Patient Demographics, Clinical Characteristics, and Medication Adherence to Treatment Among Patients on Oral Tyrosine Kinase Inhibitors in a Retail Pharmacy Setting

INTRODUCTION Previous studies have demonstrated the importance of adherence to oral tyrosine kinase inhibitors in improving outcomes, including achieving a complete cytogenic response. Patients with chronic myeloid leukemia (CML) that had a suboptimal response were more likely to be non-adherent. Early identification and intervention based on predictors of non-adherence may lead to improved outcomes for patients in the non-trial setting. This research aimed to determine the rate of adherence and persistence to oral tyrosine kinase inhibitors (TKI) and to assess associated effect of patient characteristics using real world data from a retail pharmacy setting. METHODS This retrospective analysis of administrative pharmacy claims data included a random sample of 5000 patients who filled at least one TKI medication (bosutinib, dasatinib, imatinib, nilotinib) from national retail pharmacy chain in the study period of May 1, 2018 to April 30, 2021. Data elements included prescription fill attributes, patient-level demographics, medication adherence by therapeutic class (TKI, antidiabetics, antihypertensives and antihyperlipidemics), as well as patient health conditions and diagnoses. Patient adherence barrier data were also analyzed for a subset of patients who received select clinical interventions. This research was reviewed and approved by Advarra IRB as exempt (Pro00044844). Medication adherence was measured using the proportion of days covered (PDC) metric. For each therapeutic class, PDC was measured from first fill date for that class from May 01 2018 to April 30 2021, followed for maximum of 365 days, and calculated as the ratio of the number of days of medication available and the measurement period. A cut-off to indicate suboptimum adherence of <85% was used for TKI and <80% for other classes. Length of therapy was measured as number of days a patient had underline medication coverage from the index date to the start date of medication gap that was>45 days. PDC and length of therapy and their influential factors were assessed using generalized linear models. Persistency rates were calculated descriptively and using Kaplan-Meier analyses. Associations among PDCs in TKI and common chronic medications were assessed using multivariate correlation statistics. All statistics were conducted using SAS 9.4. RESULTS The random sample of patients had a mean age of 61.7 years (median=65.6, IQR= =51, 75) and 49.9% were male. TKI use in our sample was predominantly imatinib (2,857, 57.1%) and dasatinib (1,428, 28.6%) with fewer patients on nilotinib (556, 11.1%) or bosutinib (159, 3.2%). Among those patients with adherence barrier data, the average number of barriers was 1.7. Among TKI users, 38.3% also had hypertension, 13.6% had diabetes and 15.6% had hyperlipidemia. Percent of TKI users who had common chronic conditions and who were taking corresponding therapies were 38.2%, 33.9%, and 33.3% for hypertension, hyperlipidemia, and diabetes, correspondingly. Mean TKI PDC was 0.797 (95% CL 0.789 to 0.804) with a median of 0.889. Over half of patients (55% patients) had a PDC>=.85. Mean TKI length of therapy was 18.3 months with a median of 15 months with differences by therapy. Correlation of TKI PDC to three common chronic therapy PDC were all low: 0.095 for antidiabetics; 0.032 for antihypertensives; 0.083 for antilipidemics) and not statistically significant. Age was a significant predicator of PDC, with every 10-year increase in age associated with a 2% increase in PDC. When a patient had previously stated adherence barriers, PDC was estimated to decrease by 1.7% for each barrier faced by the patient. Only a small portion (33%-38%) of TKI patients, who had a diagnosis for a common chronic condition, had a claim for the corresponding therapeutic class. CONCLUSIONS Adherence to TKI was influenced by non-modifiable risk such as age and modifiable risks such as the number of adherence barriers. Many patients on TKI who also had a common chronic condition were not taking medications for their chronic condition, noting a discordance in care. Ongoing capture of barrier data beyond specialty medications will help predict patient adherence behavior and identify targeted interventions. Disclosures No relevant conflicts of interest to declare.

CVS health faces a new wave of disruption

Purpose The purpose of this study is to understand how Amazon’s threat may impact the Pharmacy Industry as a whole and whether traditional drugstore chains such as consumer value stores (CVS) Pharmacy will need to re-think their business strategy, especially in the digital space, to account for potential disruption. Design/methodology/approach This is a hypothetical case study used as a teaching exercise to guide the learner through a decision-making process. The case starts by presenting a disruption in the retail pharmacy business that the main character must navigate by using real-world data and insights, provided in the case, to formulate a recommendation. Findings In an extremely competitive and consolidated pharmacy market, Amazon has the potential to change the business entirely. CVS Health will potentially face strong headwinds from Amazon’s PillPack and a downward trend in prescription sales. Regardless of the new competition, CVS Health continues to be innovative in the space. Instead of being a one-trick pony, CVS has encompassed the mentality of becoming a one-stop-shop by expanding into areas such as specialty pharmacy, health clinics, pharmacy benefits management and innovative digital capabilities. Originality/value This paper provides the reader with existing and known information about the evolving retail pharmacy business and allows the reader to interpret the new information to make their own decision on how a digital business strategy team can account for potential disruption.

