Positive impact on medication adherence through Aetna's care management program

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Sep 4 2009

Aetna (NYSE: AET) announced today results of an analysis from the first half of 2009, demonstrating an average medication adherence of over 95 percent for its members taking Specialty medications. Disease states evaluated in Aetna’s analysis include: multiple sclerosis, rheumatoid arthritis, HIV, Crohn's disease, Pulmonary Arterial Hypertension (PAH), psoriasis, Hepatitis C and asthma. These conditions often require members to self-administer shots, adhere to complex dosing schedules or deal with serious side-effects. Aetna Specialty Pharmacy provides a high level of personal support and individual education to its members to ensure medications are taken appropriately and as prescribed.

“This analysis confirms that the personal attention members receive through Aetna Specialty Pharmacy’s care management program has a positive impact on medication adherence,” said Edmund Pezalla, MD, Chief Clinical Officer for Aetna Pharmacy Management. “Our coordinated care management approach has helped thousands of Aetna members with the most common chronic conditions stay on their doctor’s recommended treatment plan, which contributes to a healthier member population.”

For the first half of 2009, the averages for the following disease states were:

Multiple sclerosis, 95.33 percent
Rheumatoid arthritis, 94.65 percent
HIV, 97 percent
Crohns, 95.68 percent
Pulmonary Arterial Hypertension (PAH), 97.21 percent
Hepatitis C, 97.39 percent
Psoriasis, 94.33 percent
Asthma, 93.38 percent

Aetna manages and monitors these eight conditions closely because they have the highest prescription volume and are also known to have severe side effects, causing patients to no longer take their medication as prescribed. However, every patient using Aetna Specialty Pharmacy is offered in-depth personal support from a staff of highly qualified clinical professionals, including registered nurses, licensed practical nurses, registered pharmacists, and pharmacy technicians.

“These are some of the best results we’ve seen documented in the industry,” said Pezalla. “The combination of support we are providing is proving to work across a spectrum of conditions.”

Upon receiving a new prescription order, Aetna Specialty Pharmacy assesses the patient’s education needs and compliance risk. Clinicians confirm the dose and medical necessity. They also respond to each patient's assessed needs by offering additional education about their therapy and tips for success. They perform injection training, coordinate home health care, engage and discuss concerns and preferences with patients, in addition to providing emotional support. Aetna clinicians work with the patients’ physicians to address concerns and will call members as often as needed to check progress and proactively coordinate refills and supplies. They can offer help 24 hours a day, seven days a week.

“These patients become part of our lives and if we aren’t interacting with them directly or with their doctors, they can be sure we have thought about them at some point every day,” said Jenny Zientara, RN, with Aetna Specialty Pharmacy. “The entire care management team is personally vested in ensuring our patients have what they need to stay on their medications and stay healthy.”

Aetna Specialty Pharmacy staff members who interact with patients complete a thorough drug and disease state training in addition to their customer service training. This ensures that all clinical as well as non-clinical patient support staff are well-versed about the many disease states for which Aetna Specialty Pharmacy dispenses medications to treat.

Medication Adherence vs. Retail

For patients who use Aetna Specialty Pharmacy, the in-depth support they receive also goes beyond what they would typically see if using a retail pharmacy. This was demonstrated in an in-depth study of 1500 Aetna members receiving treatment for multiple sclerosis between March 2005 and March 2008. It showed that those using Aetna Specialty Pharmacy to get their medications had better refill rates (a common measure of compliance) than those using a retail pharmacy or different specialty carrier.

The result was that Aetna Specialty Pharmacy showed significantly higher use and refills with an adherence ratio of 91 percent vs. 85.7 percent for patients who filled their medication elsewhere.

These results reiterate past Aetna study data that looked at members with specific disease states, who refilled prescriptions between June 2006 and June 2007. It showed how many days lapsed between when refills took place and when they ideally should have, also called a refill gap. Analysis results showed that Aetna Specialty Pharmacy reduced that gap significantly as compared to retail pharmacies, with fewer days lapsed between refills: