Around 3.8 billion prescriptions are written every year in the United States. Of those prescriptions, 20% are never filled and half of the remaining 80% are taken incorrectly.1 This is called medical nonadherence, or when a patient takes their medication in a way it wasn’t prescribed, by either changing the timing, dosage, frequency, or duration. Adherence is defined in most studies as taking at least 80% of the medication doses prescribed by the health care provider.
For the CDC, improving medication adherence is a public health priority which “could reduce the economic and health burdens of many diseases and chronic conditions”.1
The National Institute of Health (NIH) attributes an estimated 125,000 avoidable deaths as well as $100 billion in preventable health care costs each year to medical nonadherence. Adherence rates worsen with chronic conditions: in many cases, including conditions such as diabetes or hypertension rates “typically fall in the 50% to 60% range” according to the NIH. That stat includes patients with good health insurance who have prescription benefits.
So why the nonadherence? We might hypothesize that cost would be the biggest barrier, and it can be for some prescriptions, but in the case of many of the chronic conditions outlined above, many generic drugs are often available at reasonable prices to treat them.2
Potential barriers to medication adherence, as noted by the NIH and CDC, include:
- Lack of motivation or denial
- Depression
- Patient denial
- Cognitive impairment
- Patient is forgetful in taking medication or seeking refills
- Inadequate understanding of dose or schedules
- Drug or alcohol use
- Cultural issues or alternate belief systems
- Complexity of treatment
- Medication does not meet patient’s expectations for improvement
- Fear of side effects
- Cost
- Adherence takes too much time or is inconvenient
- Poor relationship with their practitioner
- An asymptomatic disease being treated
As an Employer, What Can You Do? Educate and Support with Drug Management Programs
While many of these barriers stem from issues the patient must confront by themselves or with their medical provider, there are steps employers can take to assist. The NIH cites “well-utilized clinical guidelines and algorithms for disease control, emphasizing use of effective generic medications (lowering the cost barrier) when applicable” as a sound method for combatting medical nonadherence. Employers can ask their health insurance or Rx benefit administrator if they provide drug management programs and, if so, they can communicate with their members the availability of such resources and encourage their use.
Particularly for patients with complex schedules or drugs, including specialty drugs, utilizing drug management programs like Benecard’s Specialty Drug Management program aids in both educating the patient but also controlling the drug cost through specialized, team-based care. The CDC notes that interventions relying on team-based or coordinated care have been shown to increase adherence rates. For example, in Benecard’s program, each and every specialty patient managed through the Specialty Pharmacy works directly with a team of health care professionals who serve as an ongoing resource during their course of therapy. As a result, through careful and tailored communication and education, inappropriate prescribing is minimized, and patient medical adherence is optimized.
When cost is the primary driver of medical nonadherence, a copay assistance program can help alleviate the member’s cost. Copay assistance programs are initiatives put by drug manufacturers to offer coupons to patients who sign up for the program either via a form or on the manufacturer’s website. For members who are eligible for copay assistance, Benecard helps them locate a program and assist with the enrollment process.
Sources:
1. https://www.cdc.gov/mmwr/volumes/66/wr/mm6645a2.htm
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499/
3. https://www.pharmacytimes.com/view/concerns-about-medication-adherence-grow-amid-covid-19-pandemic