US Pharm . 2007;32(10):68-70.


Varolii Treatment Adherence Program Improves Refill Compliance

Prescription for Change

The retail pharmacy industry currently encounters significant changes--prescription fulfillment costs are increasing, while pharmacies lose revenue because of a competitive market and medication noncompliance. The volume of prescriptions is expected to rise substantially in the next several years for a variety of reasons, such as the impact of Medicare Part D. The number of pharmacists, however, is not predicted to adequately address this growth in prescriptions. These changes in the industry lead some pharmacies to implement communication strategies to encourage both customer loyalty and continued growth.

Proactive Response

Duane Reade, a leading retail pharmacy chain with over 250 stores in the Northeast, aimed to find a method to improve the dialogue between patients and pharmacists that could also lower operational costs. The pharmacy initially used internal resources to generate a prescription refill reminder list. This refill reminder list, in combination with a will-call bin management list, was delivered to pharmacists with the expectation to call patients in their spare time. Due to resource constraints, many calls were not made.

The Varolii Treatment Adherence Program

The Varolii Treatment Adherence program, a communication strategy from Varolii Corporation, was implemented at the retail chain to help boost medication adherence and refill efficiency with the use of improved and more frequent communication with patients.

The adherence program includes interactive voice response applications targeted at various stages in the course of therapy. In the new-to-therapy application, customers newly placed onto a maintenance medication are asked to enroll in an autofill program on an opt-in basis. A series of nonadherence predictive questions may be asked to determine which patients are at potential risk for premature discontinuation of the drug. This information is sent to the pharmacy on a routine basis, with a summary of those patients who chose to enroll in an autofill program, those patients who answered the nonadherence predictor questions, and the patients' responses to each question.

A second application reaches out to these patients on day 25 of the 30-day cycle with a refill reminder call. If the patient declines the refill, a series of "why not" questions follow, such as "Were you experiencing side effects?" These data are again sent to the pharmacy. Evaluating patients who chose not to fill via automated contact provides the pharmacy with important insight into noncompliance issues.

Results that Make a Difference
During Duane Reade's initial pilot with the Varolii Treatment Adherence program, an increase of 20% to 40% was seen in refill efficiency in most treated therapeutic classes and more than 100% was observed in some classes (maintenance medications for the treatment of chronic diseases).

"This lift in refill efficiency results in more revenue for the pharmacy, more prescriptions being filled and hopefully more compliant patients, and improved health overall, which ultimately can result in fewer dollars being spent for unnecessary hospitalizations and emergency room visits," said Dr. Michael Ross, Varolii vice president of healthcare.

In a small pilot group of stores, 18% of patients enrolled in the program--more patients than pharmacists had enrolled in the entire chain in the previous two years. In addition, less than 2% of patients opted out of the program, and responses to a postcontact customer survey have shown an 89% positive response rate. Among patients who did not listen to the entire message or immediately act, 50% still refilled and picked up their prescriptions.

Outcomes 8.0 Brings User-Friendly Features


Outcomes Pharmaceutical Health Care has launched Outcomes 8.0, the newest version of its Web-based documentation and billing platform for medication therapy management (MTM). The Outcomes platform helps local pharmacists bill sponsors--including health plans, Medicare Part D plan sponsors, Medicaid programs, employers, and pharmaceutical companies--for MTM services they provide. The software then documents and reports the value of the services back to the contracted sponsors.

Congress coined the term "MTM" in the Medicare Modernization Act of 2003. MTM describes services by pharmacists that help consumers get the best results from their medications through enhanced understanding of medications; increased consumer adherence to medication directions; and prevention of drug complications, conflicts, and interactions.

Outcomes 8.0 features user-friendly claim submission, comprehensive electronic patient charting functionality, advanced reporting, administrative access, and Web-based training modules. The seven online training modules, which pharmacists must complete before they participate in an Outcomes-administered program, take about one hour to complete and are free of charge. Other highlights include drop-down menus, help messages, and integrated documentation guidelines. All MTM claims are automatically integrated with MTM current procedural terminology (CPT) codes, and pharmacies can bill for non–Outcomes' programs as well through an available CMS (Centers for Medicare and Medicaid Services) 1500 billing wizard.

Electronic charting, another feature of Outcomes 8.0, permits the creation of detailed patient records with a master medication list and medication action plan, plus prescription history, labs, calendar appointments, and progress notes. Additionally, Outcome 8.0's Targeted Intervention Program (TIP) queue gives pharmacists a listing of identified services available for MTM-eligible patients, such as formulary or other cost-saving opportunities, noncompliance, potentially contraindicated medications, and disease state guideline adherence.

Outcomes 8.0 offers five administrative access levels. To help sponsors evaluate pharmacies, the platform features a pharmacy report card system that tracks MTM performance. Claim summary, claim remittance, and claim quality reports are available to both pharmacy and administrative system users.

