June 11, 2008 
Paul Levy who is the CEO of a hospital has a blog called Running A Hospital. He posted a summary the other day of a presentation by George Paz who is the CEO of Express Scripts. It has some good facts and there are several good comments on there about defining the terms in this area (see my old post) and whether these are reasonable rates of compliance. There is also a patient commenting about getting nurse calls and reminder e-mails which sounds great but puts them in the 1% of the population for which this happens.
The numbers do seem understated to me – 85% compliance with cholesterol lowering drugs. That might be the amount of people that get a paper prescription and then fill the drug or it might be the amount of people that get one refill, but I believe by month 6 or certainly by month 12 most compliance rates are closer to 50%.
There is clear value in adherence. Everyone should (in key therapeutic categories and using evidence-based standards) want to increase adherence to reduce total medical costs.
What surprised me most recently around this was what Kaiser had observed when looking at how doctors shared information with patients (Archives of Internal Medicine, Sept 2006):
- Only 74% of the time did the physician tell the patient the name of the prescription drug
- Only 35% of the time did the physician discuss adverse events with the patient
- Only 58% of the time did the physician explain the frequency and timing of dosing
Enabling Healthy Decisions 
Dan, I would not be as kind as GVA was. Your post is filled with misinformation, leading comments, and downright silliness. Do some research before you go posting about companies you’re not familiar with. Living in St. Louis does not give you a free pass to publicly make unreasonable assumptions about ESRX.
Dan –
I appreciate your comments. But, I don’t agree with this one on several fronts.
* I have been in most PBMs and have never seen or heard of anyone paying physicians for switching patients. I have seen patient incentives (e.g., copay waivers). I have seen pharmacist incentives. But, no MD incentives. There have been some times when generic fill rate is tied to a performance scorecard for physicians.
* I think there were some questionable practices in the early days which were in the gray area, but I think post-2002 most PBMs have been fairly clear in how P&T decisions are made and not taking pharma money.
Regardless, I think the key point of your comment is that these need to continue to be arms length relationships and consumers should understand when people have a financial motivation to push them to behavior in a particular way. I agree with that concept.
To add to your educational post, and as you and others know, two things:
1. PBMs/insurance companies are paying doctors, 100 dollars a patient, I heard for switching the patient’s branded med to a generic, if one is available. Incentive applies to initiating with a generic as well, deceiving thier own patients in many cases for financial gain, implemented perhaps as a response of the remuneration dispensed to doctors for such a long time. A response to corruption with corruption. If a branded treatment regimen that is effective and tolerable, a doctor should not manipulate thier patients’ health in such a way.
2. I live a few miles away from the Express Scripts headquarters, who last month was fined close to 10 million dollars involving over half of the United States for misleading consumers regarding rebates intended to benefit it’s members and not the execs at express scripts and the company’s bottom line.
As an ex big pharma rep, speaking of PBMs, an unrestricted educational grant size determines in a Pavlovian way what will be preferred on PBMs that, based on information and belief, atrophies the necessary and complete focus on safety, efficacy, and cost of particular medications. Furthermore, the employer providing the prescription benefit to its employees is the ultimate deciding factor regarding co-pays and thier amounts paid by thier employee, which suggest collusion between employers and PBMs.
Did not intend for this comment to be bitter, but informative, so thank you for allowing me to comment.
I take it you say my comments on Paul’s post? Those adherence numbers are really high compared to all the reports I have read. They might come from some Express Scripts pilot program or be skewed some other way? I’m going to do some searching for that presentation to see the data. I asked Paul in my comments, but he did not respond.