Managed Care - July 2008 - (Page 26) regimen is generally defined as the extent to which included medication possession ratio (a formula patients take medications as prescribed by their used to determine adherence that is measured from health care providers, wrote Lars Osterberg, MD, of the first to the last prescription), therapy disconthe Veteran Affairs Palo Alto Health Care System in tinuations, medical costs, and pharmacy costs. In all Calif., in a study of adherence published in the New those categories, outcomes were significantly betEngland Journal of Medicine. “The word adherence ter for the managed patients. “Most notably, there is preferred by many health care providers, because was a decrease in overall MS costs when members compliance suggests that the patient is passively were managed by the program,” says Sweet. following the doctor’s orders and that the Specialty pharmacies agree on the critical treatment plan is not based on a therapeutic importance of adherence. “Patient adherence alliance or contract established between the support and education are essential for sucpatient and the physician,” says Osterberg. cessful therapy,” says Kim Bergstrom, For health plans, adherence is a significant PharmD, chief clinical officer at McKesson element of cost containment. “It is a matter Specialty Pharmacy Services, which serves all of giving the right drug to the right patient at Medicare Part D plans and 120 million lives the right time,” says Brian Sweet, RPh, chief in health plans across the country. “For onpharmacy officer for WellPoint. “That is the cology drugs, for example, the side effects “Adherence for definition of quality. Some plans look at the specialty drugs is can be unpleasant, but if patients do not keep pharmacy benefit as a budget buster. We be- critical to quality on their medications, if they don’t follow lieve that quality delivered through the ben- care,” says Brian therapy carefully, they won’t benefit.” efit can be a budget saver because it can re- Sweet, RPh, chief “Many of the expensive cancer drugs pharmacy officer duce overall health costs.” emerging recently are oral, which means that for WellPoint. WellPoint’s in-house specialty pharmacy patients take them at home on a timetable esprogram is named PrecisionRx Specialty Sotablished by their physician,” adds Bergstrom. lutions. “Our approach is holistic,” says Sweet. “This can make adherence management “It is a comprehensive care management approach more complicated and difficult, and the consethat we have found to be very successful, with a quences can be severe. If patients go off their drugs, proven track record. Given the complexity of side they can become resistant to the medication itself. effects related to many treatments, we have found Maintaining adherence is extremely important. It that an aggressive approach is crucial.” can be a matter of life and death.” In describing the WellPoint approach as holistic, The cost of the average monthly cancer-drug Sweet is referring to frequent patient interactions prescription rose 15.8 percent to over $1,800 in with WellPoint nurses and pharmacists to discuss 2007, according to Express Scripts. Among the new side effects and maintenance regimens with paspecialty drugs approved by the Food and Drug Adherence to oral medications can be more of a problem than to injected drugs, says Kim Bergstrom, PharmD, chief clinical officer at McKesson Specialty Pharmacy Services. tients — followed by medical or behavioral care referrals as necessary. The interaction is usually over the telephone. “We view the interactions as clinical events, and we offer access to pharmacists 24/7 through a call line,” says Sweet. Administration last year, one breast-cancer treatment costs about $2,900 a month. And according to the Wall Street Journal, these costs are rising. An oral drug for multiple myeloma, Celgene’s thalidomide (Thalomid), increased 27.2 percent to $4,742 per prescription in 2007, up from $3,728 in 2006. Roche’s oral chemotherapy drug capecitabine (Xeloda) rose 17.9 percent to $1,200 per prescription in 2007, up from $1,018 per prescription the previous year, according to a recent review of spe- Cost effective WellPoint recently evaluated the effectiveness of its PrecisionRx Specialty Solutions approach for multiple sclerosis patients. Evaluation endpoints 26 MANAGED CARE / JULY 2008
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