Can Mail-Order Pharmacy Improve Medication Adherence?

By Kate H. Gamble, Senior Editor
Published Online: Wednesday, July 27, 2011
Follow Pharmacy_Times:
A pair of studies looking at mail-order pharmacy may shed some light on the question of what method of obtaining medications can yield the best outcomes for patients.

In one study, published online ahead of print in the Journal of General Internal Medicine, Kaiser Permanente Northern California patients who obtained new statin prescriptions via a mail-order pharmacy achieved better cholesterol control in the first 3 to 15 months after initiating therapy compared to those who purchased their statin prescription from a local pharmacy. Lead author Julie Schmittdiel, PhD, and colleages determined that greater adjusted rates of LDL cholesterol control in mail-order pharmacy users were seen across all gender and race-ethnicity groups.

After adjustment for demographic, clinical, and socioeconomic characteristics, as well as for potential unmeasured differences between mail-order and in-person pharmacy users, 85% of patients who used the mail-order pharmacy achieved target cholesterol levels, compared to 74.2% of patients who only used the local Kaiser Permanente pharmacy.

“While the findings of this study should be confirmed in a randomized controlled trial, they provide new evidence that mail-order pharmacy use may be associated with improved care and outcomes for patients for risk factors with cardiovascular disease,” Schmittdiel said. “Though mail order may not be right for all patients, this study shows that it is one possible tool in the broader health care system-level toolbox that can help patients meet their medication needs.”

Indeed, findings from another study published in the July issue of the American Journal of Managed Care suggest that patient choice may play a role in adherence. In comparing adherence rates under voluntary and mandatory mail benefit designs, a group of researchers led by Joshua N. Liberman, PhD, of Geisinger Health System found “mandatory mail appears to cause some members to discontinue therapy prematurely, particularly those without previous mail-service pharmacy experience.”

Liberman and colleagues compared adherence rates in the first year of therapy between voluntary and mandatory mail cohorts composed of individuals who initiated statin, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, platelet aggregation inhibitor, metformin, glitazone, or sulfonylurea therapy at a retail pharmacy between January 1 and March 31, 2009.

They found that although persistence rates were similar through the first 60 days of therapy, the mandatory mail cohort had a notable drop in persistence by day 90 (63.3% vs 56.3%), with a more pronounced drop among those without previous mail-service pharmacy use (50.5%).

“Offering a mail-service pharmacy option is an important benefit design tool that helps to control pharmacy costs and may facilitate medication adherence among those who successfully transition to 90-day-supply prescriptions,” the authors wrote. “However, restricting pharmacy choice by requiring the transfer of prescriptions from retail to mail-service pharmacy causes some members to discontinue therapy early. When members choose to eschew therapy rather than switch to a lower cost alternative, the unintended consequence is a reduction in medication adherence and the potential for increased medical expenses.”

In a blog post that looked at both studies, George Van Antwerp, vice president of the Solutions Strategy Group at Silverlink Communications, wrote that if patients are required to move to a 90-day mail-order prescription, “it's important to have a clear transition path for them so that they (a) understand their benefit; (b) realize how to move; and (c) don't end up simply missing refills or stopping therapy.”

Related Articles
Pharmacy operations can be improved by investing in continuing education for pharmacy technicians.
An island community is making do with a temporary pharmacy after its sole pharmacy was destroyed in a fire on January 25, 2015.
Although retail pharmacists in California are permitted to sell nonprescription syringes under legislative efforts to prevent HIV transmission among injection drug users (IDUs), recent research uncovered that many pharmacies still limit syringe access.
mscripts and Avella Specialty Pharmacy have recently completed analyzing data demonstrating the effectiveness of mobile pharmacy apps in helping HIV patients better manage their disease through improved medication adherence. Results from this analysis show that HIV patients using a mobile app which provides refill reminders, dosage reminders and other prescription management functionality are 2.9 times more likely to be adherent.
Latest Issues
  • photo
    Pharmacy Times
    Health-System Edition
    Directions in Pharmacy
    OTC Guide
    Generic Supplements
  • photo
    Pharmacy Careers
    Specialty Pharmacy Times