October 23, 2010 
So, here’s my free idea on a PBM product which could be developed and launched. If you believe (as I do) that physician’s are likely moving patients to higher strength or stronger medications based on lab data (i.e., cholesterol is still high so drug must not be working) without asking about adherence, then you have to think about (a) how to get the data into the physician’s hands that the patient is non-adherent and (b) how do you see if this is a real issue. (See prior blog post)
So what do you do? Here’s my idea…
- Select a few clients where you can get their lab data on a regular and timely basis.
- Select a few classes where physicians regularly use lab data to monitor prescription effectiveness.
- Integrate lab data into a data warehouse.
- Query the database to identify patients who have a lab done and have a medication possession ratio of less than 80%.
- Trigger a patient intervention to determine their barriers and/or other rationale for low MPR (e.g., perhaps they had samples).
- Develop a point-of-sale (POS) edit which rejects for any new drug in the product category or any increase in dosage for those patients.
- Develop messaging at the POS which tells the pharmacist to ask the patient about their adherence to the original medication.
- Message the physician about the patient’s non-adherence and barriers (if collected) and see if they still want to increase the dosage or change the medication.
This would be an interesting study.
Enabling Healthy Decisions 
I like this idea. As a retail pharmacist for 10 years, I have “discovered” these disconnects several times myself. On these occasions, a simple conversation with the patient me has led to a communication (sometimes requiring SEVERAL requests) with the physician as a red flag. I believe this problem is significant, and is all too often missed or overlooked. The real data is truly available to the pharmacy processing company. It seems logical to integrate this data, or at least make it available to the (lab requesting) prescriber. A good history is almost always the most useful tool for correct medication management. For some reason patients I find hesitate to be honest with their physician, but with a little prodding will tell me everything. My favorite recommendation is to have patients bring all of their current medication bottles with them to their office visits. Few actually do this, but the comparison of reality and the “chart” I think is worth it’s weight in gold.
Don’t get me wrong … I am excited, but the anxiety of progress is coming slowly. Success is inevitable, but on its own momentum … we should be expecting 10 years. The real pressure will come not from the private sector, but from reform mandates by CMS/Federal programs in attempt to further drive electronic integration of EMR values across the delivery chain to reduce administration costs and “transform Managed Care into a Health Science” from an audit and cost control philosophy.
Critical Mass theory is wildly over estimated.
Thought some polls rank as high as 31% of physician using e-prescribing … but the real % is extremely “soft”. In realty, that population of physicians are seldom using the devices they had on any regular basis.
On a transaction basis … we are still in FAX and paper mode. Paper for NEW and FAX for Refills.
What is real, ” …. is that e-prescibing knowledge and conversation has reached a critical mass, but utilization has lagged, and transformation is yet to achieve any significant momentum.”
I think e-prescribing adoption rate has reached critical mass now and is accelerating. Perhaps this study can be done with physicians who already e-prescribe, so you take pharmacists out of the study’s equation completely.