Inside This Issue - Opinion
Medication adherence takes center stage
July 20th, 2009
As the debate about health care reform intensifies in Washington and beyond, the National Association of Chain Drug Stores has rightly seized on medication compliance — or lack of it — as an issue where retail pharmacy can contribute in a big way to the twin goals of improving patient outcomes and limiting expenditures.
The Centers for Medicare and Medicaid Services estimate that health care expenditures reached $2.4 trillion, or 16.6% of the gross domestic product, in 2008.
In a recent speech at the Florida Pharmacy Association’s annual meeting, NACDS president and chief executive officer Steve Anderson identified what’s at stake in terms of noncompliance, citing estimates of $177 billion a year in direct and indirect costs stemming from the problem, and what community pharmacy can do to help remedy it.
“Ours is an industry and profession of highly technical issues and concepts, of jargon and acronyms,” he said. “We cannot expect members of Congress — who need to focus on many, many issues — to be 100% fluent in the language of pharmacy.
“But for the health of patients, for the vitality and even survival of pharmacy, and for the sustainability of the health care system, they must know at least one word. And that is adherence. We must take it upon ourselves to tell the story of pharmacy’s direct role in improving it — and in improving health care quality, access and affordability along with it. …
“Medication adherence is an important solution to help keep skyrocketing health care costs down.”
The case made by Anderson and other pharmacy advocates is a good one. It’s common sense that to obtain the full benefit of a medication, it must be taken as directed. But to prevail in the current debate, retail pharmacy needs more than anecdotal evidence to prove the point.
Fortunately, quantitative research data is beginning to emerge. Results from a recent study published by The New England Journal of Medicine looked at the impact of prescription drug coverage for Medicare beneficiaries by comparing spending for medications and other medical care two years prior to the advent of Medicare Part D, in January 2006, with that two years after implementation.
Funded by the National Institutes of Health, the study concluded that “groups that had no or minimal drug coverage before the implementation of Part D had reductions in other medical spending that approximately offset the increased spending on such drugs.” Although the researchers found that health care costs increased for the group that had more generous coverage to begin with, the report states that “increased use of medication led to improved control of chronic illnesses.”
That, combined with improved compliance, holds the promise of additional substantial gains over the long term. More work on the effect of pharmacy care needs to be done to pinpoint the potential savings.
The Institute of Medicine recognizes that fact. In its new report, “Initial National Priorities for Comparative Effectiveness Research,” the group spells out 100 topics that it believes the government should consider when allocating $1.1 billion in research funds to identify what health care measures work best for certain patients in specific sets of circumstances.
Among the recommendations for the Congressionally mandated program are several that relate to pharmacy, including one calling for a comparison of the effectiveness of approaches to improving patient compliance.
In the future the distribution of resources will increasingly be shaped by the effectiveness of different components of the health care system. NACDS understands that and is wise to put what community pharmacy can do at the center of its advocacy efforts. It should also work to support research that reinforces its message.