Small Doses: January News

^{Janauary 2019 Issue}

Many Don’t Plan to Get Flu Vaccine

Despite last year’s influenza season being one of the worst in a decade, many Americans don’t plan to get the flu shot, a new survey says.

By mid-November, 43% of the more than 1,000 consumers surveyed said they had gotten a flu shot, while 41% said they had not been vaccinated and do not intend to be, according to the National Opinion Research Center (NORC) at the University of Chicago survey.

When asked why they did not intend to be vaccinated, 36% of consumers said they were concerned about side effects from the vaccine. Thirty-one percent say they don’t believe the vaccine works well. In addition, 31% cited concerns about getting sick from the vaccine.

Thirty percent said a major reason they do not get vaccinated is because they never get the flu.

“Unfortunately, many people are still not getting flu shots due to broader misconceptions about the value of receiving a flu shot and concerns about the safety and efficacy of the vaccines,” says Caitlin Oppenheimer, senior vice president of Public Health Research for NORC at the University of Chicago, in a statement.

People rarely cited barriers to access-such as the vaccine costing too much (6%) or not having time to get it (5%)-as reasons they would not be vaccinated.

People age 60 and older reported the highest vaccination rate at 62%. However, 24% of people over 60 still do not plan to get vaccinated this season. Adults under age 45 are the least likely to report being vaccinated, NORC finds, and around 50% of this group said they do not plan to receive a flu vaccine.
The CDC estimates that flu vaccination coverage among adults was 37% for the 2017-2018 season and 43% for the 2016-2017 season.

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Healthcare Professionals Still Most Ethical

Nurses, doctors, and pharmacists are considered the most honest and ethical professions, according to the annual Gallup Poll rating of professions. Nurses top the list for the 17th consecutive year with 84% of respondents saying the honesty and ethical standards of nurses are high/very high; 67% say the same about medical doctors, and 66% say the honesty and ethics of pharmacists are high or very high.

Nurses have reigned as the most honest and ethical since 2001, when firefighters took the top spot following their response to the 9/11 attacks. Nurses ranked second that year, followed by the U.S. military, police, pharmacists,
and medical doctors.

Pharmacists regularly rank as the second most honest and ethical profession. Since 2002, pharmacists ceded the second spot to medical doctors just three times, in 2003, 2017, and 2018.

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Kroger’s Prescription Discount Program to Boost Store Traffic

Kroger Co. is expected to increase traffic to its pharmacies with the recent launch of its discounted prescription loyalty program.

Kroger’s new Rx Savings Club, developed in partnership with GoodRx, provides customers with discounts on commonly-prescribed generic medications for heart health, diabetes, asthma, mental health issues, women’s health, gastrointestinal health, and other conditions.

The program provides up to an 85% savings on thousands of prescriptions, according to the Cincinnati -based operator of more than 2,700 grocery stores and more than 2,200 pharmacies.

For example, atorvastatin (Lipitor) is $6 for a 30-day supply and $12 for a 90-day supply for members of the Rx Savings Club. Free medications include amlodipine for high blood pressure, metformin IR for diabetes, sertraline for mental health, and montelukast for asthma.

Members of the Rx Savings Club pay an annual fee of $36 for individuals and $72 for families (up to six people can be covered with one family membership). The program offers three tiers of low-cost medications:

• Free, 30-day and 90-day prescription;

• $3, 30-day and $6, 90-day prescriptions;

• $6, 30-day and $12, 90-day prescriptions.

“Kroger reaches millions of people a day through its stores, so pharmacy programs are an important way to drive traffic into their stores. The pharmacy business is so competitive that each retailer needs to have its own bonus card or approach to build loyalty among customers,” Ashraf Shehata, advisory principal at KPMG and a member of the firm’s Global Healthcare Center of Excellence, tells Drug Topics.

Because the pharmacy business is so aggressive, it is difficult to say how much Kroger’s prescription savings program will drive growth, according to Shehata. However, having a tier of free prescription drugs that includes high blood pressure, antidepressant, asthma and diabetes treatments-will attract the attention of patients utilizing these treatments, “a fairly large segment of the population,” Shehata says.

Compared to many other retailers, Kroger is sophisticated in the use of its loyalty cards and mobile apps, “which generate data to help improve the customer experience,” Shehata says.

