E-DRUG: Complying with formularies improves patient adherence
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[crossposted with thanks from DRUGINFO; WB]
Hi all
The full text of this paper from Jerry Avorn's group (Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School) is available online (abstract below). It deals with a common phenomenon in SA private sector healthcare: the use of co-payments to increase use of formulary approved medicines. As the authors explain: "In 2004, approximately 65% of Americans with employer-based prescription drug coverage were enrolled in 3-tier pharmacy benefit structures. In 3-tier plans, enrollees are required to pay highest copayments for nonpreferred brand-name medications (third tier), smaller copayments for preferred brand-name drugs (second tier), and smallest or no copayments for generic medications (first tier). Within these plans, physician and patient decisions to treat a medical condition with a generic rather than a nonpreferred medication can significantly affect the patient's out-of-pocket costs, with an average difference of $23 a month in 2004."
The end result: "We found that in 3-tier pharmacy benefit plans, the prescription choice made when initiating chronic therapy significantly affected patient medication adherence. First, a surprisingly high percentage of initial prescriptions were filled for nonpreferred drugs, approximately 23% of all initial prescriptions in the classes we evaluated. Patients initiated on generic medications had 12.6% greater adherence than those who received nonpreferred brand-name formulary agents. Likewise, patients who received preferred brand-name prescriptions had 8.8% greater adherence than patients who received nonpreferred prescriptions. Although the absolute differences in PDC between groups were modest (6.6 percentage points and 4.6 percentage points for generic and preferred medications, respectively, vs nonpreferred medications), these findings demonstrate a relationship between formulary compliance and patient adherence to therapy. For patients enrolled in tiered pharmacy benefit systems, clinicians can influence long-term adherence by choosing wisely within a drug class and prescribing generic or preferred formulary agents when initiating chronic therapy. In addition, patients initially prescribed generic medications were least likely to switch to a medication in a different tier within the same class. Those who received generics switched at less than half the rate of patients who received nonpreferred medications. Patients who received preferred brand-name drugs were 30% less likely to switch to a medication in another tier than patients who received nonpreferred drugs, and were almost 3 times more likely to switch to a generic than to a nonpreferred drug. These findings suggest that physician workload may decrease when more generics are prescribed, because physicians would likely receive fewer telephone calls from patients, pharmacists, or pharmacy benefits managers to change prescriptions. These findings also suggest that pharmacists may play an important role in educating patients about less expensive medicati
and facilitating switches."
regards
Andy