"Drugs don't work in patients who don't take them," says former U.S. Surgeon General C. Everett Koop.
Medication non-adherence is a major public health issue. A subset of medication non-adherence is primary non-adherence. The Network For Excellence In Health Innovation (NEHI) defines it as an occurrence "when a new medication is prescribed for a patient, but the patient does not obtain the medication, or appropriate alternative, within an acceptable period of time after it was prescribed."
Statistics on primary medication non-adherence in the US vary due to a lack of standard definition and measures. A 2010 study on primary medication non-adherence showed that 22 percent of e-prescriptions during the period of research were not filled. The percentage was higher for e-prescriptions for new medications: 28 percent. This is similar to the estimates by NEHI, which puts primary medication non-adherence for chronic illnesses at up to 30 percent.
A more recent study in 2014 by the University of Mississippi, the first that used pharmacy prescription data to measure primary medication non-adherence, revealed different results. They found that "12.2 percent of [those] new prescriptions were not claimed within a 30-day period."
Regardless of how primary medication non-adherence is measured, it is undeniable that it ultimately leads to poor patient outcomes and places even more stress on the healthcare system. Prescription drugs are an integral part of a medical care plan, and not following a medication plan can lead to recurrent health problems, the worsening of a chronic condition, or the development of more serious illnesses in the future. It can mean even higher medical costs in the future due to hospitalizations or other necessary medical procedures.
So, how can the issue of primary medication non-adherence be addressed?
Measures to Address Cost Barriers to Primary Medication Adherence
Cost is a huge barrier to receiving medical care.
Brad Tuttle at TIME points out that for the 12-month period ending May 2016, the price of prescription drugs in the US rose an average of almost 10 percent, in comparison to the 1 percent overall inflation rate during that same period. And thanks to health plans with higher deductibles and copayments, patients now bear more of their healthcare costs, putting more stress on their healthcare budgets.
There is a clear relationship between rising prices and non-adherence. Statistics from the 2013 National Health Interview Survey reveal that almost 8 percent of adults over the age of 18 reported not taking medication as prescribed because of financial concerns.
Perhaps more significantly, non-adherence tends to skew toward lower-income populations: The less money someone makes, the more likely he or she was to not pick up the prescription out of financial concern.
Provide Price Transparency Tools for Prescriptions
High drug prices aren't the only source driving this problem; the lack of price transparency also plays a large part. According to Community Catalyst, both doctors and patients are often in the dark when it comes to the cost of prescription drugs.
Providing price transparency tools for prescriptions would be beneficial for both parties. On the physician's part, combining the use of price transparency tools and formulary APIs would provide them with a fuller picture of what drugs the patient is eligible for; how much it would cost; and pertinent information such as the need for prior authorization, coverage limits, or step therapy requirements.
From a patient's perspective, discussing prescription costs and different medication options with their primary physician gets them more engaged in the process. Getting patients involved in the decision-making process can help them better manage their own medication adherence and healthcare budgets.
Such interactions between physician and patient can be especially effective for patients with chronic illnesses. First, medication adherence can have a huge impact in the management of chronic illness and ultimately reduce any future healthcare costs. Secondly, patients with chronic illnesses are the ones who may brush up against the limits of their health plans and need to pay out-of-pocket costs.
Improve Insurance Prior Authorization
Some patients are on health plans that require prior authorization before certain prescriptions will be covered by their insurance. The insurance company has to deem the drug medically necessary; otherwise, the patient has to pay out of pocket for it, explains Health Markets.
Most healthcare providers conduct insurance prior authorization manually, taking up precious time and manpower. Digital Commerce 360 estimates that it takes 15 minutes to complete one manual preauthorization request. Moreover, this manual process means that patients do not know upfront whether their requests will be granted, as it can take days for the insurance company to come back with their decision.
Consumer Affairs notes that there are other hurdles to overcome. For instance, billing errors can cause prior authorization claims to be denied, and prior authorization for a prescription may only be valid for a limited time before the process has to be done all over again.