RelayHealth Introduces NotifyRx and IntegrateRx

RelayHealth announced the launch of its NotifyRx solution, a real-time messaging notification and intervention tool that instantly delivers the latest drug information to pharmacists before they fill a prescription order that could potentially harm the patient. Four types of electronic messaging options--consumer safety, product disposal, product update, and educational material--are provided by NotifyRx.

"The usual mechanisms of transmitting vital pharmaceutical communications to pharmacies are generally slow, unreliable, and inefficient, often hindering pharmacists from being current with critical drug information when filling a patient's prescription,"said Jay Wiley, senior director of RelayHealth's Pharmacy Solutions. "In contrast, the NotifyRx solution provides timely communications that improve chances of avoiding adverse drug interactions and facilitates accurate distribution and safe use of medications."

In July 2007, the NotifyRx solution alerted pharmacies of an FDA-approved change of the drug name Omacor to Lovaza. The drug entity remained the same, but the National Drug Code number changed, which could potentially confuse pharmacists, technicians, and patients. Reliant Pharmaceuticals and retail pharmacists found this messaging pilot valuable, noting that it may have prevented incidences of double dosing.

Currently, a total of 36,802 drug stores have contracted to receive NotifyRx electronic messaging notification.

RelayHealth also announced the release of an electronic medication reconciliation solution, IntegrateRx Medication History. This product provides health care organizations with a record of a patient's medications based on information extracted from insurance claims and/or prescription records. This is made possible through the participation of pharmacies, pharmacy system vendors, hospital medication reconciliation vendors, and RelayHealth's pharmacy claims processing network, which processes prescription claims for more than 70% of the nation's pharmacies. IntegrateRx is designed to replace the typically manual process of interviewing the patient. Because IntegrateRx offers drug interaction screening, it also supports hospitals in meeting the requirements instituted by the Joint Commission.

Telemanager Technologies Extends Line of IVR Products

TeleManager Technologies introduces four new products, taking interactive voice response (IVR) from being primarily a productivity tool to a revenue-generating instrument, according to Paul Kobylevsky, COO of Telemanager. These IVR products will be available early next year.

The new SpeechRx allows physicians to call a pharmacy and dictate prescriptions into the IVR. Then the doctor's prescription is digitized and sent electronically to the pharmacy dispensing system. Prescribers have their orders verified on the phone, and the system sends an electronic verification to the physican's office to be put in the patient's file. This step-by-step verification process helps prevent medication errors.

"Since current practice habits do not need to be changed, TeleManager believes SpeechRx will greatly accelerate the adoption of e-prescribing," said Kobylevsky.

Another new product, Speech Enabled IVR, uses voice extensible markup language (VXML). Patients call the pharmacy to refill their medication and interact with the IVR by speaking into the phone. To request a refill, patients do not need the prescription number, adding the benefit of convenience. Once Speech Enabled IVR verifies the prescription information, the order is sent directly into the pharmacy dispensing queue.

Targeted Health Messaging extends the value of the new Speech Enabled IVR. The IVR reviews the patient's personal health information during the call and determines if the patient qualifies for specific messages based on the system's designed parameters. The IVR informs the patient that the pharmacy has an important message and asks if the patient would like to listen to it. Messages can relate to any subject the pharmacy considers suitable, ranging from messages about new generic medications, formulary changes, and compliance information supported by a pharmaceutical company. Messages can also be sent to patients via the Internet or as patient leaflets delivered in the store, mailed, or as part of a centralized compliance or will-call bin management program.

TeleManager also offers its next generation of TeleManagerCentral IVR. With new software and design features, multilocation pharmacies can have headquarters-based control and support to their entire IVR network. TeleManager utilizes VXML and voice-over-IP capabilities to develop a universal, scalable, and centralized IVR architecture that reduces the total cost of centralized IVR for pharmacies with multiple locations.

InforMedix Launches Med-eMonitor

The Med-eMonitor System, a new interactive "smart pillbox," was developed by InforMedix to address the problem of noncompliance among patients with chronic conditions and the elderly.

The technology alerts patients with a musical chime when the patient should take their medication, reminds the patient how to take it, and records the date and time when the pill drawer is opened. The system also asks questions about the patient's health. If a patient misses a dose or takes the wrong medication, the technology sends an alert message by email, text message, or fax to a call center or loved one. Critical alerts, such as signs of impending stroke or elevated blood sugar levels, are flagged for the call center staff within minutes.

InforMedix is retailing its Med-eMonitor System through a new program with Southern Pharmacy Cooperative (SPC) that will initially involve two of its participating independent pharmacies. The technology will be utilized to enhance the medication adherence of selected customers, such as those who require chronic care and take multiple medications. InforMedix will ship the units to customers and provide promotional materials to the independent pharmacies and their pharmacists. The pharmacists will market and sell the Med-eMonitor to retail pharmacy customers. excelleRx, a company that offers medication consultation and pharmaceutical distribution services for elderly, chronic care, and hospice populations, will provide monitoring, drug interaction risk analysis, and medication management support to customers. Upon successful commercialization through the first two pharmacies, SPC will make the Med-eMonitor System available to each of its member pharmacies.

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