Chain Drug Review, June 4, 2018

VIRTUAL ROUNDTABLE DIABETES CARE Community Pharmacists Are Available to Counsel and Educate From 103 educate patients build awareness and promote product adoption Rajora Collaborative care models can benefit from being expanded in parallel with expanded scope of practice for pharmacists For example patients can benefit from pharmacist early intervention and prescribing such as a statin Current Star Ratings state that a statin should be prescribed for patients with diabetes As such pharmacists should be able to test and monitor cholesterol levels regularly prescribe statins and monitor both safety and efficacy of statin therapy in patients with diabetes Currently PMDCs pharmacistmanaged diabetes clinics and MDCs multidisciplinary diabetes clinics exist for high risk patients with diabetes These pharmacist led and multidisciplinary approaches have proven outcomes in lowering A1c levels Opening access to PMDCs could benefit all patients with diabetes Kerley With the evolving health care landscape a patient centric approach to collaborative care among physicians and community pharmacists will continue to contribute to improving patient outcomes and advancing the profession of pharmacy Community pharmacists extend care into the communities where the patients reside by leveraging local stores and offering a wider range of availability Patients with chronic conditions like diabetes can benefit from having personalized and frequent contact with their very own health care team CDR How significant is prescription adherence in managing diabetes What are the relevant lessons for pharmacists and patients from successes and failures in the broader effort to boost adherence Brennan Research shows that when people take their medications as prescribed they can experience better overall health outcomes and lower their risk of costly and life threatening complications This is especially important with diabetes Because cost can be a barrier to accessing and taking medications CVS Health launched ReducedRx a prescription savings program that offers discounts on certain medications including insulin through our PBM CVS Caremark In addition our pharmacists can work with patients with diabetes to develop proactive medication management plans that help individuals keep risk factors under control manage existing conditions and stay adherent to their medication and treatment regimens Frank Nearly half of patients with type 2 diabetes fail to achieve adequate blood glucose control and one of the major contributing factors is poor medication adherence One key to success in managing patient adherence is to tailor adherence interventions to the patients specific adherence barrier s which may differ by medication especially for patients with diabetes and the various drug formulations available A one size fits all approach will not work Zabeli Its very important and has been for some time Again diabetes is a more difficult condition to selftreat and adherence to medication and blood glucose testing regimen are critical in reaching a reduced A1c Its a little dated now but there was an article about pharmacist intervention MTM and actual blood glucose monitoring It was in the January 2011 issue of the Journal of Diabetes Science and Technology It documented improvements Michael Schlanger Trividia Health in patient care through a focused MTM program Kerley Since pharmacological treatment is most often necessary for a person with diabetes to maintain glycemic control it is very important for them to stay adherent to these regimens to ensure beneficial outcomes Unfortunately medication adherence is often poor The reasons for medication nonadherence can include age perception and duration of disease polytherapy psychological factors safety tolerability and cost Pharmacists can work with patients to identify the barriers to medication adherence and offer innovative solutions Strategies can be individualized to include partnering with the physician to reduce the complexity of the prescription regimen educational initiatives improved doctor pharmacist patient communication and prescription reminder systems Schlanger Diabetes does present unique challenges in terms of patient compliance due to the fact that diabetes affects everything from patient diet to comorbidities such as hypertension skin care concerns eye issues etc multiple areas of the body are impacted Due to this often a patient will have to adjust lifestyle in addition to managing their diabetes This creates especially for the newly diagnosed a lot of new information and often requires changes to patient behaviors Patient education is the first step in changing these behaviors pharmacists have an opportunity to drive awareness of the importance of adhering to their prescribed testing regimen and any medication program The good news is that preventative and maintenance based solutions are available should be used regularly and are affordable Trividia Health as an example offers a portfolio of innovative high performance blood glucose monitoring systems and supplemental health care products targeted towards people with diabetes such as a fast acting glucose portfolio for low blood sugar fiber for a healthy diet and a skin care portfolio to protect and hydrate dry cracked skin Products manufactured by Trividia are branded under our TRUEplus brand co branded under a store brand and our brand or sold as a straight private label The products that we manufacture are made with performance and efficacy in mind and priced to ensure that consumers can afford them to promote regular use Schroeder For patients navigating the world of health care pharmacy prior authorizations and drug interactions can be confusing Studies have shown retail adherence averaging 30 to 50 when patients are asked to manage their therapies on their own and up to half of all new prescriptions may never get filled Patients make multiple trips to the pharmacy every month and still may not be getting the most benefit from their medications Thrifty Whites RxMedSync model makes correct and timely filling of prescriptions much easier The internal system identifies all eligible patients who are on two or more maintenance medications and the store team reaches out to discuss the benefits of the program with each patient The model has more than 77000 enrolled patients who have opted to utilize the program Upon individuals enrollment the pharmacy team performs an