregivers. So maybe you're not the actual patient yourself. We with our telehealth solution, we have a group telehealth that allows us to bring other individuals, with obviously the permission of the patient, into the conversation. So we can bring in a caregiver who may not even be in the same city as the patient, which is sadly, definitely what we're seeing today. People have not been able to come together like they have in the past to go to office visits with family members. Our solution will really bring anybody regardless of their condition assistance.

Drug Topics®: So there have been some concerns that COVID-19 is bringing forth in people with immunocompromised conditions or comorbid conditions, increased stress, anxiety during this time. What have you seen on the effects of stress on disease outcomes in those with chronic conditions being exacerbated by COVID-19?

Polek: We’re certainly still in the middle of this pandemic, so we're still measuring that. But the early reports have shown that patients of all kinds are seeing an increase in stress. That's why it's more important than ever to reach out. We're all feeling it. Don't stay isolated, use whatever technologies you have to make sure that you reach out to your doctor, to your pharmacy to your family members. So yes, unfortunately, stress is increased in patients with comorbid conditions, which can cause a decline in their status, so we're telling people stay connected. Help is out there for you.

Drug Topics®: There's also been some concern about inappropriate use of some medications or also over the counter drugs promoted by some media or social media for COVID-19. Have you seen issues with that as well?

Polek: Certainly, there have been reports that patients will go into pharmacies or their providers and ask them about this. As I always recommend, whether it's a pandemic time or not, if you hear something that piques your interest in taking a medication, you need to speak to a health care professional, you need to talk to your doctor, you need to talk to a pharmacist to ensure that that medication is appropriate. Just because it helps someone with one condition does not mean it's going to help you and it's definitely important. Do not ever take a medication without being prescribed by your doctor.

Drug Topics®: What do you see as the biggest takeaways on medication adherence and the pharmacist’s role?

Polek: The pharmacist is really the most accessible health care provider. So many studies show that we are visited by patients 10 to 20 times more often than a physician. We're very accessible. We're typically behind a counter or just phone call away. Pharmacists are at the forefront of medication adherence, and we are the medication experts. It's what we strive to do every day. Please, I tell people all the time, we're here for you reach out to us, we'll help you stay adherent.

Drug Topics®: Great. Those are all the questions I have, is there anything that you wanted to add or think that we missed before we wrap up?

Polek: Every time I do these interviews, I can't help but stress enough that this is really a very stressful time for everyone, whether you have a medical condition or not, and we really just want you to stay connected. So do that in any way, shape or form that you can and it's just really exciting that here at DrFirst, we have those tools to help connect patients, prescribers, pharmacies, really anybody in the healthcare world and, you know, just hope that those tools are being used to the best of their ability.

Drug Topics®: Heidi, thank you so much for joining me today.

Polek: You're welcome.