Adherence varies across market segments


The US healthcare system could avoid hundreds of millions of dollars in medical costs if medication adherence rates improved, according to a CVS Caremark report.


The US healthcare system could avoid hundreds of millions of dollars in medical costs if medication adherence rates improved, according to a CVS Caremark report.

In the 2013 State of the States: Adherence Report projects potential cost-savings within each state by examining medication adherence rates and the use of generic drugs across 4 common health conditions: diabetes, hypertension, dyslipidemia (high cholesterol), and depression. The potential cost-savings among the states range from $19 million to $2.1 billion based on state member characteristics. The report looked at 3 distinct market segments serviced by CVS Caremark’s PBM business-health plans, employer-sponsored plans, and Medicare Part D prescription drug plans (PDPs).

“These projections are broken down on a state-by-state basis in the report to call attention to the savings that could be achieved by encouraging people to stay on their medications and to consider generic alternatives when they are available,” Christine Cramer, CVS Caremark spokesperson told Formulary.

There are many factors that influence adherence, including demographics and access to pharmacy services, which are also highlighted in the report at the state-level, according to Cramer.

There were also some nationwide findings when looking at data across the states:   

·         Across all market segments (health plans, employer-sponsored plans and PDPs), patients with depression generally had the lowest adherence rates, while patients with hypertension were most adherent.

·         Medicare beneficiaries had the highest adherence rates across the 3 groups.

·         Ninety-day dispensing rates were generally highest among members of employer-sponsored plans. 

·         Regional variations were apparent across the groups. The lowest adherence rates for health plan members with diabetes and depression occurred in the Midwest, while the lowest rates for patients with any condition in employer-sponsored plans and PDPs occurred in the South.

The rising cost of healthcare in this country is a major concern for managed care and hospital decision-makers,” said Cramer. “There are costs that are avoided when people stay on medication-reduced frequency in trips to the emergency room and in-patient hospital stays, to name a couple of examples-these add costs to the system. Getting patients to take their medications can help people remain healthy and reduce costs. This report gives managed care and hospital decision-makers a means by which to compare rates across the states and across health insurance market segments to become aware of adherence rates and the factors that influence adherence behaviors.”

There is no one-size-fits-all approach to getting patients to become more adherent to their medications, according to Cramer. “Adherence rates fluctuate across populations, regions and markets.” Cramer said. “CVS Caremark is working to develop solutions to customize patient outreach and to develop a deeper understanding of the myriad of factors that impact adherence so that patients remain healthy.”

The good news is that there are many partners in the adherence space who are working toward developing solutions, according to Cramer. “These include concrete approaches like designing new packaging and pill boxes that help simplify medication regimens, better medication education and coordination in post-operative care to help reduce readmissions, and pharmacy-based programs such as the CVS Caremark Pharmacy Advisor counseling program and Maintenance Choice.”

Pharmacy Advisor is a condition-based program that alerts pharmacists when patients are not adherent to their medication regimens or have a gap in care, allowing them to intervene with patients and communicate with their physicians in real time. Maintenance Choice allows patients taking 90-day supplies of medications for chronic conditions the choice of receiving them by mail or picking them up at a CVS Pharmacy retail location, giving people greater options when accessing their medications. 

In addition to the 2013 State of the States report, the CVS Caremark Pharmacy Care Research Institute (PCRI) also released Advancing Adherence and the Science of Pharmacy Care: Volume III, a compendium of adherence research conducted by CVS Caremark and its research partners over the last several years.

As one element of this research, CVS Caremark has been working in a multi-year collaboration with Brigham and Women’s Hospital to research pharmacy claims data in order to better understand the factors that influence medication adherence.

A full copy of the CVS Caremark 2013 State of the States:  Adherence Report and the research compendium, Advancing Adherence and the Science of Pharmacy Care are available at

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