Over the past decade, treatment in a variety of cancers, particularly breast cancer, chronic myelogenous leukemia, and non-small cell lung cancer, has switched from intermittent intravenous therapy to self-administered targeted oral anticancer medications (OAMs). There are more than 50 of these medications approved by FDA to treat cancer; but when it comes to these drugs, any deviation from 100% adherence can result in treatment failure. Adherence starts from the initial fill. What are the barriers to therapy initiation, and how can they, and other adherence barriers during the course of treatment, be addressed?
The biggest hurdles for OAM adherence
When it comes to therapy initiation and subsequent fills of OAMs, a consistent issue is cost, says a study in the Journal of Clinical Oncology. The authors noted an overall abandonment rate of 18%. This rate rose to as high as 49.4% for those with out-of-pocket costs greater than $2,000 a month. For therapy initiation, only 3% of those in the lowest-cost out-of-pocket group delayed getting their medication, compared with 18% in the highest-cost group.
While pharmaceutical companies offer medication access programs that assist patients with the cost of these medications, one of their biggest issues is that patients often don’t know about the programs and have trouble with the enrollment process. Artificial intelligence (AI) can improve outcomes for medication access programs by flagging the patients most likely to drop out of treatment because of costs and other adherence barriers.
Other predominant factors to OAM adherence are age and side effects, according to a study in Cancer Treatment Review. Another study in the Journal of Oncology Pharmacy Practice, which compared the effectiveness of pharmacist educational interventions to a nurse-led control group, found the most significant barriers were forgetfulness, wanting to avoid side effects, feeling depressed or overwhelmed, and falling asleep before taking medications.
Different pharmacy types deliver different outcomes
Another factor for non-adherence of OAMs could be the type of pharmacy channel. A retrospective analysis published in BMC Health Services Research compared and measured adherence rates of patients filling prescriptions in traditional retail versus specialty pharmacy channels. The authors found that the specialty pharmacy group had the highest proportion of adherent patients (71.6%) compared with traditional retail (56.4%).
In addition, the overall rate for prescription abandonment at traditional pharmacies was 2%, compared with .08% for specialty pharmacies. Prescription abandonment was also associated with higher co-pays.
The authors did note that the better medication adherence rate for specialty pharmacies may be attributed to their more intensive therapy management programs, compared to retail pharmacies. Specialty pharmacies typically offer phone counseling by a pharmacist or nurse at therapy initiation and contact prior to each refill to monitor outcomes and encourage adherence. Some specialty pharmacies provide 24-hour nursing support and many have therapeutic centers dedicated to oncology with staff specializing in this area.
How AI helps patients with therapy initiation
The ability of patients to bear costs such as higher co-pays is tied to social determinants of health (SDOH). AI technology is designed to work with large and complex data sets such as SDOH as well as demographic and consumer behavior. AI can help pharmacies, payers, and pharmaceutical companies predict which patients are more likely to abandon their OAMs either during therapy initiation or over the course of the prescription. AI can then personalize interventions that will help these patients better manage their health, while maximizing the use of resources.
Recently, a study published in the American Journal of Managed Care found that machine learning technology, which is a precursor to AI, accurately predicted inpatient and emergency department utilization, using exclusively publicly available SDOH data such as gender, age, race, and address.
AllazoHealth uses artificial intelligence to help payers, pharmacies, and pharmaceutical manufacturers overcome barriers to successful therapy initiation and adherence. The AllazoHealth AI engine predicts and targets at-risk patients and then optimizes interventions by channel, message, and timing.
AllazoHealth is the only healthcare AI adherence company to run a randomized control trial. Partnering with Blue Cross Blue Shield North Carolina, we demonstrated a 5.5 times uplift in adherence compared with traditional programs.
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