CVS Caremark Study Finds Patients with Complex Therapies Struggle to Stay Adherent to their Medications

WOONSOCKET, R.I., Jan. 10, 2011 /PRNewswire/ -- Patients with chronic heart disease are likely to have multiple doctors and take nearly a dozen medications that are filled in at least two different pharmacies -- and that is a problem that is resulting in many patients struggling to keep their medications straight, according to a new study conducted by researchers from Harvard Medical School, Brigham and Women's Hospital and CVS Caremark.

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The study, published today in the Archives of Internal Medicine, concluded that the health care system needs to find ways to help patients simplify, synchronize, centralize and organize their medication management. Among the potential solutions: creation of a "pharmacy home" to coordinate pharmacy care from a single point of contact. "Consolidating prescriptions in a single pharmacy home may help improve health care quality similar to the intended effects of a patient-centered medical home," the researchers said. In addition, the researchers said there is a need to synchronize medication regimens for patients because "those who make numerous trips to the pharmacy to pick up their medications, or fill prescriptions at different pharmacies, may have difficulty taking their medications as prescribed."  

"The complexity that typical patients with heart disease face when trying to manage their medication treatment regimens is nothing short of dramatic," said Niteesh K. Choudhry, M.D., Ph.D., of Harvard and Brigham and Women's Hospital, and the lead author of the study.  "While the treatment of chronic disease is extremely complex, our results clearly demonstrate filling prescriptions at many different pharmacies on many different occasions makes it even harder for these patients to take their medicine as directed by their doctors."  

"Some people might look at these results and say it is not surprising that patients who have multiple doctors, and take medications purchased from multiple pharmacies are less likely to be adherent," said Larry Merlo, president and  chief operating officer of CVS Caremark. "But these findings show that the health care system needs to do a much better job helping these patients consolidate and manage their pharmacy care if we are intent on improving their health outcomes."

The study reviewed pharmacy claims from the CVS Caremark pharmacy benefit management (PBM) book of business for 1.83 million patients taking statins, and 1.48 million patients taking angiotensen converting enzyme inhibitors (ACE inhibitors) or rennin angiotensen receptor blockers (ARBs) between June 1, 2006 and May 30, 2007. The researchers selected these medicines for review because they are the most widely sold medications for the treatment of cardiovascular disease, which is the condition that imposes the greatest clinical and economic burden in the U.S. and abroad.

During a three-month period, patients filled prescriptions for an average of 11 medications representing an average of six different drug classes, the researchers said. "More striking, during this 90-day time frame, 10 percent of these patients filled prescriptions for 23 or more medications . . . and 11 or more different drug classes, had prescriptions written by four or more prescribers, filled these prescriptions at two pharmacies and made 11 or more visits to those pharmacies," they said.

Among solutions discussed in the study are:

• Creating a centralized pharmacy home -- similar to the concept of a medical home -- where a patient's pharmacy care is evaluated and renewals and refills are better synchronized and managed. This could include providing financial incentives for patients to fill prescriptions at a single pharmacy, so that a single health care professional has a full view of the patient's needs and care.
• Encouraging programs that reduce complexity of both filling and taking medications by streamlining the number of trips it takes to fill their prescriptions through programs like 90-day versus 30-day prescriptions and coordination through mail order pharmacies.
• Experimenting with programs and technologies that may make it easier for patients to better organize their medications.

The therapeutic complexity study is part of the CVS Caremark research effort aimed at better understanding how consumers interact with their health care providers so that they stay adherent to their medications. The study is the work of CVS Caremark's previously announced three-year collaboration with Harvard University and Brigham and Women's Hospital to research pharmacy claims data to better understand patient behavior around medication adherence.

Past industry studies show one-quarter of people receiving prescriptions never fill their first prescriptions, and patients with chronic diseases such as diabetes and coronary artery disease adhere to their ongoing medication regimen about half of the time. Non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. health care system estimated at about $300 billion annually.

About CVS Caremark

CVS Caremark is the largest pharmacy health care provider in the United States. Through our integrated offerings across the entire spectrum of pharmacy care, we are uniquely positioned to provide greater access, to engage plan members in behaviors that improve their health and to lower overall health care costs for health plans, plan sponsors and their members. CVS Caremark is a market leader in mail order pharmacy, retail pharmacy, specialty pharmacy, and retail clinics, and is a leading provider of Medicare Part D Prescription Drug Plans. As one of the country's largest pharmacy benefits managers (PBMs), we provide access to a network of more than 64,000 pharmacies, including approximately 7,100 CVS/pharmacy® stores that provide unparalleled service and capabilities. Our clinical expertise includes one of the industry's most comprehensive disease management programs. General information about CVS Caremark is available through the Company's Web site at http://info.cvscaremark.com.

SOURCE CVS Caremark