Sunday, July 11, 2010

Prescriptions often go unfilled

Program dispenses hope for patients in need

By Christina E. Sanchez • THE TENNESSEAN • July 11, 2010

Constance Hallmark went without 11 medications for several conditions — lupus, osteoarthritis, hypertension, osteoporosis, fibromyalgia — because she couldn't work and didn't have health insurance.

She simply couldn't afford her medicine. So she went without for eight months, believing her only option was to suffer.

In fact, a chunk of Americans are going without. More than one in five prescriptions, many for chronic diseases, go unfilled, according to a recent Harvard Medical School study.

Some people are struggling to afford their medications. Other people don't have transportation to a pharmacy. Then there are people who get too busy.

But the cost of not filling prescriptions is great. It can mean long-term health consequences and more expensive treatment.

"Ten or 15 years ago, we were just writing prescriptions and expecting people to fill them," said Dr. Parminder Bolina, who practices internal medicine and is director of ancillary services for Nashville Medical Group. "The reality is different now. We realize people either can't afford to fill them or don't have time. We have to figure out ways to help them."

The Harvard study looked at more than 75,000 electronic prescriptions over a 12-month period and found that about 22 percent of prescriptions went unfilled. That number jumped to 28 percent with newly prescribed medications, the researchers found.

The unfilled prescriptions most often were to treat chronic diseases such as diabetes, high blood pressure and high cholesterol.

Cost plays big roleCost is often the biggest factor for patients such as Hallmark, especially when it comes to brand-name drugs, which are getting more expensive, according to a recent AARP study.

Prices of many brand-name medications have increased by nearly 10 percent from April 2009 to March 2010, the biggest spike in eight years, the senior advocacy group reveals in its report "Rx Watchdog."

"When anyone does not take life-sustaining medication, death is the result," said Hallmark, who now gets her prescriptions through a local nonprofit medication assistance program, the Dispensary of Hope. "I don't know what I would do without the Dispensary. It gives me peace of mind."

The Dispensary of Hope partners with pharmaceutical companies to supply medications to people who cannot afford them. The organization provides more than 700 kinds of medications at 64 sites across the country, including 25 in Tennessee.

The demand for its services keeps growing, said Jason Dinger, chief executive officer for the Dispensary, founded in 2003.

"Most uninsured Americans go without their medications," Dinger said. "You get to a certain point in your income level where you have to make difficult choices."

The Dispensary is working with clinics to get onsite locations for those who need assistance.

"We are adding sites at a rate of about one per week," Dinger said. "That can help people who have to get on a bus to travel 30 minutes to get to a pharmacy."

But sometimes physicians don't even know their patients can't afford their medications, and that is why doctors need to initiate the conversation, Bolina said.

"As a physician, you have to be aware of what the person's insurance is, what their options are, whether they have to rely solely on generics," Bolina said. "I think this is something that is becoming so front and center in our minds as physicians."


Electronic prescriptions could help doctors be more aware, because the patient's medication history gets stored on computers, said Rick Sage, vice president of pharmacy clinical services for Emdeon, an e-prescribing network company based in Nashville.

"The problem with physician-written prescriptions is sometimes they never make it to the pharmacy," Sage said. "With electronic prescribing, we guarantee the transaction will make it to the pharmacy. Also, physicians can use their software to view the patient's medication history and if a medication was filled. It can reduce prescription abandonment."

But adoption of electronic prescribing has been slow over the past 10 years. About 84 percent of pharmacies are on board, but only about 25 percent of physicians nationwide have adopted it.

For people with insurance, companies such as Aetna also recognize that patients stay healthier if they maintain their medication.

Aetna has case managers who check in to see if patients are on certain medications, and if they are actually taking them, said Dr. Edmund Pezalla, national medical director of pharmacy management.

"Drug adherence has been a problem for many, many years," Pezalla said. "The human costs as well as the monetary costs are too high to go on." - Check out website and see if you Qualify.

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