PMU78 - MEDICATION THERAPY MANAGEMENT WITH DIRECT PATIENT ENGAGEMENT TO ADDRESS NON-ADHERENCE TO SPECIALTY DRUGS

Abstract

Non-adherence to high cost specialty drugs (SD) is considered a serious clinical and financial problem, often cited as a high priority in value based care. One such factor related to non-adherence is a patient’s perception of “feeling worse” which is tied to impatience for, or absence of, clinical benefit and treatment adverse events. “Feeling worse” is estimated to account for 15-66% of non-adherence. We analyzed patients in a specialty pharmacy’s medication therapy management (MTM) program database to better quantify the contribution of “feeling worse” to non-adherence. Retrospective review of patients on a SD participating in an MTM program who completed a telephone assessment prior to first prescription fill and prior to first prescription refill. The assessment included the following disease/treatment burden (DTB) query: “How are you feeling today?” which patients responded to on a Likert-style, self-rated health scale (1=miserable and 10=wonderful). Mean scores at first fill were compared to mean scores prior to first refill. Adherence was measured using Utilization Review Accreditation Commission (URAC) 3.0 standard - proportion of days covered (PDC). In 2017 23,186 unique patients with a total of 45,256 prescription fills received for 140 different specialty drugs to treat 355 different chronic diagnoses (e.g., cancer, auto-immune, HIV, pain, psychoses, multiple sclerosis, transplant) were identified. 5,167 patients (22%) had before and after DTB query responses and adherence measures. The mean DTB at first fill was 5.65 and the mean DTB at first refill was 6.86. The mean DTB change from before to after was +1.21 (21.1%); which was a significant improvement (P=0.0211). The PDC at refill was 0.89, representing a non-adherence rate of 11%. Patient’s sense of well-being and observed drug adherence were significantly better than published data. Whether direct telephone patient engagement contributed to these results warrants further investigation.