From antibiotic stewardship to formulary management, there are myriad ways pharmacies of all kinds can improve the health status of its patients. The following seven industry developments demonstrate that better clinical outcomes can translate into better business outcomes for pharmacies, creating more value for the entire health care system.


Antibiotic Stewardship


Fill rate for outpatient antibiotic prescriptions drops 9%

Outpatient providers are writing fewer prescriptions for antibiotics, particularly for broad-spectrum medications whose overuse has been blamed for the rise in antibiotic-resistant bacteria. That’s the takeaway from a report released by the Blue Cross Blue Shield Association. The report is based on an analysis of 173 million claims for outpatient antibiotic prescriptions filed by more than 31 million commercially insured Blues enrollees from 2010 through 2016. The analysis found that between 2010 and 2016, the antibiotic prescription fill rate declined by 9 percent. In 2010, there were 90.7 prescriptions for every 100 enrollees, whereas in 2016, there were 82.6. Prescription fill rates for broad-spectrum antibiotics dropped by 13 percent over that period, compared with 5 percent for intermediate-spectrum antibiotics and 3 percent for narrow-spectrum antibiotics. Fill rates fell most for infants—22 percent—followed by children and adults at 16 percent and 6 percent, respectively. “This decrease suggests that the national push to reduce use of antibiotics in children has had marked success,” the report said.

Annual expenditures on antibiotics decline by nearly 17% over six years

That’s according to a study published in the journal Clinical Infectious Diseases. Researchers analyzed antibiotic expenditure data in the prescription medication sales database maintained by the QuintilesIMS Institute. They found that from 2010 to 2015, providers and pharmacies purchased a total of $56 billion of antibiotics to be dispensed to patients. The annual amount purchased in 2015 dropped by 16.6 percent to $8.8 billion, compared with $10.6 billion five years earlier. The percentage of the total bought by community pharmacies dropped to 42.6 percent in 2015 from 55.5 percent in 2010. However, the percentage of the total bought by other settings all increased over that six-year period: 30.8 percent from 29.1 percent for nonfederal hospitals; 14.2 percent from 10.6 percent for other nonretail providers like long-term care facilities; 8 percent from 2.6 percent for physician offices and clinics; and 4.4 percent from 2.2 percent for mail-order pharmacies. “These results reinforce the importance of antibiotic stewardship efforts across the spectrum of healthcare,” the researchers concluded.


Immunizations and Vaccines


More than 5 million additional flu shots attributed to state pharmacist vaccine-enabling laws

State laws enabling pharmacists to administer seasonal influenza vaccines led to a dramatic increase in the number of adults getting flu shots over an 11-year period. That’s the finding of a study by Avalere Health, funded by the National Association of Chain Drug Stores and published in the journal Clinical Therapeutics. The study compared the adult flu vaccine rates before and after states passed laws allowing pharmacists to give immunizations to adults. All 50 states and the District of Columbia now have such laws. The first was Michigan in 1990, and the last were Louisiana and South Carolina in 2010, per the study. Researchers looked at changes in adult vaccine rates from 2003 through 2013. Overall, the rate rose to 40.3 percent in 2013 from 32.2 percent in 2003. Without the state laws, the predicted rate would have been 38.2 percent in 2013. The difference equates to an additional 5.2 million flu vaccines administered in 2013. “These findings suggest that pharmacies and other nontraditional settings may offer accessible venues for patients when implementing other public health initiatives,” the researchers concluded.

CDC identifies 21 different types of approved influenza vaccines for the 2017-2018 flu season

The Centers for Disease Control and Prevention laid out the agency’s strategy to fight the influenza virus for the 2017-2018 flu season. In its 24-page game plan, the CDC listed the 21 different types of vaccines available to help prevent people from getting this season’s anticipated strains of the flu virus. Consistent with past guidance, the CDC recommended that all persons age six months or older receive a flu vaccine by the end of October unless medically contraindicated. The agency’s game plan, published in the Morbidity and Mortality Weekly Report, provided detailed guidance to health care providers on the appropriate use of flu vaccines for specific high-risk populations and other patient situations. For example, the CDC said pregnant women “may receive any licensed, recommended, age-appropriate influenza vaccine” but identified the types of flu vaccines that should and shouldn’t be used.


Medication Adherence


More than two-thirds of patients cite cost as the top reason for not filling a prescription

Most patients get their prescriptions filled, but when they don’t, cost is the primary reason. That’s the finding of a survey of 3,003 adults conducted by Truven Health Analytics and NPR. A little more than 63 percent said they received a prescription for medication within the previous 90 days. Of those who got a prescription, 97 percent got it filled. Of the 3 percent who didn’t, 66.5 percent cited cost as the primary reason. Other reasons were they “didn’t need” the medication (11.2 percent); they “felt better” (10.9 percent); they “forgot” (2.3 percent); and “side effects” (0.7 percent). Further, 24.6 percent said they missed a dose of their medication, citing “forgot” as their No. 1 reason (52.1 percent), followed by “felt better” (14.6 percent) and drug “not working” (14.1 percent). Almost 24 percent of the respondents said they used a drug manufacturer coupon or rebate to help cover a drug co-payment.

Fewer than two-thirds of adults are adherent to their oral diabetes medications

That’s according to a report released by Express Scripts, the St. Louis-based pharmacy benefit management company. The report is based on an analysis of pharmacy claims filed by 1.4 million commercially insured diabetic patients who filled at least one prescription in 2016 for the management of diabetes. The report said only 63 percent of adults age 20 or older were adherent to their drug regimen. The analysis defined adherence as having a supply of medication that covered at least 80 percent of the time the patient is prescribed to be on the drug. Adherence varied by gender, age, number of oral diabetes drugs and pharmacy channel. For example, 75.1 percent of men age 65 or older were adherent, compared with just 40 percent of women age 20 to 44. Patients prescribed two to three oral diabetes drugs and who were taking six or more other non-diabetes drugs were more adherent than patients prescribed one oral diabetes medication and who were taking no other prescription drugs; the rate was 65.3 percent to 43.2 percent, respectively. Patients who had their oral diabetes medications delivered to their home were more adherent to their medications (81.4 percent) than patients who filled their prescriptions through a combination of home delivery and retail pharmacy pick-up (71.9 percent) or by retail pharmacy pick-up alone (53.7 percent).


Formulary Management


63% of hospital pharmacies operate formularies with restrictions on non-formulary medication use

That’s according to a survey of 392 hospital pharmacies conducted by the American Society of Health-System Pharmacists. The ASHP published the survey results in the American Journal of Health-System Pharmacy. The balance of respondents—37 percent—operates open formularies with few restrictions on prescribers. Whether their formularies are closed or open, most hospital pharmacies are taking a variety of actions to improve prescribing practices and medication use. For example, 89.9 percent are comparing the effectiveness of drug products when making formulary decisions; 89.7 percent are using evidence-based clinical guidelines; and 89.2 percent allow therapeutic interchange of prescribed drugs. Most hospital pharmacies also are using technology to improve the quality, safety and cost performance of their drug formularies. For example, 72.9 percent offer an online drug library or database to prescribers that includes only approved formulary items; 55.6 percent incorporate dose rounding or standardization into their pharmacy management systems; and 53.6 percent embed drug information and formulary restrictions into their CPOE systems. “Pharmacists continue to expand their role in improving the prescribing of medications in both hospital and outpatient settings,” the report said. “The adoption of EHRs and medication-use technologies has contributed to this growth.”

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