Impacting Adherence to Biologic Medications

San Antonio—According to an analysis of prescription claim and medical record data, patients had improvements in adherence to their biologic therapies if they received interventions from their clinicians. Results were presented at the NASP meeting in a poster presentation. The poster was titled The Impact of Clinical Interventions on Medication Utilization in Adult Patients Receiving Self-Administered Biologic Therapies at a Specialty Pharmacy.

The study’s authors noted that patients with chronic diseases have trouble adhering to their medications, leading to high healthcare costs. In addition, they mentioned that the overutilization or stockpiling of drugs and the automatic refilling of medications contributes to increasing costs.

Previous studies have shown that medication adherence improves when patients had satisfactory contact with healthcare professionals, had disease and treatment education, and if pharmacists called patients or performed other interventions to discuss adherence or medication-related problems.

In this analysis, patients who received biologic drugs from Diplomat Specialty Pharmacy enrolled in drug therapy management programs that included proactive and reactive clinician-provided interventions. Diplomat, based in Flint, Michigan, is the nation’s largest independent specialty pharmacy.

Pharmacists called patients to encourage them to refill their prescriptions and intervened if patients indicated they had missed doses, experienced adverse events, requested counseling, or had suboptimal adherence based on the results of disease-specific questionnaires.

The analysis included patients who were at least 18 years of age as of January 1, 2013, enrolled in a drug therapy management program between January 1, 2013, and August 31, 2013, and received FDA-approved doses of subcutaneous abatacept, adalimumab, certolizumab pegol, etanercept, or golimumab. They also received a direct intervention in May 2013 and received care for at least 3 months before and after the month of intervention.

The intervention group included 176 patients, while 7511 patients did not receive an intervention. More than half of patients received adalimumab and approximately 40% took etanercept. Fewer than 5% received abatacept, certolizumab pegol, or golimumab.

The authors measured adherence using the medication adherence ratio (MPR). For patients with a starting MPR less than 0.80, those who received an intervention had a 38.5% improvement, compared with a 23.2% improvement for those who did not receive any interventions. For patients with a starting MPR from 0.80 to 0.90, those who received an intervention had a 9.4% improvement, compared with a 3.5% improvement for those who did not receive any interventions. Patients with a baseline MPR of 0.90 or higher had a decrease in adherence over time, which was similar if they received an intervention or if they had no intervention. The overutilization of medications also did not differ between the intervention and nonintervention groups.

There were a few limitations to the study, according to the authors, including that it only evaluated adherence and not persistency. Patients who discontinued therapy after the intervention month were not included and interventions that did not occur in May 2013 were not assessed. The authors also mentioned that Diplomat does not automatically ship medications, which could have affected the results found in patients with a starting MPR of 0.90 or higher. They recommended that future analyses evaluate all interventions during a specific time period and examine how interventions affect persistency rates.