One question I frequently get is “what should I know about adherence”. This is then followed by “so what should I do about it”.
Here’s my starter list of what you need to understand about medication adherence.
- It’s a $290B problem.
- Patients fall off therapy quickly.
- There are a lot of reasons for non-adherence…it’s not just about reducing out of pocket spend. AND, to make it more complex, there are variations by gender, culture, medication, condition, trust, copay levels, etc.
- There are lots of predictors of non-adherence (old study, Express Scripts, Merck tool), but generally the best predictor is past behavior.
- Interventions can improve adherence (CVS Caremark study, Express Scripts study, Silverlink data). BUT, physicians generally don’t see non-adherence as an issue they can address. (see also White Coat adherence)
- Patients don’t think they’re non-adherent (see “Rx Adherence Hits The Ignorance Wall” by Forrester that says only 8% of people think they are regularly non-adherent).
- Adherence reduces total healthcare costs (CVS Caremark study, Sokol study).
- Communications matter (misperceptions, physician-patient gap, health literacy, what physicians tell patients).
- There are lots of cool technologies that will work for different people (talking bottles, monitoring devices, iPhone reminders, websites, pill boxes). BUT, improved labeling and bottle design may not be the answer (analysis of Target improvements).
- Starting on generics (or lower cost drugs) improves the probability of adherence.
- Pharmacist involvement is key and impactful (CVS Caremark study, Ashville).
- 90-day prescriptions lead to better medication possession ratio (Walgreens study, CVS Caremark study, Kaiser study, Express Scripts study).
- Complexity of therapy (e.g., number of prescriptions) increases the likelihood for non-adherence.
- Electronic prescribing gives us new visibility into primary adherence and should also create opportunities to improve this issue.
- It’s an area where everyone wins and there’s lots of research…but there’s no silver bullet.