What Patient Characteristics Influence Use of Mail-Service Over Local Pharmacies?

A recent article in the American Journal of Managed Care identified better compliance (84.7% vs 76.9%) in patients using mail-service rather than a local Kaiser pharmacy.  However, the self-selected groups had much different characteristics such as race, socioeconomic deprivation score, Medicare versus commercial insurance and financial incentives to use mail-service.   I am still not sure whether place of service matters in most situations.  I think the services any pharmacy provides to improve adherence makes a bigger difference.  These include reminders, compliance monitoring and notification, incentives and personal connections with a pharmacist.

Lowering Patient Pay Only One Way to Improve Medication Adherence

Peter Pitts of the Center for Medicine in the Public Interest (partially funded by drug companies) and a former FDA associate commissioner argues that lawmakers should include reducing patient pay as a key part of health care reform.

I argue in a recent issue of American Health & Drug Benefits that other methods may work better at a lower cost. Excerpt:

"Programs to help patients maintain adherence can focus on incentives (such as lower patient pay), refill reminders, or interventions supported by analytics that detect adherence issues. Lowering copayments or coinsurance provides an easy-to-implement solution with proved short-term benefits; however, little is known about the long-term, lasting impact of this approach. Other potential incentives may tie lower patient pay, contribution to health savings accounts, or lower deductibles to completion of health risk assessments, participation in disease management programs, or maintaining adherence for defined durations (eg, every 6 months). This begs the question whether lowering patient pay offers better value than other services, such as those that detect and notify providers of poor adherence. Lowering patient pay by $5 for every chronic medication would cost upwards of 10 times more than intervention services that focus on adherence plus other medication therapy problems, missing preventive services, and gaps in evidence-based care."