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    Mandatory mail order can hinder medication adherence

    Mandatory mail-order programs are hampering medication adherence, said a pharmacy educator during a recent roundtable on medication adherence.


    Marie Smith
    Marie Smith, PharmD, the Henry A. Palmer professor of community pharmacy practice and assistant dean for practice and policy partnership at the University of Connecticut School of Pharmacy, was one of the speakers at the roundtable, which was sponsored by the New England Healthcare Institute (NEHI).

    "There are many patients being asked to sign up for automatic refill programs, done under the guise of helping patient adherence," she said. However, the metrics used to prove the point of increased adherence with mail-order programs are not accurate and typically track only whether a prescription was filled or refilled. "Prescription-filling metrics are not adherence metrics. Authentic metrics would look at how a patient takes a medicine as assigned by their prescriber," Smith said.

    "A lot of the pharmacy benefit managers and health plans contract for services and rates based on these metrics that I think are flawed," Smith said, adding that automatic refill programs promote waste and potential abuse of prescription medications.

    At the roundtable, Smith shared the case of a patient included in past medication adherence research conducted at the University of Connecticut. The female patient was admitted to the University of Connecticut Health Center after experiencing a severe allergic reaction to one of her chronic medications. The patient's medication was changed by her physician at the hospital. Within 48 hours, a pharmacist visited the patient at home to reconcile all of her medications. "The pharmacist developed a medication action plan for her that included new medications and medications that had been stopped, and went over the plan with her," Smith said.

    Two months later, the patient called the pharmacist, asking whether she should be taking the medication to which she originally had the allergic reaction. He assured her that she should not and asked her what had prompted the question. "She had received a package of medications that included the drug that was the cause of the reaction in the first place at her doorstep as a result of an automatic refill program," Smith said.

    While there are many technological solutions and gadgets designed to promote medication adherence, Smith believes the solution boils down to a "really well-written" medication plan that is shared between the healthcare provider and the patient.

    Christine Blank
    Contributing Editor Christine Blank is a freelance writer based in Florida.