Patient satisfaction with clinic-based medication pick up: Addressing pharmacy-level challenges to buprenorphine access

Introduction: Pharmacy-level challenges that exist for patients when seeking to fill buprenorphine prescriptions at traditional retail pharmacies can result in a less than optimal treatment experience. High patient satisfaction with treatment for opioid use disorder (OUD), which for oral buprenorphine treatment includes the necessary step of obtaining medication after being prescribed, is associated with positive health outcomes and, therefore, is of great clinical interest. The objective of this study was to examine patient satisfaction when participating in a pharmacy program that coordinated buprenorphine delivery and provision to patients at office visits instead of requiring patients to fill their prescriptions at local pharmacies.Methods: We conducted a voluntary and anonymous survey to assess patient satisfaction when the need to seek a retail pharmacy to fill buprenorphine prescriptions was alleviated. The survey was completed by 714 patients prescribed buprenorphine for OUD treated at 15 office-based opioid treatment clinics that integrated the clinic-based pharmacy program as an extension of their treatment services. The survey consisted of 16 questions evaluating satisfaction with the pharmacy program and prior retail pharmacy experience.Results: Majority of patient respondents reported high levels of satisfaction with the pharmacy program. Specifically, 97.6 percent (n = 697) of respondents noted feeling respected and/or that the pharmacy staff cares about their wellbeing, 91.7 percent (n = 655) of respondents reported that they are more likely to make their treatment appointments and/or stick to their treatment plan when the physical need to seek a pharmacy to fill their prescription was alleviated. The survey resulted in an 83.8 Net Promoter Score, further supporting a high patient satisfaction. Patient responses regarding how the program impacted their recovery illustrated common themes of more convenient, more private, judgment free, quicker, and stress free. The survey responses also validated previously reported pharmacy-level barriers for patients with OUD that the program sought to alleviate. Transportation challenges and/or undue time spent obtaining medication were indicated by 77.6 percent (n = 528) of respondents, 56.8 percent (n = 386) of respondents experienced feelings of stigma or shame at retail pharmacies was experienced by 56.8% (n = 386) of respondents, and pharmacies not reliably stocking their medication was indicated by 37.1 percent (n = 252) of respondents.Conclusions: The survey findings demonstrate that patients were highly satisfied with the provision of pharmacy-dispensed buprenorphine at their treatment visit in place of having to seek to fill prescriptions at retail pharmacies. Responses indicated the pharmacy program may also be a motivating factor for patients to attend treatment appointments. Continuing to develop and research strategies that alleviate physical barriers to buprenorphine access and result in high patient satisfaction, like this clinic-based pharmacy program studied, have meaningful implications for both patients and treatment providers.

Acceptability and Feasibility of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis in Kenya: A Qualitative Study of Client and Provider Perspectives

As countries scale up pre-exposure prophylaxis (PrEP) for HIV prevention, diverse PrEP delivery models are needed to expand access to populations at HIV risk that are unwilling or unable to access clinic-based PrEP care. To identify factors that may influence implementation of retail pharmacy-based PrEP delivery in Kenya, we conducted in-depth interviews with 40 pharmacy clients, 16 pharmacy providers, 16 PrEP clients, and 10 PrEP providers from two provinces. Most participants expressed strong support for expanding PrEP to retail pharmacies, though conditioned their acceptance on assurances that care would be private, respectful, safe, and affordable. Participant-reported determinants of feasibility centered primarily on ensuring that the intervention is compatible with retail pharmacy operations (e.g., staffing levels, documentation requirements). Future research is needed to develop and test tailored packages of implementation strategies that are most effective at integrating PrEP delivery into routine pharmacy practice in Kenya and other high HIV prevalence settings.

Secular Trends of Use of Medicines with Special Reference to Antibiotics in the Southern City of India

Introduction: Monitoring the consumption profile of medicines has become one of the important tools for assessing the rationality as it depends on the various indigenous factors. ICMR-NIN monitors drug consumption at retail pharmacy outlets with an objective to document the precepts and practices exist between prescription and consumption of medicine. This facilitates to translate in developing interventions and policy strategies for promotion of rational use of drugs.