initial medication review to ensure that each patient is taking the correct medications at the correct times and isnt missing any therapy Once the team knows that the medications are correct it aligns them to fill on the same date each month and proactively schedules the patients pickup appointment This allows patients to make one trip to the pharmacy every month and know that they are getting the proper medications Each subsequent month the patient care team reaches out 10 days prior to the upcoming medication fill due date to review any therapy changes doctor visit outcomes and adverse effects Simplifying this process has resulted in adherence scores of higher than 95 and patients averaging 355 days on therapy each year Thrifty White has even created programs to sync 30 day and 90 day fills allowing patients to customize their schedules and still receive the full benefits As Thrifty White has continued to see the success of this adherence model we have added additional disease state management resources for patients and patient counseling patient services such as injection training device training and COPD training and support We actively look for industry partners such as health plans PBMs pharmaceutical manufacturers industry consultants employers state department of health entities providers and health systems and ACOs accountable care organizations to find collaborative patient care models Aligning to the same goals and finding ways to foster partnerships and bring programs and resources to patients is the most productive way to truly support patients in their quest for healthy outcomes The foundation will always be medication adherence and working tirelessly to bring patient solutions that support their care plan is how pharmacists will continue to bring value and maintain their highly respected status as HCPs Rajora Like most asymptomatic chronic conditions current levels of adherence and persistence are not adequate with diabetes care medications to avoid the complications that the condition brings over time Adherence falls off further as diabetes patients transition from orals to injectables e g insulin Numerous studies show average insulin adherence is approximately 60 and approximately the same percentage report regularly omitting insulin even though they know they should take their medication Another study reports 20 often skipped injections and 10 restricted daily injections Whats no surprise is nonadherent patients have significantly higher overall health care costs directly related to hospitalization Conversely they have much lower pharmacy prescription costs On average nonadherent diabetes patients generate approximately 10000 less in pharmacy revenue than adherent patients Its believed a root cause of patients low adherence results from patients poor health literacy as it pertains to diabetes care Pharmacists can play a significant role in helping close the knowledge gap with patients to help them understand the micro and macro vascular damage that is caused by nonadherence Motivational minicounseling sessions are believed to help patients appreciate the health risks they are subjecting themselves to by choosing to be nonadherent Additionally its believed improving the injection experience by converting to insulin pens from syringes has a clear impact on adherence Pharmacists can likewise play a strong role in helping their patients improve their injection experience by advocating and converting patients to using short pen needles 4 mm 5 mm and 6 mm that are thin 32 gauge in diameter and have large inner diameters all of which are believed to positively impact patients compliance and persistence with injection therapy Attanasio Prescription adherence is critical for managing diabetes its importance cant be overstated However we as members of the health system and a patients care team need to ensure we understand and address the root cause of a patients nonadherence For example there may be many reasons contributing to a patients inability to take their medicines as prescribed Often though we focus only on access and or cost While that is certainly an issue that must be addressed we cant overlook possible psycho emotional issues which might persist once access is resolved We need to be mindful that patients may be in greater need of more education on side effects and recommendations for over thecounter medicines that can alleviate them In some circumstances patients may need counsel to return to their provider Again it comes back to treating the whole patient CDR Given the epidemic of prediabetes how can pharmacies help stop its progression into full blown diabetes with targeted programs and messaging Kerley In 2015 the ADA reported that 841 million Americans age 18 and older had prediabetes The good news though is that it is possible to prevent prediabetes from developing into type 2 diabetes Eating healthy food losing weight and staying at a healthy weight and being physically active can help bring blood glucose levels back into the normal range Behavior changes take continuous reinforcement and support Due to accessibility and the frequency in which they see patients community pharmacists are available to counsel educate and increase awareness of diabetes thereby helping their patients lead healthier lifestyles Schlanger Engaging patients through screening events outreach programs in store messaging etc allows the pharmacy to touch a large at risk population who may or may Sara Konz Cardinal Health not be aware of the risk factors or early signals that may indicate that they could develop type 2 diabetes if lifestyle changes are not made Pharmacists educate the population in the risk factors and what products and possibly medications are available for those at risk consumers to help monitor themselves and how to make positive lifestyle changes like betterinformed diet choices exercise and possibly a medication protocol There is an opportunity here for pharmacies to reach out to consumers to position themselves as the resource for affecting positive lifestyle changes and living a healthy life Konz Education and awareness is key It is important for people to know they should be talking to their doctor about proper screenings Warning signs can be mild and many people will not notice them until damage has already been done Regularly talking to patients about screening measures and providing simple healthy lifestyle To 106 104 Chain Drug Review June 4 2018