Patients facing a disease as complex and life-altering as cancer require much more than a prescription. They require ongoing, holistic support. That support ranges from therapy and risk-mitigation counseling to assistance with reverification and ongoing adherence support throughout the course of their treatment.
Advanced clinical care management, with close collaboration across providers, physicians, pharmacists and others, is crucial to ensuring optimal outcomes for patients on complex cancer therapies. A key component includes therapy-specific and patient-personalized ongoing communication and counseling to support medication adherence.
A survey of 2,000 patients by Accenture Life Sciences found that 70% of respondents highly valued adherence support. However, only about 20% received the services they expected. Clearly, patients want high-level support.
Because of its direct, positive effect on patient outcomes,1 adherence support benefits healthcare providers, biopharmaceutical manufacturers and payers by reducing episodic costs over the course of a patient's treatment journey. Best of all, better adherence helps prolong survival and improve quality of life for millions of patients worldwide.
Why it's so hard to stick to a treatment regime
Oral chemotherapy provides targeted treatment that's less invasive than IV medications. However, it also comes with increased patient responsibility. When patients don't receive education and support to help them manage the physical and logistical hurdles, they can easily fall off track.
Reasons for nonadherence include:
Side effects. Oral medications can cause difficulty swallowing, nausea, vomiting and diarrhea, among other issues. These side effects can prompt patients to miss doses or stop treatment altogether.
Cost. The high cost of oral medication is a major burden for many cancer patients. Patients with high copays for prescription drugs face enormous out-of-pocket costs and because of the expense, patients often stop therapy or ration doses, despite known risks. "If a patient can't afford groceries or their mortgage payment, then they're likely to choose those things over their next prescription," said Ann Fish-Steagall, director of clinical policy for Biologics by McKesson.
Comorbidities. Even something as simple as taking a pill requires meticulous planning. Patients may take multiple pills for cancer therapy on top of medication for comorbidities. They take some with food, some on an empty stomach. And different medications have different cycles. Complex regimens, if not planned for properly, lead to non-adherence.
How specialty pharmacies improve adherence
Because of their experienced clinicians and comprehensive view of patients' medical conditions, specialty pharmacies are in a prime position to address adherence. Multiple studies illustrate the higher adherence rates associated with specialty pharmacies. According to a Biologics by McKesson internal study, patients who have access to nurse counseling—which specialty pharmacies provide—stay adherent twice as long than without counseling.
Biologics by McKesson, an oncology and complex-care specialty pharmacy, has clinical teams for blood cancers and solid tumors, as well as an emerging complex care team for non oncology diagnoses and therapies. From within those divisions, it assigns each patient a dedicated clinical care team. This care team delivers services that include phone calls from pharmacists to help educate patients on their therapies as well as calls from nurses to check on patients’ status and work with them to manage any possible side effects. "Patients have access to the same pharmacist, nurse and pharmacy technician throughout their course of care," said Paula Bickley, vice president, Market Access, for Biologics. "This means that the Biologics team has the unique opportunity to really get to know their patients."
About 84% of patients agree to the clinical care services Biologics provides. During a 30- to 40-minute phone call, the pharmacist provides education about treatment and treatment goals, the underlying disease, dosing requirements and side effects. Pharmacists also gather information to develop a risk score that rates patients' probable treatment compliance.
"That score dictates frequency, timing and content of ongoing nursing calls," Bickley said. "During those calls, the nurse can mitigate any signs of noncompliance."
To further improve adherence odds, every month, patients receive a call from their pharmacy technician to schedule delivery for the next shipment and to get a pill count. If the technician notices something amiss, he or she will bring in the rest of the care team, as well as the prescriber, to discuss next steps.
"We take it very seriously that we are dispensing an expensive drug, possibly a lifesaving drug, and we want to set up patients so they have every opportunity to gain as much benefit from that drug as possible," Fish-Steagall said.
Why adherence matters to payers
As the industry shifts to value-based care, providers and payers alike look more closely at the causes behind emergency room (ER) visits, lengths of stay, and admissions and readmissions, among other factors. If improved adherence means improved outcomes, naturally healthcare systems notice the reduction in complications and total healthcare spend.
Even seemingly simple steps, such as allowing patients to self-report symptoms, can improve outcomes. A study out of Memorial Sloan Kettering Cancer Center in New York asked 766 advanced cancer patients to either report symptoms weekly using a tablet computer or report symptoms during oncologist visits.
The self-reporting group had a median overall survival rate of five months longer and stayed on their therapy two months longer than the control group. Seventy-seven percent of the self-reporting participants reported symptoms that required immediate action from nurses.3
Although drug price still matters—a lot—to payers, they should also consider the benefits of adherence support provided by specialty pharmacies. Improved adherence may positively affect their bottom line; more importantly, it benefits patients fighting a terrible disease.
"Specialty pharmacies are better trained to provide the kind of care coordination that is going to change how patients access care," Bickley said. "Biologics operates under the strong conviction that excellent patient care coordination and support drives the best outcomes and lowers overall medical spend. Reducing drug waste, unexpected ER admission, managing patients through formidable side effects… this is true healthcare reform."
- Conn VS, Ruppar TM, Enriquez M, Cooper PS. Patient-Centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis. Value Health. 2016;19(2):277–285. doi:10.1016/j.jval.2015.12.001
- Given BA, Given CW, Sikorskii A, Vachon E, Banik A. Medication Burden of Treatment Using Oral Cancer Medications. Asia Pac J Oncol Nurs. 2017;4(4):275–282. doi:10.4103/apjon.apjon_7_17
- J Clin Oncol 35, 2017 (suppl; abstr LBA2)