In order to improve the insurance prior authorization process and enhance patient experience, healthcare providers can leverage automated tools like APIs, which can perform this task in under a minute. APIs take the hassle out of the manual process and make it easier and faster for both the physician and patient to know whether a certain prescription will be covered.
In the event that a prior authorization is denied for a certain drug, the physician can then explore other medication options that are covered and provide a similar level of medical care to the patient.
Offer Copay Assistance Where Needed
For patients with chronic illnesses, the high costs of prescription drugs can take a financial toll. Even if patients know their financial liabilities and carefully budget their medication expenses, they may still have difficulties keeping up with their healthcare costs. Financial burdens in the form of high copayments can hinder patients from adhering to their treatment plans because they simply cannot afford it.
Financial inability leads to medication non-adherence. Charles P. Vega, MD at MedScape [login required] points to research showing that 63 percent of patients who hit the limits of their copayment for prescription drugs are likely not to adhere to their medication.
In such cases, organizations that can offer some form of copay assistance can ease the way for patients to adhere to their medications. Speaking to PatientEngagementHIT, Lisa Roome-Rago, Director of Enterprise Outpatient Care Management at Advocate Health Care, suggests that clinicians and care managers can also help relieve some financial burden by finding ways to reduce copayments for patients.
Curant Health Chief Operating Officer Marc O'Connor agrees that providing copay assistance can help improve medication adherence. In an article at Managed Healthcare Executive, he points out that helping patients with their copayments "positively affect[s] both sides of the value equation in value-based care, where value equals outcomes divided by costs."
Tackling Mental Barriers to Improve Primary Medication Adherence
It's not just costs that affect primary medication adherence. Patients have their own mental barriers that we have to contend with in order to improve outcomes.
Educate Patients about Their Medications
Fear, lack of information, or even ignorance about their medications can lead patients to not fill their prescriptions. Sara Heath, who authored the PatientEngagementHIT article linked above, argues that this mental barrier is pervasive and cites research revealing that "fifty-two percent of patients reported negative beliefs associated with taking a medication."
The reasons why include:
- Adolescent patients might be reluctant to take medication in front of their peers.
- Some patients fear that they may become dependent on medication.
- Other patients may spurn their prescriptions in favor of alternative remedies.
That's why nurturing a relationship with patients is important to improve medication adherence, the team at medical company AmerisourceBergen writes. Physicians and other healthcare providers have a key role to play in educating patients about their health conditions, the benefits of their medications, and the side effects, if any.
Healthcare professionals should also get patients more involved in making decisions about their healthcare, but this requires providing patients with all the necessary information to make an informed choice.
When patients get the full picture of their medical treatment plan and the costs involved, they are more likely to adhere to their doctor's advice, as they now know their own role and responsibilities.
Make It Convenient for Patients to Fill Their Prescriptions
Another barrier to filling prescriptions is finding in-network pharmacies. The frustration of having to look up locations of nearby in-network pharmacies can put patients off from medication adherence, or at least introduce a point of friction.
Again, technology can fill the gap. APIs have a role to play, as does medication synchronization. Jason Turner, PharmD, shares how coordinating the refilling of prescriptions for chronic illness patients has improved medication adherence.
Turner believes that medication synchronization can address some of the important barriers to primary medication non-adherence by making it efficient, easy, and convenient for patients to fill their prescriptions. Using the Medicare Star Ratings model, he introduced synchronization to his pharmacy business in 2013 and developed enhancements to improve the process.
The results? His flagship pharmacy saw a double-digit rise in prescription volume once medication synchronization was implemented. He was also able to replicate the process at his second pharmacy location, which saw success in the form of an 11 percent increase in prescription volume.
Making it easy and seamless for patients to get their prescriptions can lead to better primary medication adherence.
Tags: Pharmacy, Price Transparency