Multifaceted strategies can improve patients' medication adherence

Key Points

Interventions for medication adherence should be multifaceted, speakers told attendees at the recent Pharmacy and Technology Conference in San Diego sponsored by the National Association of Chain Drug Stores.

In the United States alone, the cost of medication nonadherence is more than $170 billion annually. According to the New England Healthcare Institute (NEHI), 13% of total healthcare expenditures may be due to poor medication adherence, and nearly $300 billion is wasted because patients don't take their medications.

This type of intervention might:

Patients with diabetes, chronic obstructive pulmonary disease, asthma, or heart failure, and patients who were recently discharged from the hospital after admission for any cardiovascular condition are prime candidates for interventions. "The return on investment for these patients should be excellent," Nau said.

Reducing refill complexity

There is increasing evidence that reduced complexity can greatly affect whether patients obtain timely refills, Nau said. "One type of complexity occurs if the patient has multiple chronic medications but is getting them refilled on different dates and perhaps at different pharmacies," he said.

Some small studies have shown that a significant improvement in adherence can occur if the refill dates are consolidated, so that patients are getting all medications refilled on the same date at the same pharmacy. "By consolidating the refills dates, you have reduced the inconvenience of having to make multiple trips to a pharmacy," Nau said. "This could also allow the pharmacist to schedule an appointment with the patient on the refill date, so that the pharmacist can talk with the patient to ensure that he or she has no problems with the medications and is achieving therapeutic goals."

Rite Aid compliance and adherence programs include automated courtesy refills to aid patients in making on-time refills and to allow the pharmacist to monitor compliance, reminder calls, and medication therapy, thus providing patients with complex drug therapies an opportunity to measure adherence and outcomes. Rite Aid's Loyalty Card program provides an incentive to customers to fill their prescriptions properly, awarding points toward tiered rewards that include discounts and health screenings.

In addition, its Ask the Pharmacist program "allows patients to interact with our pharmacists at any time," Mohall said.

E-prescribing: No impact?

According to Nau, the early evidence on e-prescribing suggests that it does not have a significant impact on medication adherence. However, this could change if pharmacists and physicians work together to contact the patient for whom a drug was prescribed but never picked up.

"Some e-prescribers indicate that they would prefer to have the pharmacist handle the follow-up with the patient, rather than the physician receive a message from the pharmacist with the expectation that the physician would contact the patient," Nau said. "However, the pharmacist may need to get additional information from the physician to follow up on initial nonadherence if the patient was not an existing customer of the pharmacy."

Health plans can also help to lower the barriers to medication adherence by keeping the cost share at a reasonable level and encouraging use of generic medications or lower-cost alternatives. "They should also note that value-based insurance design is about more than just lowering the co-pay," Nau said. "It also should include efforts to educate and monitor the high-risk patients. This may be done through medication therapy management services."

A typical mid-sized employer with $10 million in annual claims might be wasting more than $1 million because of nonadherence, according to NEHI. "Employers should demand information from their health plan and/or PBM on the quality of medication use for their employees," Nau said. "This would include reports on adherence for persons who are at high risk for hospitalization."