R.Ph.s play key role in combating noncompliance

Remember this bit of advice: "Take your medicine; it's good for you"? Well, it appears that a lot of people haven't been following that counsel. It is estimated that 80% of patients don't take their medications as prescribed, and about 20% of all prescriptions are never filled. Patient noncompliance not only poses serious health consequences but can also result in significant losses of revenue.

How big an issue is noncompliance?

"This is a huge, huge problem," said Liz Boehm, an analyst for Forrester Research Inc. Boehm told attendees at a recent conference on patient persistence and compliance hosted by Dendrite International in Bedminster, N.J., that in the course of a year in the statin drug class alone the pharmaceutical industry loses $3.9 billion as a result of noncompliance.

Some of the larger health insurers are now beginning to attack the issue of noncompliance aggressively and are utilizing pharmacists as major players in their strategy. Over at Aetna, the managed care benefit provider, pharmacists are playing a huge role in helping patients become more compliant.

Mark Rubino, R.Ph., chief pharmacy officer, Aetna Pharmacy Management, said that in the statin and antidepressant categories, there is a 30%-40% drop in patient noncompliance after just a couple of months. "We've built a number of systems whereby we notify doctors and patients about the importance of staying on their medicine," Rubino told Drug Topics.

One intensive initiative Aetna has undertaken involves making outbound calls to its members as well as to their physicians. In a pilot program that targets congestive heart failure (CHF) patients and patients with coronary artery disease (CAD), Aetna uses a proprietary system that looks at data to determine how seriously ill a patient will be in 10 to 12 months. The system rates the patient, and, if the score goes beyond a certain number, the information is turned over to a case manager. Severely ill people who have lab, medical-claim, or pharmacy-claim evidence that they are going to get significantly sicker in the next 12 months can expect a call from a case manager-and so can their doctor.

Aetna's system is a tool that helps assign work to the case managers but also gives them good information as they are making the phone call to the patient and doctor, Rubino explained. The system places triggers so that, for example, if a patient who was diagnosed with heart failure wasn't prescribed a drug or hasn't been filling his/her prescription, the case manager will be alerted and will contact the patient and the physician to recommend appropriate drug therapy.

"If a patient should have been on an ACE inhibitor because of diabetes and hypertension and he or she was not on that therapy, this was a big gap," noted Rubino.

Aetna's case managers are typically nurses, Rubino said, but "we saw an opportunity to place pharmacists there and see what value they could bring, given their in-depth knowledge of drug therapy."

The pilot program began in Atlanta in 2005 and finished up this past February. Utilizing pharmacists as case managers has so far produced a 3:1 projected return on investment. Rubino said that the return is based on adding, changing, or improving therapy. And so far, patients have been very receptive to pharmacists as case managers.

"The true actual savings will not be seen for a year or two, so our goal is to watch these patients over time to make sure they stay on drug therapy," Rubino concluded.