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Express Scripts aims to help patients stay on their meds with a product that predicts who will stop taking prescriptions before the person actually does it.
The pharmacy benefits manager is launching ScreenRx, a program that uses a computer to sift through hundreds of factors that affect patients and forecast who is most likely to forget a refill or simply stop taking their drugs. The company then plans to contact those patients to help them stick with their doctor's orders.
Express Scripts executives say their new program is focused on a big target.
They estimate that about $317 billion in additional medical expenses were heaped on the U.S. health care system last year because people didn't comply with prescriptions. These additional expenses might include a heart attack for someone who stops taking cholesterol medicines or an amputation for someone who doesn't adhere to diabetes treatment.
The St. Louis company runs prescription drug plans for employers, government agencies and other clients. Chief Scientist Bob Nease said the data Express Scripts collects gives it a fairly good sense for factors that keep people from complying with a prescription. For instance, those less likely to comply include younger patients, parents with small children or men who have female doctors.
People who live with a partner or are married are slightly more likely to comply than those who live alone.
The analysis, called predictive modeling, doesn't delve into why patients stop taking their meds. It sorts through more than 400 variables that could affect a patient to see which people have enough red flags to warrant concern. For instance, a young, single male with a house full of kids who sees a female doctor might draw the program's attention.
"You can think of it as a screening test," Nease said. "You want to identify people who are at risk ... before their symptoms arrive, and then you want to intervene in a way that addresses their problem."
Once a patient has been flagged, they receive a phone call. An Express Scripts representative will talk to the person to see if they need help. The PBM then might send the patient a pill box if they have a hard time remembering their prescriptions or a special beeper that goes off when it's time to take medicine.
If the patient struggles to pay for the drugs, Express Scripts could provide information on assistance programs.
Such a program could be useful, according to Dr. Michael Venturini, an Indianapolis cardiologist who estimates that as many as 30 percent of the patients he sees every week have trouble sticking with their medications.
"Compliance is a large problem," he said, noting that the cost of the drugs is probably the largest reason behind it.
Analysts say predictive modeling programs that aim to forecast patient behavior and improve care have been evolving in health care over the past few years, and the Express Scripts product is the latest evolution.
"They have put a lot of money behind really trying to get the patient, the consumer to make good decisions," said Arthur Henderson, an analyst who covers Express Scripts Holding Co. for the investment banking group Jefferies & Co.