With primary care physicians in short supply, doctors’ schedules on overload and about 30 million people scheduled to enter the health care system by 2014, patients may start to feel neglected. But experts say consumers often overlook the skills and expertise of their pharmacists, and that they should be viewed as a reliable go-to professional for education and information on prescription drugs.
Pharmacists may still dispense pills, but they’ve ramped up their role to become an important member of a patient’s health care team, enhancing access, improving outcomes and integrating care.
Pharmacists are giving patients the time that physicians are no longer in a position to give, says Brian Solow, chief medical officer at pharmacy benefit manager OptumRx. They are advocating for consumers with their physicians and health insurance companies and counseling patients one-on-one whether it’s face-to-face, online or over the phone--often 24 hours a day, seven days a week.
“They are making life easier for patients, and providing health care on the patient’s terms,” says Nimesh Jhaveri, executive director of pharmacy and healthcare experience at Walgreens.
Cynthia Tyler can vouch for that. The Chicago resident balances many medications for several conditions and followed her pharmacist, Hakeem Idris, and pharmacy technician, Rallin Singleton, when the pair moved to a location 12 blocks farther.
Tyler’s loyalty is consistent with a recent Ipsos/Walgreens study reporting 70% of respondents would switch or consider switching pharmacies to fill their prescriptions from a pharmacist trained in specific areas that suit their needs.
Tyler claims her loyalty has been well-earned and counts on the pair to ease her concerns when adding new medications to her drug regimen. Their thorough explanation of what she can expect in treatment and improvements along with any potential drug side effects and how to stem them also keeps her coming back.
They also help her keep on track or adherent to her drug protocol.
Medication adherence is a priority for improving outcomes and containing individual and system costs, experts say. According to the National Association of Chain Drug Stores, the overall spend resulting from poor medication adherence is approximately $290 billion per year.
To help change that picture, Walgreens pharmacists counsel patients and the company has introduced the well-experience store model in several locations in which pharmacists come out from behind the pharmacy counter and sit at a desk to talk to patients.
Jhaveri says consumers are responding favorably to the company’s pharmacy-directed programs. For example, Walgreens’ pharmacist-led training and counseling program for patients receiving an injectable diabetes medication improved adherence by 24%.
Another Walgreens’ study says patients starting a first-time statin regimen for coronary disease
benefited from face-to-face counseling with a community pharmacist, demonstrating better average medication adherence, 61.8%, than those who did not participate, 56.9%.
A study of medication therapy management programs in which pharmacists played more of a mediation role among Minnesota Blue Cross/Blue Shield patients found reductions in health-care costs of 31.5% per person, to $8,197 from $11,965.
Beyond the retail pharmacy, there’s the online pharmacy and the Pharmacy Benefit Manager (PBM). The PBM is not always the first place consumers turn when they want more personal attention from a pharmacist, says Solow, but claims it does offer advantages. He says an August 2011 study reports patients using mail order pharmacies like OptumRx and Walgreens online pharmacy had statistically better adherence, 49.7%, than those using retail which stood at 42.8%.
That said, consumer preferences and styles vary. Both OptumRx and Walgreens offer a host of direct-to-consumer medication therapy management and disease therapy management, drug adherence and safety programs addressing conditions like infertility, osteoporosis, depression, multiple sclerosis, programs for seniors and the management of specialty drugs.
A recent study says patients receiving text message reminders to take their medicine had better medication adherence rates, 85%, than those who did not, 77%. The adherence rates for those taking chronic anti-diabetes medications were even higher, at 91% versus 82%. Significant improvement was also seen in those who opted to receive text message reminders for beta-blocker therapy.
My Medication Reminders, OptumRx’s text messaging program, allows participants to provide the PBM with their mobile phone numbers and time zones to select any combination of reminder choices including daily medication dosing reminders that ping a patient to take a medication at the right time.
As a PBM, OptumRx has the unique advantage of seeing all of a patient’s medications, says Solow, and makes a daily review of pharmacy claims to detect clinically significant drug/drug interactions (DDI) as well any medications that may be missing from a regimen.
The Medication Therapy Management program is geared toward Part D members who have a higher drug spend, are on multiple medications, and have a multitude of chronic diseases (the exact criteria changes year-to-year based on CMS guidance). All of these MTM members are eligible to receive a Comprehensive Medication Review (CMR) but the majority of seniors across the country fail to take advantage of this free service.
A comprehensive specialty/biologics program provides one-on-one outreach to review a patient’s care plan over several months. The same pharmacist and patient are consistently paired to enhance the pharmacist/patient relationship.
Jhaveri says that personalized programs will continue to grow. He envisions a future in which pharmacists, much like nurse practitioners, will be able to prescribe for some classes of medicines.
How to maximize the relationship with your pharmacist
Refill your medications as required. Set reminders and consider texting as a tool for refill alerts and dosage reminders to maximize the benefits of your medications.
Ask questions. Any time you’re prescribed a new drug, discuss expected outcomes, including potential side effects and how to manage them.
Review all your medications with your pharmacist. Be sure to identify all the drugs, vitamins and other remedies you are on to identify a potential DDI or discover if a medication is missing.
Close the physician-pharmacist loop. Allow your pharmacist to reach out to your physician to discuss your drug-therapy regimen.
Discuss substituting a generic for a brand. Ask for a generic when it’s available and proven to be clinically effective. This and a 90-day medication refill program will save you considerable money and improve adherence up to as much as 15% according to a Walgreens’ study.
Use all available pharmacy resources and encourage family seniors to follow suit. Many pharmacies offer little-known perks like free or reduced flu shots, help with diet and fitness and physicals to make customers savvier, healthier consumers.