The association of pharmacy fill synchronization with breast cancer endocrine therapy adherence

Abstract

Background One‐third to one‐half of patients prescribed adjuvant endocrine therapy are nonadherent during the recommended 5‐year endocrine therapy course. This study investigated whether poor pharmacy synchronization of medication fills (requiring refills on different days) acts as a barrier to adherence. Methods A cohort of older women with stage 0 to III endocrine receptor–positive breast cancer in 2011 was identified from the Surveillance, Epidemiology, and End Result–Medicare claims‐linked cancer registry. Women with endocrine therapy and at least 1 other medication fill were identified, and the 3‐month synchronization of their fills was calculated as 1 minus the quotient of the number of pharmacy visits and the number of filled medications. Regression models were used to examine the association between synchronization (in quartiles adjusted for the number of medications) and adherence to endocrine therapy (defined as a medication possession ratio ≥80%) over the subsequent year. Results During the 3 months after the first endocrine therapy prescription, the study cohort of 3212 women had a mean of 8.6 pharmacy visits (standard deviation, 4.7) with a mean synchronization of 0.3 (standard deviation, 0.2). Those in the third (odds ratio, 1.29; 95% confidence interval, 1.04‐1.59) and fourth (most) medication number–adjusted synchronization quartiles (odds ratio, 1.49; 95% confidence interval, 1.19‐1.86) were more likely to be adherent than those in the least. Multivariate model predictions showed that the proportion of patients who were adherent over 1 year varied from 68.9% in the least synchronized quartile to 76.6% in the most synchronized one. Conclusions Prescription refill synchronization is strongly associated with adherence to endocrine therapy. Efforts to improve adherence should address this.

Association of Endocrine Therapy Initiation Timeliness With Adherence and Continuation in Low-Income Women With Breast Cancer

“…9,11 Prior studies of adherence in Medicaid-insured women reported that 55% to 60% were adherent in the first year, compared with 84% of Medicare-insured women. 15,17,18,21,[37][38][39] These differences suggest a role for insurance status and/or incomes in adherence trends; these findings may also be attributed to age differences between the 2 populations, although this seems less likely given the strong association between socioeconomic status and medication costs and treatment adherence. 37,40 Fewer studies have examined continuation of AET in any population of patients with breast cancer.…”

Getting in sync with adherence to endocrine therapy in breast cancer

“…Finally, when prescribing endocrine therapy, oncologists can recommend synchronization programs to their patients and prescribe quantities that allow alignment of refills, which can minimize trips to the pharmacy. Neuner et al's study also found that patients with 90‐day prescriptions were also slightly more likely to be adherent (odds ratio, 1.008) in comparison with patients receiving 30‐day prescriptions, and this provides another tool that physicians can use to improve adherence while reducing patient copays.…”

“…In this issue of Cancer , Neuner et al explore the relationship of breast cancer patients' prescription refill synchronization and patient adherence to adjuvant endocrine therapy. Prescription refill synchronization refers to the alignment of prescription refills to the same pharmacy visit and is hypothesized to improve medication adherence by reducing the total number of trips that a patient must take to the pharmacy and thus the financial and logistical barriers to medication adherence.…”

“…Much more work is needed to further explore the problem of adherence in oncology and to identify interventions to improve adherence and cancer outcomes, whether by better managing toxicities, reducing financial stress, or simply making patients' lives easier by synchronizing fills. The article by Neuner et al sheds light on one such path.…”

“…Taken in the context of the adherence literature, Neuner et al's study offers hope that synchronization, especially when patients with low baseline adherence are targeted, has the potential to improve adherence to endocrine therapy for patients with breast cancer. Future studies should evaluate the impact of synchronization on adherence to endocrine therapy and on breast cancer outcomes.…”