Pharmacists Mike Boivin, John Papastergiou and Hitesh Pandya kicked things off with a ground-level view of what happens at the dispensary counter with plan members. In one case, a patient had been using samples for an antidepressant from his physician. When he learned his plan did not cover the drug, he paid for the medication himself—but this led to a decrease in his adherence.
“We see this all the time when patients start paying out of pocket. They try to make a 30-day supply last longer by splitting or skipping doses. This means the medication is not as effective, and that’s especially true for depression,” said Papastergiou.
In another case, lack of vaccine coverage delayed access to biologic medications, since immunizations are required before treatment can begin. “When vaccines aren’t covered, patients devalue them, and some see the pharmacist as a salesperson trying to sell them something,” said Boivin.
And while anyone in Ontario taking multiple medications can receive government-funded medication reviews from pharmacists, only so much can be accomplished in one review, particularly for patients who may be having trouble. “Adherence takes time, and the current public funding model doesn’t enable that,” said Boivin. Private plans can close that gap by covering pharmacist services such as medication care plans that include scheduled followups.
What can result, they add, is the “de-prescribing” of medications. “If outcomes are sub-optimal due to poor adherence, doctors will often prescribe another line of therapy that’s not needed. When we establish adherence, doctors can de-prescribe because patients can manage their conditions with fewer medications,” said Pandya.
All the articles from the event can be found in our special section: 2015 Pharmacy Solutions in Drug Plan Management Conference Coverage.
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