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July 27, 2023

Cost and Other Barriers To Medication Adherence

When it comes to managing health, taking prescribed medication correctly and consistently is crucial. However, a significant number of people struggle with medication adherence and don’t take their medicines as prescribed. This situation can lead to serious health complications and higher costs for both patients and the healthcare system. One of the main obstacles patients face is the cost, which can often act as a barrier to medication adherence, making it difficult for people to maintain their treatment regimen.

The Size of the Problem

The issue of medication non-adherence is more widespread than many people realize. Recent studies show many patients, particularly older individuals with chronic diseases, do not take medications as prescribed. For example, one study conducted among older community-dwelling people with at least one chronic disease found that 60% were non-adherent to their medication regime.

The impact of this non-adherence is far-reaching, affecting not just individual patients but the healthcare system as a whole. When patients don’t take their medication as prescribed, it can lead to a worsening of their conditions, increased hospitalizations, and even higher mortality rates. This, in turn, places a significant burden on the healthcare system, resulting in increased costs and resource usage.

Moreover, non-adherence can undermine the efforts to reduce morbidity and mortality associated with chronic diseases. It’s not just about taking medication. Understanding the purpose of the drug, managing side effects, and feeling satisfied with the treatment regime are all crucial factors in ensuring patient adherence. By understanding the current statistics and the impact of non-adherence, we can begin to develop strategies to improve medication adherence and, ultimately, patient outcomes.

Factors Affecting Medication Adherence

Non-adherence falls into two categories: intentional and unintentional. Intentional non-adherence is when the patient consciously decides not to take medication. This can be due to a variety of reasons, including:

  • Concern about potential side effects
  • Lack of conviction that the drug is necessary.
  • Unconvinced of the medication’s effectiveness, or
  • The patient is simply feeling better and thinks they no longer need it.

Unintentional non-adherence occurs when the patient wants to take their medication but fails to do so for reasons beyond their control. This could be due to forgetfulness, misunderstanding instructions, or inability to afford the medication.

This raises the question of cost as a barrier to medication adherence. It’s a sad reality that for many people, medication costs can be a significant reason for not following the recommended treatment. When patients struggle to afford their medication, they skip doses, take less than the prescribed amount, or avoid filling prescriptions. This is a serious issue, leading to poorer health outcomes and higher healthcare costs in the long run.

For pharmacy benefit managers (PBMs), understanding the factors that affect medication adherence, including the role of cost, is crucial in finding solutions that ensure patients have access to the medication they need.

Barriers to Medication Adherence

Cost-related non-adherence occurs when the price tag of prescribed medication is high, making it challenging for individuals to afford their treatment consistently. This particularly impacts patients without insurance or with high-deductible insurance plans.

However, cost is not the only obstacle. Here are some other common barriers to medication adherence:

  1. Forgetfulness and Poor Time Management: Many people simply forget to take their medication, especially if they are on multiple drugs with different dosing schedules.
  2. Confusion About Medication Dosing Schedule: Complex medication regimens can be confusing, leading to mistakes and non-adherence.
  3. Poor Understanding of the Illness and Medication: Lack of understanding about the disease and the role of the medication in managing it can lead to non-adherence.
  4. Fear of Side Effects: Some patients may be afraid of potential side effects and choose not to take their medication as a result.
  5. Lack of Symptoms: If a patient doesn’t feel sick or if the symptoms of their illness are not apparent, they may not see the need to take their medication regularly.
  6. Mistrust: Some patients may mistrust their healthcare provider or the pharmaceutical industry, leading to non-adherence.
  7. Depression: Mental health issues, such as depression, can also affect a person’s ability to adhere to their medication regimen.

Understanding these barriers is the first step toward addressing them and exploring strategies to overcome these obstacles.

The Impact of Non-Adherence

The cost of medication non-adherence does not only refer to financial expenses. The issue is multifaceted and can have significant impacts on both individual patients and the healthcare system as a whole.

From an individual patient perspective, not taking medication as prescribed can lead to poorer health outcomes. This might mean the patient’s condition worsens, and they experience more severe symptoms or delayed recovery. In some cases, non-adherence can even be life-threatening. Diseases such as diabetes, high blood pressure, asthma, and mental health disorders are particularly affected by cost-related non-adherence. Additionally, non-adherence can cause higher personal healthcare costs, such as more frequent doctor visits, additional tests, and hospitalizations.

