Lack of medication adherence remains widespread problem

PATIENTS WHO do not follow their medication regimens cost the U.S. healthcare system an estimated $290 billion a year, or 13% of total healthcare expenditures, according to the New England Healthcare Institute. In addition, those with low levels of medication adherence spend nearly twice as much as those who have better adherence.

Non-adherence is widespread; only about half of all U.S. patients take their medications as prescribed by their physicians, according to the Congressional Budget Office.

The Patient Protection and Affordable Care Act promotes medication adherence indirectly through several provisions including incentives to establish patient-centered medical homes and accountable care organizations as well as innovative payment models, as highlighted in a recent study in the April 28 issue of The New England Journal of Medicine.

The control group received behavioral advice from one interactive-voice-response telephone call without personalization in addition to a general cholesterol management guide delivered through the mail.

The experimental group also received reminders to refill prescriptions, tips for overcoming adherence barriers and encouragement to follow up with their doctors. Adherence was based on the use of a statin.

The findings indicate that 74.4% of the experimental patients vs. 60.7% of the control group showed six-month prevalence rates. In addition, the experimental group had medication possession rates (MPRs) over 80%, which is considered optimal from a population standpoint, while the MPR for the control group is 38.9%.

CIGNA is trying to ward off non-adherence before it gets out of control. Last year, the insurer developed CoachRx, an interactive Web site that helps members using CIGNA Home Delivery Pharmacy identify their barriers to medication adherence and then provides solutions to stay on track. It is one more program in the health plan's tool kit for finding gaps in care. Approximately 5,000 customers have used CoachRx services-either through the Web-based portal or the pharmacist consultation hotline-indicating an increase in engagement of 20% month over month.

In addition to having access to a clinical pharmacist, members can schedule automated medication reminders and record their own messages to be relayed by text, phone or email. The program also offers educational materials, discount coupons to offset drug costs and free pill boxes to organize medication, all based on a member self-assessment.

"Many programs are one-size-fits-all, but we realize that it is critical to study how different people react and what drives them," says Yi Zheng, assistant vice president, pharmacy clinical programs for CIGNA. "If we understand barriers, then we can personalize solutions. The result is an individualized approach around their issues connected to adherence."

CIGNA utilizes what Zheng calls "onboarding packets" to encourage proper use of a medication when it is first prescribed. They address the drug's use, treatment goals and possible side effects to help avoid repercussions in the future.