A program using claims and refills data to identify diabetes patients who are adhering to their medication regimens but not lowering their blood glucose levels could lead to improved pharmacy care in 54,000 community pharmacies. "We are working to get pharmacy, medical, and lab claims data back to our pharmacists so they can utilize that information along with the refill data they have on hand," said Thom Stambaugh, R.Ph., chief pharmacy officer for Cigna Pharmacy Management, the pharmacy benefit management company for six million Cigna health plan members.
CPM's Diabetes Outcome Improvement Program now informs only physicians, said Stambaugh. "We want to involve [R.Ph.s] in this program as soon as possible," he said. "There is no better place than the pharmacy for diabetes patients to be informed about drug alternatives and the effects of their drugs."
The Cigna program reviews medical, pharmacy, and lab claims data to help determine if lack of adherence might be contributing to high blood glucose levels. The presence of diabetes comorbidities, including hypertension, kidney disease, or high cholesterol, is also identified. Physicians are sent the information, including hospital or emergency room visits, as well as recommended treatment goals for each member. The doctors are encouraged to review the data and consider whether adding or changing therapy would help the member achieve treatment goals. Members are reevaluated every six months.
In the May 2004 issue of Diabetes Care, the journal of the American Diabetes Association, researchers from Yale University School of Medicine, conducting an extensive literature review, reported that "a large proportion of people with diabetes have difficulty managing their medication regimens." That includes the appropriate use of oral hypoglycemic agents and insulin. The researchers further found that some form of adherence monitoring, such as tablet count, electronic monitoring, or physician and pharmacist interactions, improved compliance.
Another article reported on the effectiveness of pharmacy care in diabetes education. In the December 2005 issue of Pharmacotherapy, the journal of the American College of Clinical Pharmacy, researchers from the Medical University of South Carolina concluded that "diabetes management services from clinical pharmacists achieved significant improvements in A1C values, blood pressure, and aspirin use. Continued efforts in diabetes education and management are needed to further improve clinical, economic, and humanistic outcomes."
"A major issue related to adherence is medication cost," Stambaugh said, "and pharmacists can be encouraged to address alternatives like generics or assistance programs if they see that a patient is failing to fill his or her prescriptions."
The CPM program was implemented nationwide last year following a successful pilot project in the New York tri-state area. Participants in the pilot who took their medications appropriately lowered their hemoglobin A1c blood glucose level by 1.4% on average, and they had 13% fewer emergency room visits and 18% fewer hospitalizations than in the six months prior to their participation in the pilot program. This resulted in a 24% reduction in medical costs for members who achieved their recommended blood sugar goals, which is an HbA1c level of below 7%. Outcomes of the nationwide implementation will be released later this year, according to Cigna officials.
Almost 21 million people-about 6.3% of the U.S. population-suffer from diabetes, and another 41 million people are estimated to have prediabetes, a condition that increases the risk of developing Type 2 diabetes, according to a report issued in October 2005 by the Centers for Disease Control & Prevention. The CDC and independent studies predict that a third of all Americans born in the year 2000 may develop the disease.
"This is a growing problem that is not going to go away without serious intervention, which is why programs like ours are so important," said Stambaugh. "The more information our pharmacists have about adherence, the better outcomes we can achieve."
THE AUTHOR is a Gettysburg, Pa.-based healthcare writer.