Medication adherence is one of those inescapable topics when it comes to covering pharmacy benefits and something that continues to plague health plan pharmacy directors as they implement programs to improve outcomes and control costs. According to Express Scripts Holding Co.’s 2011 Drug Trend Report, failure to take medications as prescribed cost the U.S. $317 billion in 2011. That’s a pretty big number for something that seems like a no-brainer, but there are a million-and-a-half reasons why a person may be nonadherent, and calling a patient up to say, “Just take your meds already!” doesn’t work in every case.
I was recently inspired by CVS Caremark Corp.’s The State of the States: Adherence Report, which looks at geographic variations in adherence, to talk to a few insurers about whether their data match up with CVS Caremark’s findings. The interesting thing was, the discussion became more about how to measure adherence. The CVS report took into account medication possession ratio, first-fill persistency rates and generic dispensing rates, but some people I spoke with felt that proportion of days covered – which is preferred by CMS – is a more accurate way of measuring adherence.
The bottom line, however, was that these metrics are all just based on data, and there’s no way to tell what’s really going on behind the scenes. Something that may be complicating PBMs’ and insurers’ efforts to measure adherence is the advent of membership-based generic drug discount programs offered by retail chains, which don’t have to submit the claims to the PBM if they’re being processed as cash. A new study by Prime Therapeutics LLC takes a closer look at this hypothesis, which is the lead story in the May 11 issue of Drug Benefit News.
Sharon Frazee, Ph.D., vice president of research and analysis at Express Scripts, contends that PBMs have a responsibility to collect as many adherence data as possible, even if the source is a membership-based program. Since it is in the interest of both the pharmacist and the PBM to improve adherence, wouldn’t this be an opportunity for plans and their network pharmacies to work together to ensure more complete data collection?