Medication Adherence Solutions

By Brett Kappelmann, PharmD
Owner, Cooper Drug Store

Suppose you go in for a routine checkup with your primary care provider.  They check your blood glucose level and it measures over 300.  You have never had high levels before but you figured the day would come due to the high percentage of diabetes running in your family.  Your doctor prescribes a medication that he tells you will help control your blood sugar.  You take the prescription to the pharmacy, hoping that just maybe it is on the four dollar list, but the pharmacist tells you that not only is it not on the list, this drug is available only in the brand-name version.  You wait at the pharmacy for an hour as they duke it out with your insurance company and finally get it covered at eighty dollar copay!  The pharmacist then proceeds to counsel about the high percentage of nausea and vomiting for people taking this medication.

"Great," you tell yourself sarcastically.  You justify to yourself that you feel just fine even with blood sugars that high, and with all of your responsibilities at home and at work, you can't afford to be dealing with the side effects from starting a new medication.  "I'll start it next month," you tell yourself, but by next month, and the month after, there are ten other reasons to justify not taking the medication.  And those blood sugars continue to creep up.and up.and up. 

I see different versions of this scenario play out every day as a pharmacist.  In the scenario above, this customer is at risk of quite literally shaving years off her life-expectancy as well as severely impeding her quality of life once the diabetic complications start setting in due to chronically high blood sugars.  Medication non-adherence is at an all-time high today due to many of the factors represented above.  Lack of medication reconciliation, lack of medication availability, intention non-adherence, poor medication understanding, and cost of medication are the five basic causes of non-adherence.  But how do you overcome these causes?  Let's look into a few solutions.

Lack of medication reconciliation.  Keep a current list of your medications with you at all times.  On that list be sure to include the dose, directions, indication, and prescribing physician.  Utilize your pharmacy to help you with the list if necessary.  Don't forget your OTC medications.  Refer to this list often to make sure you have not forgotten a medication.  It also will come quite handy on your trips to the doctor or hospital.

Lack of medication availability and cost of medication.  Utilize the expertise of your doctor and pharmacist in case a medication becomes unavailable or perhaps cost prohibitive.  Nine times out of ten there is an alternative, and many times that alternative is a less expensive generic.  Also, be proactive by calling in refill requests days before you run out of your current supply.  Oftentimes the pharmacy will have to call the prescriber for refill authorization or sometimes the prescription will be held up to due to an insurance situation such as a prior authorization.  Both instances could affect adherence if you run out before the next refill is ready.

Intentional non-adherence and poor medication understanding.  This can only be overcome through education of need, expected side effects, and outcomes associated with medication use as well as identification of reason for intentional non-adherence and overcoming that barrier.  In the situation above, what if the pharmacist counseled that the high incidence of nausea and vomiting could be minimized if the medication is taken with food?  What if the patient was better educated on the long term effects of non-controlled diabetes?

To conclude, if you have a chronic condition or conditions that causes you to be on multiple medications, partner with a pharmacy that specializes in finding innovative ways to find solutions that allow you to take the right medications at the right time, every time.  For example, at Cooper Drug Store, we offer three such programs, each designed to meet the needs of a specific set of patients.  No-Wait Refills is our autofill program designed for the patient with perhaps a busy schedule who is only on one to three maintenance medications.  We will keep track of the date to refill your meds and then even give you an email or text when ready.  SyncRx is designed for the patient on multiple medications who seems like they spend literally every other day at the pharmacy.  We will synchronize all of your meds to come due at the same time!  Not only that, we keep track of when you will come due for a refill and proactive call you days before you run out to review your medication list in order to prepare your next month of medications.  Finally, we have recently released the Med Manager Medication Adherence Program through our closed-door pharmacy, Golden Plains Pharmacy Services, which takes SyncRx to the next level by packaging your oral medications in strip packaging, sorted by administration time and day.  We are the first pharmacy in our area to offer this unique and innovative service to the patients who live at home.

Although medication adherence can be a challenge, with a little planning, education, preparation, and assistance from your pharmacy, you can soon be an adherent patient and hold your head up high when you go in for the next checkup with your doctor.

