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Medication adherence in complex conditions

There are plenty of reasons at least 50% of people with chronic conditions don't follow prescribed treatments.1 They may not understand their therapy's impacts. Dosing and timing requirements may be complex. It may be a challenge to manage the cost of copays along with other basic needs.

Adherence rates are often even worse for people with rare and complex conditions, which may require more in-depth treatment plans. Health care leaders are finding value in evidence-based adherence programs to support patients with rare diseases. 

That’s where Optum Frontier Therapies comes in. We are an independent specialty pharmacy for people with rare disease. And we're creating a customized approach for improving access and adherence to advanced, emerging therapeutics.

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Evidence-based, patient-centric intervention

About 30 million Americans, or nearly one in 10, have a rare disease.2 More than 90% of rare diseases lack an FDA-approved treatment. There are still myriad challenges for patients once they do find a treatment.

That’s why it’s so critical to create evidence-based care models that meet the patient where they are. 

Optum Frontier Therapies uses a validated, customized intervention approach developed by Jay Bryant-Wimp, RPh, vice president of research and development and patient outcomes. 

First, our highly trained pharmacists and nurse coaches assess a patient and/or their caregiver to better identify actions that can improve medication adherence.

This reveals each patient’s barriers to adherence and leads to the next step in Bryant-Wimp's approach: identifying and initiating evidence-based interventions that may improve their overall quality of life.

To execute this approach, Bryant-Wimp’s team developed a 20-question patient phenotype assessment. The assessment combines elements from the Morisky Medication Adherence Scale as well as Oyekan’s Readiness Assessment Ruler.3,4

How does it work in practice? Once a patient completes the assessment, they are aligned with a phenotype, which serves as a foundation for their individualized care plan. Then, our pharmacists and nurse coaches can best direct them to the most appropriate interventions, such as:

  • Collaborative care planning
  • Medication therapy management
  • Symptom self-management training
  • Medication adherence scorecards
  • Prior authorization and copay review

These recommended interventions are incorporated into a further tailored care map, which we implement for each individual patient. 

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A validated method to ensure adherence

Bryant-Wimp’s team analyzed and tested this approach using data from a random sample of patients with rare disease.

The team measured the group’s proportion of days covered (PDC) and the medication possession ratio (MPR) for 12 months prior to initiating the phenotype assessment and intervention method. They then repeated this process at the end of the 12-month period.

The results were significant. The approach helped achieve5:

  • Increased adherence of at least 10% for each intervention
  • An overall reduction in preventable hospitalizations
  • 100% patient satisfaction

Just as important, patients living with rare and complex conditions received customized care, improved access to groundbreaking therapies,  and the promise of a better tomorrow.

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In summary

Bryant-Wimp sums up this innovative approach to medication adherence as a key example of the Optum Frontier Therapies care philosophy: 

“For patients living with rare and complex conditions, emerging therapies have the potential to improve overall quality of life. However, these promising new therapies require high-touch, personalized models to better address challenges with access and adherence."

“Our build-for-purpose approach to intervention speaks to the core of our mission at Optum Frontier Therapies. We are based in evidence, but we are always patient-centric, and always committed to treating patients as unique individuals."

"Our team is dedicated to listening first and meeting the patient where they are, which in turn allows us the ability to improve patient outcomes.”

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  1. Kleinsinger F. The Unmet Challenge of Medication Nonadherence. Perm J. 22 (2018): 18-033, doi:10.7812/TPP/18-033.
  2. National Organization for Rare Disorders. Rare Disease Facts. 2019.
  3. Dias de Oliveira-Filho A, et al. The 8-item Morisky Medication Adherence Scale: validation of a Brazilian-Portuguese version in hypertensive adults. Res Social Adm Pharm. 10, no. 3 (2013): 553-561, doi:10.1016/j.sapharm.2013.10.006.
  4. Oyekan E, et al. The B-SMART Appropriate Medication-Use Process: A Guide for Clinicians to Help Patients- Part 1: Barriers, Solutions, and Motivation. Perm J. 13 (2009): 62-69, doi: 10.7812/TPP/07-057.
  5. Bryant-Wimp J, et al. Adherence Answered: Algorithmic evidence-based approach to attacking symptoms of non-adherence in patients with bleeding disorders. Poster presented at World Federation of Hemophilia 2016 World Congress.



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Tag: Articles, Articles and blogs, Rare disease, Articles and blogs

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