Patient Compliance and Specialty Pharmacy Products
Kevin Cast, VP of CuraScript, on how adherence can boost cost-effectiveness and improve forecasting.
By on Mar 9, 2010Kevin Cast, VP of CuraScript, on how adherence can boost cost-effectiveness and improve forecasting.
How do we do the best thing for patients taking speciality drugs, while driving cost out of the system? asks Kevin Cast, VP of CuraScript, the specialty drugs arm of Express Scripts, a large pharmacy benefits management (PBM) company. He makes the key point that reducing cost, with some 55 million people enrolled in the company's programs, is a major driver of the business. Specialty drugs for conditions such as multiple sclerosis, hepatitis or cancer are usually expensive, so PBM organizations are supportive of healthcare reform.
Clearly, to improve the cost-effectiveness of drug administration, adherence to treatment has to be addressed, and there are several causes of non-adherence. These include not getting the prescription filled, taking incorrect doses, incorrect timing of doses, missing doses, and stopping early. About 18% of retail prescriptions are never filled, and 69% of medication-related hospitalizations are related to non-adherence, amounting to $100 billion annually.
Up to half of patients with chronic diseases do not comply with treatment, costing the health system up to $290 billion annually. Then there are the indirect costs, such as about $50 billion in lost productivity. These are typical of costs that, if driven out of the system, could pay for a large part of proposed healthcare reforms.
Medication possession ratio
Cast considers that, when trying to measure compliance, the tool used has to be carefully chosen. Simply stating that a patient is 20% compliant because he or she only took two months out of ten months' medication may only tell part of the story. In this example, persistence could be a better measure.
He illustrates the problem with a real life patient with psoriasis, who stopped treatment because she misinterpreted a flare of her condition and thought it was an adverse reaction. Such patients require intensive counselling to improve their understanding and compliance, but importantly they make forecasting extremely difficult.
A better tool is medication possession ratio (MPR), according to Cast. In essence, this compares the measurement period with the period for which treatment was actually available to the patient. For new treatments, there is always a delay until the prescription is filled, and for ongoing therapy the gaps (such as for the psoriasis patient) need to be documented. Treatments for hypertension have MPRs of about 83%, and diabetes is worse at 77%. Specialty drugs have around 80% MPR.
Compliant patients save money
Cast emphasizes that a more compliant patient will ultimately save payers money. MPR is a quite sensitive tool that helps with supply chain planning, and it has been shown that patients receiving drugs from a specialty pharmacy have higher MPRs than patients using retailers.
Such data need to be included in demand forecasting, Cast advises strongly. He cites pretty telling numbers from a study in multiple sclerosis, where there was a clearly developing preference by patients for specialty pharmacies, and considerably higher MPR in the latter over one year 80% versus 68%. This was reflected in a 91-day difference in time on therapy, in favor of specialty pharmacies, and translates into an increased demand of about $10 million for that manufacturer.
Improving forecasts
These are just a few statistics from a rich output that enables detailed planning by the manufacturer, and ultimately much better forecasts, asserts Cast. In 2008, we drove a lot of patients into specialty pharmacy, he explains in the region of 1,000 patients in this marketplace, equating to a 10% growth. An opportunity is created to build tailored programs for patients, delivered by specialty pharmacies that drive higher MPR and better patient care. In this study, specialty MPR rose from 82% to 88%, while retail MPR stayed about the same.
The bottom line is that the programs work, says Cast. We positively impacted MPR and took really good care of those patients. The take-home question is: Once all the MPR information is available, what do you do with it? You have to maximize your supply chain, which means engaging with brand teams and discussing what MPR is telling you about forecasts. Specifically, it can help with inventory management, sales expectations, and operational metrics. It is powerful knowledge.