Although estimates of the cost of medication nonadherence differ, everyone agrees it's too high. A 2014 study in Risk Management and Healthcare Policy cited a number between $100 and $300 billion, while a late 2018 analysis in the Annals of Pharmacology posited more than $528 billion.
Here are six things healthcare executives should know about improving medication adherence.
1. Align incentives
“One of our taglines at the American Pharmacists Association (APhA) Foundation is ‘Align the Incentives. Improve the Outcomes. Control the Costs,’” says Benjamin M. Bluml, RPh, and the Foundation’s senior vice president of research and innovation.
“If we properly invest in and align the incentives for patients, providers, and payers, we consistently observe significant improvements in care delivery, quality of care, and reductions in the total cost for care over time,” he says.
“This means collaborating in a team-based care effort—that includes a pharmacist—to change and improve the way care is delivered,” says Bluml. “After all, the primary treatment modality for chronic disease is medication, so if we don’t get medication right and help people understand its value we're never going to ‘get there.’”
The Foundation has realized excellent success with patient-centered, team-based care initiatives to improve adherence, Bluml says, specifically citing cardiovascular disease, depression and diabetes. For example, patients made 30-minute appointments with pharmacists on a quarterly basis to review finger-stick blood glucose readings and discuss cholesterol, diet, and exercise goals.
“This gives patients a focus for their role, then an incentive to follow up with their provider,” he says. “Here’s an idea for payers: Tell patients if they keep regularly-scheduled visits with their pharmacist for diabetes-related care they'll get a free BG monitor and test strips to stay on track, and you can even take care of the copayment. You’ll spend your per-member dollars differently, but save $1,000-plus per person per year when they're not in the ER or hospital as much, eliminating huge costs. The member becomes a more engaged, informed decision maker.”
2. Not just 'one and done'
“Payers already know they're paying for medications and that there will continue to be more highly specialized therapies,” says Deborah Hauser, RPh, MHA, and network director of pharmacy for Einstein Medical Center in Philadelphia.
She seconds strategic use of medication management therapy programs that incorporate pharmacist “touch points” with patients during the course of therapy and result in engagement.
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"This is not about just filling a prescription and walking away,” Hauser says. “If a patient doesn’t take their medication, a pharmacist can also assess whether there's a lack of motivation, a socioeconomic reason, intolerable side effects, or the inability to follow proper instructions.”
When they wonder out loud if their medication is “doing anything,” the pharmacist can explain the medication is not for symptomatic control, but to treat underlying disease, she says. “Especially with costly therapies, when a health plan has standards that apply to their use, there must be accountability. Is the medication being used as intended?”
At Einstein's specialty pharmacy, pharmacists call members to ask, “How many have you taken?” or “Do you have any left over?” and then re-educate and reinforce how important the medication is to overall health status.
“There are a lot of stakeholders here, so who's going to do the work?” says Hauser. “A pharmacist is the best stakeholder to assess and engage the patient about the importance of medication adherence.”
3. Realize one-size-fits-all isn’t long term
At the clinical services and analytics company RxAnte, Kerri Petrin, MPH, and vice president of client services, knows that effecting behavior change in members remains a major challenge.
“We’re first approached by clients because they notice that a static approach to adherence outreach has resulted in flattening population-level adherence rates,” says Petrin. “We see a tremendous value materialize when we’re able to help our clients adopt an evidence-driven, member-centric approach that identifies the best method and time to engage a member-based upon their predicted risk of nonadherence, past receptivity to interventions, and the most effective time to intervene.”