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Forgetfulness cripples drug adherence


A survey by Express Scripts shows that patients tend to think that they are more compliant than they are.

Promising as those findings may be, Americans aren't nearly as compliant as they think they are. Research indicates drug adherence rates might be less than 50% in some cases. The least-adherent patients are most likely to overestimate their adherence. In the survey of Express Scripts members, more than 90% of patients in the least-adherent group reported taking their medication as directed. In reality, fewer than 25% did so.

"The gap between perception and reality is huge," says Sharon Frazee, Express Scripts' vice president of research and analysis. Frazee notes that failure to take medications as prescribed costs about $317 billion annually in unnecessary medical expenses.


While health plans, pharmacy benefits managers and employers have focused a great deal of attention on clinical and economic barriers that contribute to noncompliance, these issues are secondary, Frazee says.

The bulk of the problem, researchers found, lies in a patient's inability to focus on mundane tasks like taking their medicine, refilling a prescription or calling the doctor for a prescription renewal. Humans aren't a very attentive lot, Frazee says. In fact, simply forgetting to take a dose of medicine accounts for 39% of all nonadherence, while forgetting to refill a prescription and procrastinating on getting a renewal accounts for another 30%.

Addressing economic or clinical barriers are straight-forward hurdles, but addressing behavior is far more complex, she says. For example, a payer can help a patient overcome cost barriers by encouraging them to switch to a generic alternative, a solution that requires a one-time action on the part of the patient. In contrast, remembering to take a dose of medicine requires a patient's constant attention, often multiple times a day.

Payers have long relied on educational outreach to address the problem of patient compliance, but education only goes so far.

"Education is great, but education isn't the end all and be all," Frazee says. "If your two-color brochure isn't moving the needle, it's not likely a three-color brochure will either."

Toward that end, Express Scripts developed a predictive model that uses roughly 400 factors to identify which patients are at greatest risk of nonadherence. The company is now piloting an intervention program to reach out to patients with diabetes, hypertension and hyperlipidemia who are likely to be nonadherent. Targeted interventions include providing forgetful patients with audible timer devices that remind them to take their medication and encouraging those who put off filling prescriptions to sign up for home delivery or auto-refill services. The company plans to begin testing intervention programs for asthma, COPD and osteoporosis later this year.

"You can't treat nonadherence as if it's a monolithic thing," Frazee says. "You have to look at the various causes."

- Shelly Reese

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