Chronic disease problems are growing, and this places an increasingly heavy demand on health systems. Reasons for the upward trend include aging populations, changes in lifestyle and behavior, and non-adherence to medical treatment. The upswing takes a toll on the economy, increases the cost of healthcare, and reaps a high price in human life. Pharmacy benefit managers (PBMs) play a vital role in helping to reduce the impact by providing improved adherence solutions that combat rising chronic disease trends.
The Chronic Disease Burden
The number of patients suffering from chronic diseases is surging, with more than 1.8 million Americans projected to die each year from non-communicable, chronic diseases by 2040, according to the most recent Global Burden of Disease* study. This figure represents an increase of more than 100,000 compared with 2017, resulting in an escalating demand for healthcare that creates tremendous pressure on U.S. health systems and impacts the nation’s financial strength. Examples of chronic diseases that fall into this trend include diabetes, heart disease, hypertension, arthritis, asthma, and Crohn’s disease.
Reasons for the Upswing of Chronic Diseases
Scientists have identified five primary reasons for the prevalence of chronic diseases increasing. These include:
- Increased life expectancy and lower fertility rates are creating aging populations, with 16% of Americans aged 65 years and older, according to 2019 data. Around 85% of all older adults have at least one chronic health condition, and 60% have two or more.
- Non-adherence to medication protocols. Research shows that approximately 30% to 50% of patients taking long-term prescription medications don’t follow the dosage and frequency requirements.
- Lack of enough regular exercise, because of limited space available and increased reliance on technology for work, social, and entertainment activities. A WHO-led study of school-going teens showed that 85% of girls and 78% of boys did not get at least one hour of physical activity per day.
- Unhealthy lifestyles, with poor nutrition, ongoing smoking, and alcohol usage, all lead to factors such as elevated blood lipids, diabetes, high blood pressure, and obesity.
- Higher long-term stress levels, which cause poor sleep and result in a greater risk for chronic disease development.
Quantifying the Cost of Prevalent Chronic Diseases
Heart disease, cancer, stroke, COPD, and diabetes cause more than two-thirds of all deaths and swallow more than 75% of the annual spending on public and private healthcare. Research from the American Action Forum shows that when healthcare costs are combined with the indirect costs of lost economic productivity, the total cost of chronic disease in the United States reaches $3.7 trillion each year. This computes to approximately 19.6% of the country’s GDP, with certain conditions carrying a higher cost of non-compliance than others.
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The Non-Adherence Issue
One reason for the increased longevity currently contributing to the chronic disease trends is that medicines are available to help manage chronic conditions effectively. However, this solution only works when patients adhere to medication protocols. For example, treatment success in hypertension patients depends significantly on whether they use their medication appropriately to manage their blood pressure.
Many patients across the broader healthcare system don’t even fill prescriptions, for reasons ranging from lack of funds to difficulty accessing transport or simple forgetfulness. This non-adherence trend leads to an estimated $100 billion in preventable costs annually.
Suggested Solutions to Lower Non-Adherence
Medication non-adherence remains a huge challenge in healthcare. Pharmacy benefit managers (PBMs) are uniquely positioned to help combat this issue and contribute significantly to slowing the surging chronic disease trends. The U.S. HHS offers some helpful adherence solutions in its guide for public health practitioners. Potential multifactorial solutions include:
- Regimen simplification through formulary management
- Lower cost alternatives and stringent drug cost management
- Better health literacy, including education about side effects
- Leveraging technology to provide automated refills, electronic reminders, and remote patient monitoring
- Patient communication and follow-up, including face-to-face virtual or in-person counseling with a pharmacist
- Improved delivery and shipping services, issue of 90-day supplies, and
- Adherence packaging.
Socioeconomic factors also play a role in predicting non-adherence. For example, data shows that patients struggling with food insecurity or transportation challenges could be at higher risk of non-adherence because of the difficulty they experience affording or obtaining medications.
A patient-centered approach that includes interventions to reduce such barriers and encourages a healthier lifestyle could significantly impact those suffering from the most prevalent chronic diseases.
Taking a Patient-Centered Approach
Pharmacists and PBMs have an important role in finding solutions to the rising chronic disease trends. With the healthcare system shifting to value-based, accountable care, integrating PBMs into patients’ healthcare teams is essential for enhancing patient results.
A patient-centered approach that prioritizes proactive interventions and addresses the barriers to medication adherence will lead to greater compliance, reduced healthcare costs for patients and organizations, and improved clinical outcomes.
Xevant’s intelligent analytics platform delivers actionable data to help you optimize treatment planning, manage drug costs and adherence, and improve clinical outcomes. Contact us to schedule a demo today.