The World Health Organization announced a global pandemic on March 11, 2020, in response to the severe acute respiratory syndrome coronavirus 2,1the cause of the coronavirus disease 2019 (COVID-19).

The socioeconomic impact of the virus has led to a major economic crisis with worldwide record unemployment, lack of transportation, social isolation, and an overwhelming demand for specialized health care services. Health care providers have shifted their efforts to prioritize acute care, and coincidentally, some have been forced to close their businesses or furlough workers in response to state practice provisions.

The economic situation has forced many patients to make difficult decisions about which maintenance medications they will continue to take. Adherence, or even worse, self-discontinuation, may have also been affected as the pharmaceutical industry has been overwhelmed by increased demand.

More than half of patients already do not take their medications as prescribed because of costs.2 Medication adherence barriers can also include transportation.3 Unemployed patients who once could afford their copays are now compelled to prioritize other essential items over their health needs. Now more than ever, pharmacists are in a unique position to increase awareness about medication adherence and offer alternative patient solutions to prevent nonadherence.3

Decline in Prescription Fills
PrescribeWellness, a national pharmacy network, investigated prescription fill data to provide a preliminary descriptive summary. In 2019, 5,802,679 chronic condition prescriptions were filled. Refill statistics comparing fill data for March and April 2020 showed that maintenance medication adherence in 2020 decreased from 2019 (Figure 1). Prior to COVID-19, the mean volume of fills for maintenance medications was much higher (1,545,291 for oral antidiabetics, 1,978,085 for antilipidemic agents, and 2,279,303 for renin-angiotensin system agents). From March and April 2019 to March and April 2020, a decrease of 2% (n = 31,307) in fills among a consistent population of patients with diabetes, a 6% decline (n = 1 22,959) in patients taking antilipidemics, and a 5.5% decrease (n = 124,810) in fills among a consistent population of patients with hypertension were observed. In total, these numbers represent 279,076 prescriptions that were not filled among patients with chronic conditions, compared to last year. In total, these numbers represent 279,076 chronic condition prescriptions that were not filled compared with last year.



Interestingly, the volume of filled oral antidiabetic agents and renin-angiotensin system agents in 3452 patients coprescribed a repurposed medication (eg, hydroxychloroquine, tocilizumab, or lopinavir/ritonavir) for COVID-19 increased by 3.5% (n = 55) and 6% (n = 166), respectively (Figure 2). However, the mean fill volume for these patients (n = 2449) taking antilipidemic medications fell from the previous year. It is speculated that patients who are being treated for COVID-19 are receiving more attentive and personalized health care services during the pandemic, resulting in improved acute and chronic condition management.



Conclusion
Pharmacists are in a unique position as frontline responders to improve medication adherence in such dire times to preserve expected positive outcomes in patients with chronic diseases. As health care providers, pharmacists can relay findings from professional agencies and scientific publications to diffuse speculation from social media and provide scientifically valid information on multidrug interactions and risk of adverse drug events or reactions. Furthermore, pharmacists can provide guidance on cost-effective alternatives and educate patients on the health ramifications of medication nonadherence.

Editor's Note: Jennifer M. Bingham, PharmD, BCACP, discloses an outside interest in Tabula Rasa Op-Co. Conflicts of interest resulting from this interest are being managed by the University of Arizona in accordance with its policies. The other authors did not receive any specific grant from funding agencies in the commercial, not-for-profit, or public sectors for this study. All authors receive salary from Tabula Rasa HealthCare (TRHC) and own TRHC shares.
 
Jennifer M. Bingham, PharmD, BCACP, is the director of ambulatory care residency programs and research at Tabula Rasa Op-Co in Tucson, Arizona.

Lauren Arlington, MPH, is the manager of pharmacy business intelligence, and Farah Madhat, PharmD, MA, is executive vice president of the pharmacy provider division, at Tabula Rasa HealthCare PrescribeWellness, in Moorestown, New Jersey.

Veronique Michaud, PhD, BPharm, is the chief operating officer of the Tabula Rasa HealthCare Precision Pharmacotherapy Research and Development Institute, in Orlando, Florida.

Jacques Turgeon, PhD, BPharm, is the chief scientific officer at Tabula Rasa HealthCare in Orlando.



REFERENCES
  1. 2009 H1N1 Pandemic (H1N1pdm09 virus). Centers for Disease Control and Prevention. Updated June 11, 2019. Accessed 23 April 2020. cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
  2. Prescription price transparency and the patient experience. SureScripts. Published February 2020. Accessed April, 24 2020. surescripts.com/docs/default-source/pressrelease-library/2020_price-transparency_data-brief-patient-survey.pdf
  3. Hincapie AL, Taylor AM, Boesen KP, Warholak T. Understanding reasons for nonadherence to medications in a Medicare Part D beneficiary sample. J Manag Care Spec Pharm. 2015;21(5):391-399. doi: 10.18553/ jmcp.2015.21.5.3