On a broader scale, medication non-adherence places a substantial burden on the healthcare system. It’s estimated to account for up to 50% of treatment failures and around 125,000 deaths each year in the United States alone. Furthermore, it costs the U.S. healthcare system between $100 billion and $289 billion annually. These costs come from avoidable hospitalizations, emergency care, and additional medical procedures. By understanding the impact of non-adherence, we can work towards solutions that improve compliance and, ultimately, deliver better health outcomes.

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Reducing Medication Non-Adherence

Improving medication adherence among patients is a multifaceted challenge that requires a comprehensive approach involving PBMs, medical practitioners, patients, and insurers. Strategies that could make a difference by eliminating cost as a barrier to medication adherence include:

  • Comprehensive Healthcare Reforms: PBMs can advocate for reforms that address the pricing and affordability of prescription drugs, making them more accessible to all individuals.
  • Transparency in Drug Pricing: PBMs can encourage transparency in drug pricing, which would enable patients to make informed decisions and promote healthy competition in the pharmaceutical industry. This includes providing data on rebates, clawbacks, spread pricing, and other factors contributing to the overall cost.
  • Promotion of Generic Drugs: PBMs can encourage the use of generic medications, which can significantly reduce drug costs. Additionally, they can explore avenues for importing more affordable medicines, providing alternatives for individuals struggling to afford their prescriptions.
  • Negotiation of Drug Prices: PBMs can negotiate drug prices with pharmaceutical companies to get lower prices for prescription drugs, making medications more affordable for patients and increasing adherence.
  • Collaboration with Health Insurers: PBMs can work closely with health insurance providers to ensure patients understand their coverage and explore options for more affordable medications. They can also help patients navigate high deductibles, co-pays, or limited drug formularies.
  • Financial Assistance for Life-Threatening Drugs: PBMs can provide information about patient assistance programs, discounts, and coupons to help patients afford life-saving medications. They can also facilitate communication between patients and healthcare providers to discuss financial concerns and potential alternatives.
  • Advocacy for Change: PBMs can support initiatives and organizations advocating for improved access and affordability of prescription drugs. They can contribute to the ongoing conversation surrounding drug pricing and accessibility, and advocate for patients at the policy level.

From the patient’s viewpoint, simplifying a drug regimen can also help. If a patient takes multiple medications at different times of the day, it can be easy to forget a dose. Tools like pillboxes or medication calendars can help them stay organized and remember when to take each medication. In addition, regular check-ins with healthcare providers can help ensure patients take their medication as prescribed and can provide an opportunity to address any issues or concerns.

How Xevant Can Help

Xevant can help PBMs and other stakeholders address medication non-adherence effectively in multiple ways. The company’s intelligent analytics platform empowers PBMs with real-time data and insights. This platform includes automated analytics for optimized business practices, reduced operating and drug costs, and improved patient outcomes.

Xevant’s platform is designed to help PBMs avoid problems at the patient, group, or overall plan level. It identifies escalating issues through automated alerts, allowing for timely intervention. This immediate intervention results in improved member health, lower client and analytics costs, and reduced clinical oversight.

In addition, Xevant’s software aids in rebate optimization and transparency, helping PBMs manage utilization, ensure optimal formulary adherence, and maximize rebate value. This means PBMs can account for costs down to the penny and reduce or eliminate fees in the rebate supply chain, ultimately lowering the cost of medication for patients.

By leveraging tools like Xevant’s solution, PBMs can more effectively manage pharmacy benefits. Book a demo today to discover how to achieve lower costs for patients, better medication adherence, and improved healthcare outcomes.

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Sahily Paoline (1365x2048)


Sahily Paoline, Chief Clinical Officer

Sahily is a licensed pharmacist and expert business leader with more than 20 years of experience delivering high-quality clinical care, building and leading organizations, and staffing and motivating teams in the pharmaceutical and digital health industries. Sahily specializes in Clinical Program Management, Pharmacy Practice and Operations, and building and growing business. She is passionate about the use of data and technology in patient care and believes in a holistic approach to healthcare.


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