Flu Shots Now Offered in Downtown Augusta at Cooper Drug

By Brett Kappelmann, PharmD

Owner, Cooper Drug Store

Isn't this weather wonderful!  As temperatures begin to drop and we finally receive relief from another sweltering hot summer, it is time to start thinking about vaccinating against the flu as we head into another winter season.  The Centers for Disease Control and Prevention recommends that everyone over the age of 6 months should be vaccinated against the flu each year in the fall.  You can get your flu shot at your doctor's office or even at your pharmacy.  For the first time in our 90 year history, we are now offering flu shots at your local independent pharmacy in downtown Augusta.  There is no cost to Medicare Part B beneficiaries since the flu shot is covered at 100% annually.  We even take care of the billing for you!  We also bill private insurances if covered.  For the noninsured, the cost is just 27 dollars.  Our primary immunizer is our pharmacist Rachel Henman, who served as a mass immunizer for several years before joining the Cooper Drug team.   We also have been holding off-site flu shot clinics at several locations around Augusta and the surrounding communities and I am proud to announce that they have been a complete success!  Please call us at 775-2289 for questions and to get on our scheduling list or even if you are interested in having us give a flu shot clinic at your group location.  We only need about twenty participants to be able to come to your location.  We appreciate your support to your local, independent pharmacy. 

Why should people get vaccinated against the flu?  Influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently. Even healthy people can get very sick from the flu and spread it to others. Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During a regular flu season, about 90 percent of deaths occur in people 65 years and older. The "seasonal flu season" in the United States can begin as early as October and last as late as May. 

During this time, flu viruses are circulating in the population. An annual seasonal flu vaccine is the best way to reduce the chances that you will get seasonal flu and lessen the chance that you will spread it to others. When more people get vaccinated against the flu, less flu can spread through that community.

How do flu vaccines work?  Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine.  The seasonal flu vaccine protects against three influenza viruses that research indicates will be most common during the upcoming season.

Three kinds of influenza viruses commonly circulate among people today: influenza B viruses, influenza A (H1N1) viruses, and influenza A (H3N2) viruses. Each year, one flu virus of each kind is used to produce seasonal influenza vaccine.

Who Should Get Vaccinated This Season?  Everyone who is at least 6 months of age should get a flu vaccine this season. It's especially important for some people to get vaccinated such as people who are at high risk of developing serious complications like pneumonia if they get sick with the flu. This includes people who have certain medical conditions including asthma, diabetes, and chronic lung disease, pregnant women, and people 65 years and older.  If you are pregnant or under the age of six, you should get your flu shot at your doctor's office.

Mail Order Medical Supplies:  Buyer Beware
By Brett Kappelmann, PharmD

Last week, one of our elderly patients came into the pharmacy complaining about the constant harassment she was receiving from Liberty Medical over her diabetic test strips.  According to this patient, Liberty would call her several times a week when they deemed it was time for her to reorder her strips.  Basically, they refused to leave her alone until she ordered them again.even if she didn't need them.  And sometimes, she said, they'd just send her strips and lancets without contacting her at all.

Due to massive marketing campaigns, many Medicare recipients have the misconception that there is a significant advantage (like lower prices) to purchasing certain home medical supplies-such as diabetic testing supplies or nebulized medications-from large mail order companies.  In reality, patients can receive these same products at the exact same price from your local, friendly, independent pharmacy.  In fact, there is actually no real advantage to selecting these mail order providers, and utilizing these giant companies can often be inconvenient and/or even potentially harmful to the beneficiary.  Here are just a few of the advantages of staying local for home medical equipment:

·         The Same Price:  Medicare patients will pay the same price (which is often nothing if they have a Medigap (also known as a supplemental) plan regardless of who provides their home medical equipment.  Unlike many mail order pharmacies, every company that bills Medicare for medical equipment is paid at the same rate and must charge their patients the same price.

·         No Waiting:  Mail order companies often take several days to several weeks to ship supplies to their patients.  When using a local supplier, this problem is eliminated.

·         No Damage from Shipping:  We routinely encounter patients who show us medical supplies that have been extensively damaged during shipping.  While these companies usually offer replacements, this often means additional waiting periods.

·         No Temperature Extremes from Shipping:  Many medical supplies are also temperature sensitive.  For example, most diabetic test strips must be stored under 86 degrees.  However, these mail order companies do not usually provide any means of avoiding extreme temperatures during shipping (even during the heat of the summer), which could lead to inaccurate readings.

·         No Wasted Supplies:  Many mail order companies have been known to ship products to patients on a fixed schedule.whether they need them or not.  In fact, many patients who use these companies end up accumulating huge stockpiles of diabetic testing supplies.  With local medical equipment providers, you receive the required supplies only when you need them.

       Please consider supporting your local pharmacy if there is ever a need for medical supplies such as diabetic testing strips. I am confident that you will find your needs will be met without all of the extra hassle that comes from dealing with a mail order company.

Thanks, Dad!
By Brett Kappelmann, PharmD, Owner

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