Study finds many patients with chronic illnesses not adhering to prescriptions

A significant number of patients with chronic illnesses are not filling their prescriptions, according to a new study conducted by CVS Caremark and Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). The study, published in April in the American Journal of Pharmacy Benefits, found that more than 20% of patients who were prescribed asthma controllers and more than 34% of patients who were prescribed medications for high cholesterol did not fill their initial prescriptions.

The review looked at e-prescriptions written by 507 doctors in the Horizon BCBSNJ network between January 2006 and October 2006, and claims data. The study indicates that the issue of nonadherence is larger than previously thought, and it highlights the need for additional educational efforts and intervention programs to improve the likelihood of patients adhering to the protocols prescribed by their doctors.

Nonadherence to essential chronic medications has been widely recognized as a major public health problem in studies published in medical journals. Past studies show one-quarter of people receiving prescriptions never fill their first prescription, and patients with chronic diseases, such as diabetes and coronary artery disease, adhere to their ongoing medication regimen about one-half the time.

Nonadherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. healthcare system estimated at about $300 billion annually, the study said.

“Most previous studies on primary nonadherence have depended upon patient self-reporting or focused on hospital populations that could be tracked more closely,” said Joshua N. Liberman, vice president of strategic research for CVS Caremark, and the study’s primary author. “With the increasing use of e-prescribing, we can now get a more accurate picture of how many members fail to fill that first prescription and insights into factors associated with that failure.”

Richard Popiel MD, vice president and chief medical officer for Horizon BCBSNJ, said analyzing e-prescribing data gives a clear picture of how many patients don’t fill their prescriptions. “The study shows there needs to be more education and intervention to ensure patients understand the importance of adhering to prescribed medical protocols,” he noted.

Woonsocket, R.I.-based CVS Caremark has launched a multiyear effort to better understand why people stop taking their medications. One effort is a 3-year collaboration with researchers from Harvard and Brigham and Women’s Hospital in Boston to study pharmacy claims data to better understand patient behavior around medication adherence. The CVS Caremark and Harvard collaboration is also looking at adherence through the lens of e-prescribing, among other topics. Another effort is the launch of the Behavior Change Research Partnership led by experts from Carnegie Mellon University, Dartmouth University’s Tuck School of Business, the University of Pennsylvania Medical School, and The Wharton School of Business.