Kroger’s approach can help people who do not have a pharmacy benefit manager acting on their behalf, Shehata says. “Also, Kroger’s club can help it keep more of its revenue versus dealing with a pharmacy benefit manager that only pays a small dispensing fee to retail pharmacies.” 

"Our mission is to help lower the cost of prescriptions in America, and we are very pleased to have worked with Kroger to develop such a significant Rx savings program,” says Jim Sheninger, pharmacy strategy officer for GoodRx, in a statement. “The popularity of the medications included in these discounts, coupled with the extra low-cost pricing tiers, should result in meaningful savings for patients and families-savings that are absolutely critical in this high-priced healthcare landscape.”

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Diabetics Cut Insulin to Save Money

One-fourth of patients with type 1 or type 2 diabetes use less insulin than prescribed because of high out-of-pocket costs of the medication, a new study says.

In the study, published in the Dec. 3 issue of JAMA Internal Medicine, researchers also found that one-third of patients experiencing cost issues do not discuss the problem with their physicians.

“You might have heard stories of patients rationing their insulin. The stories are really powerful, but they don’t tell us how common this problem has become,” says Dr. Kasia Lipska, senior author of the study and an endocrinologist at Yale University School of Medicine, in a Yale statement. “Our findings show that these are not isolated incidents and that skimping on insulin is frighteningly common. As clinicians, we have to advocate for change because the status quo is simply cruel and not acceptable.”

A quarter of patients who indicated they engaged in any type of insulin underuse were much more likely (43% versus 28%) to have poor glycemic control, the researchers found.

Lower-income patients were more likely to report cost-related underuse, and nearly two-thirds of those patients said they also experienced difficulty affording other diabetes management equipment.

“The data we collected speak loud and clear to the fact that cost is a huge barrier to insulin accessibility,” said Pavithra Vijayakumar, co-first author of the study and a medical student at Yale. “I hope this spurs more action to help patients afford this life-sustaining medication.”

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Long-Acting ‘Smart’ Drugs May Be the Future

A research team is experimenting with long-acting “smart” drug formulations that remain dormant in patients until needed.

Adah Almutairi, PhD, associate professor the Skaggs School of Pharmacy and Pharmaceutical Sciences and director of the Center for Excellence in Nanomedicine at UC San Diego, and his team are experimenting with nanoscale polymer shells that can deliver drugs and diagnostic technology “in ways that are smart enough to respond to disease,” says Almutairi, the keynote speaker at ASHP’s Midyear Clinical Meeting in December.

ASHP provided a summary of the session on its website.

While it is very challenging to produce polymer shells that can provide a stable system sensitive to the patient’s internal chemistry, “we have been able to achieve this,” Almutairi says.

Almutairi and her team tested the technology for the delivery of antivascular endothelial growth factor therapy in the eye to treat age-related macular degeneration. The polymer shells release the drug only in response to the presence of reactive oxygen species in the eye, leaving much of the initial dose available for later release in response to active signals of disease, she says.

The polymer-shell injection procedure is in stark contrast to the current treatment, which requires patients to undergo intraocular injections several times a year to deliver sufficient medication to the eye to limit the progression of disease.

The nanopolymer technology has also allowed the researchers to diagnose inflammation, indicating the presence of cancer, edema, gout, and rupture-prone arterial plaque in animal models. Almutairi said the team “has confirmed in multiple scenarios that the polymer shells activate only when needed and don’t prematurely release their medication or diagnostic cargo,” ASHP says.

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Influenza Vaccine Cuts Heart Deaths

Heart failure (HF) patients who had been vaccinated against the flu had a reduced risk of cardiovascular death, a recent study finds. Influenza is a serious health risk to people with HF. The goal of the study was to determine if vaccination improves long-term survival in patients who were newly diagnosed with HF.

Published in the Dec. 10 issue of Circulation, researchers found that HF patients in Denmark who received one or more flu vaccinations had an 18% reduced risk of death.

The nationwide cohort study included all adult patients diagnosed with HF in Denmark from January 1, 2003, to June 1, 2015. The cohort included more than 134,000 patients.

Researchers found that annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared to intermittent and late vaccination.

“In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders,” the researchers write.