Primary Adherence – Technology, Kaiser Study, and EHRs

I think we all know that primary adherence is a real issue.  Depending on what you read, you see that anywhere from 20-30% (or more) of patients don’t start therapy.  They are prescribed a drug, but they never fill it.  This is due to lots of reasons:

• They get a sample.
• The drug costs too much leading to abandonment.
• They don’t feel like they need the prescription.
• They feel better.
• The doctor tells them only to fill it if something else doesn’t work.

These issues vary based on whether it’s an acute drug or a maintenance drug.  It also varys by drug class. 

I’ve always been surprised that pharmaceutical manufacturers focus so much on ongoing refills leading to improved MPR rather than focusing on primary adherence which would grow their market significantly.  One of the big reasons for this has been visibility.  Without electronic prescriptions and mapping those to claims data, it was hard to identify who had a prescription and didn’t fill it.  You could do something with data out of the PPMS (Physician Practice Management System) or through more complicated processes to get data out of their notes, but it wasn’t easy. 

So, this new study by Kaiser caught my attention. 

If you are a diabetic, have high cholesterol, or high blood pressure and you receive medical care at an integrated healthcare system that has electronic health records (EHRs) linked to its own pharmacy, then you are more likely to collect your new prescriptions than people who receive care in a non-integrated system, a Kaiser Permanente study shows.

That’s a strong sell for an integrated model, but perhaps more realistically for the use of EHRs.  You can also see some of the data from Surescripts around this topic of electronic prescriptions and adherence. 

This creates a great opportunity for pharmacies, PBMs, payers, and pharmaceutical manufacturers to leverage technology to improve primary adherence.  By identifying people who don’t fill a prescription they receive, companies can help determine which of those are intentional and which of those should be addressed.  This should help address the overall costs attributed to non-adherence and be a business driver for all these entities. 

[Note: If you’re interested in working on primary adherence, let me know.  We have several approaches for this at Silverlink.]