The Academy of Managed Care Pharmacy (AMCP) recognizes drug utilization review (DUR) as an essential evaluation tool to facilitate the improvement of medication prescribing, administration, and use to enhance patient outcomes and help reduce overall healthcare costs. Additionally, AMCP supports programs that encourage patient adherence and persistence to prescribed treatment regimens to achieve maximum therapeutic benefits. These programs should be informed by the patient’s medical history, the value of the prescribed treatment, and anticipated outcomes, and leverage comprehensive communication and evidence-based approaches. As medication management experts, AMCP recognizes the pivotal role pharmacists play in ensuring the success of these initiatives.
Drug utilization review (DUR) is a structured, ongoing review of health care provider prescribing, pharmacist dispensing, and patient use of medication. Reviews are completed by clinical pharmacists at a variety of settings including PBMs or health plans. It occurs prospectively (before dispensing) or retrospectively (after dispensing) and may include educational programs directed at prescribers or patients on common drug therapy problems. One focus is medication adherence, defined as the ability of a patient to take a medication or comply with a treatment protocol according to the prescriber’s instructions.1A related term, persistence, refers to a patient’s ability to continue taking a prescribed medication or follow a treatment protocol as directed by their health care provider, without significant interruptions or early discontinuation.2
Pharmacists in managed care settings develop and utilize DUR programs to improve medication use patterns and prescribing trends for individuals or groups of patients. For example, DUR programs may be used to identify nonadherence, which can trigger managed care pharmacist follow-up. Additionally, each state is required to develop a DUR program to ensure appropriate use of outpatient prescription medications covered under the state’s Medicaid program.3
AMCP's "Access, Affordability, and Outcomes: The Value of Managed Care Pharmacy" (AAO) report includes examples that help convey effective drug use management strategies.4 Managed care pharmacy approaches to drug and benefit management can improve adherence with initiatives like instituting 90-day supplies and using mail-order pharmacies.
The report highlights original research that found that a greater proportion of patients receiving 90-day supplies than those receiving 30-day supplies achieved a proportion of days covered (PDC) of 80% or more. Additionally, the report found that using mail-order pharmacies led to patient cost savings of 13% for brand medications and 22% for generic medications. Lower patient prescription costs have been shown to improve adherence.5
A 2022 study entitled “Medication Adherence and Compliance: Recipe for Improving Patient Outcomes” expressed how important medication adherence is for improving patient outcomes and reducing health care costs.6 The study suggested that enhancing provider and patient education with effective communication strategies boosts adherence rates. Several factors can influence medication adherence. Those include patient-related factors like health literacy and beliefs about illness and medication. Other provider-related factors include communication skills, trust, medication regimen complexity, and side effects. By addressing these factors through patient-specific or tailored communication, better adherence and improved health outcomes can be achieved.
There is also great potential for digital health tools like mobile apps and electronic reminders for medication adherence. These tools are a personalized approach that facilitates communication between the patient and provider. This facilitation through digital health tools leads to increased adherence and improved patient engagement in their own care.7
Successful medication adherence requires a multifaceted approach. Comprehensive, individualized strategies are needed to address the various barriers patients face. Health care providers can improve adherence rates and provide more efficient care by focusing on patient-specific education, communication, and utilization of digital health tools.
AMCP offers a wide variety of educational opportunities, from events and webinars to online training.
