Skip to main content

Medication Adherence: Effectiveness of Physician Alerts to Resolve Potential Gaps in Pharmacotherapy

This study was presented at the 22nd Annual Meeting of the Academy of Managed Care Pharmacy, April 2010, San Diego, CA.
May/June 2010, Vol 3, No 3 - Conference Highlights AMCP
Download PDF

Joshua N. Liberman, PhD

Joshua N. Liberman

Poor medication adherence is frequently the cause of preventable hospitalizations and patient illness. Costs to the US healthcare system resulting from nonadherence have been estimated to exceed a staggering $100 billion annually.1 Inpatient clinical decision support systems provide physicians with real-time information to improve clinical practice.2

Typically, outpatient practices do not have access to real-time feedback and patient information. This fact, coupled with the fractured healthcare system, leads to incomplete information and has created an opportunity for pharmacy benefit managers (PBMs) to provide clinically valid feedback to assist physician decision-making.

In a recent commentary, Shrank and colleagues stated that PBMs have “a unique opportunity to promote health and generate value in the healthcare system.”3 To realize this value, CVS Caremark supports numerous outreach efforts to improve adherence to essential therapies. Consensus clinical guidelines recommend standards of pharmacotherapy care for different conditions. PBMs can operationalize these guidelines and identify patients who may benefit from treatment additions.

This present study evaluated changes in care after a fax-based messaging intervention delivered to physicians with a recommendation to add:

  1. An osteoporosis-preventive agent for women with long-term glucocorticosteroid use4
  2. An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for adults with diabetes
  3. A lipid-lowering agent for individuals with diabetes aged ≥30 years.5

A total of 337 employers and health plans representing 5,508,559 individuals, participated in a program that delivered a fax alert to a provider when pharmacy claims indicated the absence of a recommended therapy. From January 1, 2009, to March 30, 2009, a total of 78,768 alerts were sent to providers regarding osteoporosis (n = 1763), ACE/ARB (n = 22,915), and dyslipidemia (n = 54,090).

Through September 30, 2009, therapy addition rates (“gap closure rate”) occurring within 90 days of the intervention were compared with a control group selected from employers and health plans that did not implement the program.

Adjusted odds ratios were derived by logistic regression, with adjustment for age, sex, previous medication use, and out-of-pocket participant cost-sharing.

Figure 1

Figure 2

Figure 3

Analysis showed that gap closure rates were higher for cases than for the controls:

  • 23.5% versus 15.1% for osteoporosis (Figure 1)
  • 13.2% versus 7.7% for ACE/ARB (Figure 2)
  • 13.6% versus 9.1% for dyslipidemia (Figure 3).

The odds ratios for the addition of therapy by day 90 were significant (P <.001) for each intervention— osteoporosis (1.62), ACE/ARB (1.88), and dyslipidemia (1.46). Older age and higher risk scores (Pharmacy Risk Group score) were significant predictors of adding the concomitant therapy, whereas member cost-sharing was not significant.

Fax alerts to providers were an effective mechanism for communicating potential gaps in pharmacotherapy and enhance medication adherence. In 3 months, these 3 fax alerts resulted in a total of 3842 individuals implementing pharmacotherapy in accordance with evidence- based medicine. Future research should focus on the subsequent adherence and the medical value of additive therapy.


  1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-497.
  2. Kawamato K, Houlihan CA, Balas A, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330:765. Epub 2005 Mar 14.
  3. Shrank WH, Porter ME, Jain SH, Choudhry NK. A blueprint for pharmacy benefit managers to increase value. Am J Manag Care. 2009;15:87-93.
  4. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum.2001;44:1496-1503.
  5. American Diabetes Association. Standards of medical care in diabetes care— 2009. Diabetes Care. 2009;32(suppl 1):S13-S61.
Related Items
Can Technologic Innovations and Formulary Considerations Improve Healthcare Outcomes?
Charles Bankhead
June 2018 Vol 11, No 4 published on June 25, 2018 in Conference Highlights AMCP
AMCP Nexus 2017 Highlights
December 2017 Vol 10, No 9 published on January 3, 2018 in Conference Highlights AMCP
Challenges and Opportunities in Managing Type 2 Diabetes
Laura Morgan
June 2017 Vol 10, No 4 published on June 22, 2017 in Conference Highlights AMCP
Payers’ Perspective: Incorporating Real-World Evidence in Patient Care
Lilly Ostrovsky
April 2017 Vol 10, No 2 published on April 18, 2017 in Conference Correspondent, Conference Highlights AMCP
Implications of Real-World Data and Pharmacoeconomics for Managed Care
Lilly Ostrovsky
May 2016 Vol 9, No 3 published on May 25, 2016 in Conference Highlights AMCP
Last modified: August 30, 2021