The State of the States: Adherence Report

Diabetes Health recently submitted some questions to CVS Caremark Corporation regarding its “The State of the States: Adherence Report.” The report compiled data from more than 50 million patients to track their level of adherence to drug prescriptions for four chronic diseases: diabetes, depression, high blood pressure, and high cholesterol.

Interested in how CVS created the report, we sent several questions to the company. Helena Foulkes, Executive Vice President and Chief Health Care Strategy and Marketing Officer at CVS, provided these answers.

Why are patients not taking their medication as directed by their physicians?

Medication “nonadherence” (not taking medications as prescribed) is a common issue that negatively impacts the health of millions of patients and costs the healthcare system approximately $290 billion a year. Patients stop taking their medications for a variety of reasons, including cost, the complexity of managing multiple medications, forgetfulness, or simply not considering themselves sick.

Is adherence higher with generic medications?

There is a body of research that indicates that the cost of medication is a factor that impacts adherence. For example, a study conducted by CVS Caremark, Harvard, and Brigham and Women’s Hospital, which was published in the American Journal of Medicine in March 2011, found that “dispense as written” (DAW) requests were associated with excess costs and that patients are less likely to fill prescriptions for the more expensive branded medications.  In fact, the study results showed that for patients with a chronic condition who were starting on a new therapy, those with a DAW prescription resulting in a fill with a brand name drug were 50 to 60 percent less likely to fill the more expensive brand medication than those who were able to fill the less expensive generic drug.

How was this information compiled?

“The State of the States: Adherence Report” was compiled by a review of CVS Caremark pharmacy data for our PBM members-more than 50 million patients. Our researchers examined adherence measures for four common chronic diseases: high blood pressure, high cholesterol, depression, and diabetes. 

In our analysis, we apply a definition of adherence that represents effective care in a well managed pharmacy benefit program.  Four metrics were selected based on their importance to adherence and ranked. These metrics include medication possession ratio (MPR), an industry standard measure of how well patients are taking their medications as prescribed, as well as first fill persistency rates (FFPR), which quantify how many patients who are new to a medication continue to take it. 

We also considered two other measures – the percent of prescriptions that are dispensed with the generic version of the medication and the percent of prescriptions dispensed through mail-order pharmacies.

Do some states have higher adherence rates?

The State of the States Report examined a number of factors relating to adherence, and each state was assigned a ranking ranging from Gold to Silver to Bronze. For medication possession ratio (MPR), the adherence metric we weighted most heavily, the states with the highest rankings were Hawaii, Maine, Massachusetts, Vermont, and West Virginia.

Which states have the lowest adherence rates?

For medication possession ratio (MPR), the adherence metric we weighted most heavily, the states with the lowest rankings were Alaska, Michigan, Montana, Oregon, and Tennessee.  However, these states did not rank the lowest in all factors, and some had above average generic dispensing rates or first fill persistency rates, for example.

What are the factors that contribute to states having high versus low adherence rates?

Many factors contribute to adherence, so it is difficult to isolate those that are most significant for each state. Low first fill persistency rates can contribute to lower MPRs. In general, increasing the use of generics and mail dispensing rates could provide opportunities for improved adherence. 

How does CVS Caremark plan on using this information to assist patients in improving adherence?

We hope this information will help spark a dialogue with healthcare providers and policy makers at the state and federal level about how we can develop a better, more affordable, and accessible health care system.

While these data provide us with a snapshot of medication-taking behavior across the US, CVS Caremark also develops and implements programs that enable our pharmacists to focus on adherence as they interact with our customers and PBM members. For example, we have created a program called Pharmacy Advisor®, a unique approach to help our PBM members with chronic conditions such as diabetes and cardiovascular conditions achieve better health outcomes by promoting improved medication adherence and closing gaps in care. 

Through the program, CVS Caremark engages pharmacy benefit management plan members face-to-face at CVS pharmacies or by phone when they fill prescriptions through CVS Caremark’s mail service pharmacy.

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