How to Improve Patient Drug Adherence from the PBM Level

Close-up of a doctor holding a chart.

According to an oft-cited study by the World Health Organization (WHO), medication non-adherence can impact a patient’s health outcomes more so than improvements in medical treatment. Inadequate adherence compromises patient outcomes, patient mortality, and economic benefits.

In the U.S., non-adherence results in 50 percent of treatment failures and 125,000 preventable deaths annually while costing $290 billion in avoidable healthcare costs. In addition, for those suffering from chronic illness, up to 50 percent of patients don’t take their medications as prescribed.

Despite these staggering statistics, drug adherence is commonly thought of as a “patient problem,” not a critical health system and employer issue. In this article, we’ll address how to improve patient adherence holistically and offer some adherence strategies.

Why do patients not take their medications correctly or adhere to other medical advice?

Numerous reasons exist for patients not taking their medications, including “poor communications between healthcare providers and patients, fear of side effects, high medication costs, interaction with other prescriptions, and simple forgetfulness,” according to the American Heart Association. Adherence rates can also decrease “as time passes after the initial prescription is written, or as barriers emerge or multiply.”

The American Medical Association recently addressed eight reasons why patients don’t take their medications, delving more specifically into these reasons:

  • Fear: Many patients may choose not to take their medications as prescribed out of fear of potential side effects. On the other hand, they may have had side effects with another similar medicine in the past (or witnessed side effects in family members or friends), opting not to take the newly prescribed drug.
  • Cost: Another barrier to medicine adherence is cost. Even over the last year, in the face of a global pandemic, the average price increase for common medicines was “more than twice inflation,” according to the American Hospital Association. The high cost of drugs may encourage patients not to fill their prescriptions regularly or take partial doses to make their medicine last longer.
  • Misunderstanding: Patients may not understand how to take their medicine or why it’s essential, resulting in non-adherence. For example, they may be unaware of the drug’s benefits or unsure of their condition. Additionally, drug and treatment information may be shared beyond the patient’s level of understanding, causing them not to take their medicine.
  • Too many medications prescribed: Common with patients suffering from chronic illnesses or disorders, when patients have multiple prescriptions and frequent dosing, non-adherence is common.
  • Lack of symptoms: When taking prescribed medication, patients may not feel any different or believe that the medicine is making a difference. Because of this, they may stop taking their medicine, not seeing the benefit.
  • Mistrust: With recent and frequent news stories about abuse by pharmaceutical companies or prescribing physicians, patient mistrust increases, leading to suspicions about prescribed drugs.
  • Worry: Like mistrust, patients may worry that they’ll become dependent on or addicted to a medicine, leading to non-adherence. One way to improve adherence, in this case, is with “patient-physician communication,” as insufficient communication accounts for 55 percent of non-adherence by patients.
  • Depression: Finally, the American Hospital Association cites depression as a significant contributor to non-adherence. People who suffer from depression are less likely to take their medications as prescribed. And with anxiety and depression spiking during the global pandemic, this is a serious concern for adherence rates moving forward.

Why is medication adherence important to patients?

As we see by the statistics cited at the beginning of this article, not taking medicine as prescribed can lead to increased health issues, hospitalization, or death. However, the only worry isn’t physical health. It’s also financial health, as increased healthcare expenses result from ongoing medical issues or unnecessary hospitalizations or nursing home admissions.

To lessen the effects of patient non-adherence, a team approach is needed to solve these problems. Let’s examine how medical adherence can be improved.

How can medical adherence be improved?

According to a 2011 Mayo Clinic study, “because barriers to medication adherence are complex and varied, solutions to improve adherence must be multifactorial.” This requires bringing medical professionals, families, employers, pharmacy benefit managers (PBMs), and patients into the mix to find realistic and effective solutions.

To reach optimal medical and therapeutic outcomes, patient adherence rates of 80 percent or more are required. So how do we get there? What are some adherence strategies? Let’s look at how PBMs can specifically improve medicine adherence.

To increase the proper use of prescribed drugs, PBMs, can partner with patient adherence programs. By teaming up with these programs, PBMs can demonstrate added value to employers, pharmacies, and health care providers, by increasing positive outcomes through adherence.

PBMs are also an excellent source of information, providing patient education on the importance of taking medicines as prescribed. Further, PBMs can develop or share health adherence apps, such as medication timers or exercise reminders, prompting the patient to take positive steps towards better health while incentivizing them along the way.

Finally, PBMs can encourage relationships between healthcare providers, pharmacies, and patients, allowing patients to have multiple, familiar contacts while streamlining their health journeys. For example, PBMs can partner with pharmacies that offer automatic refilling, simplifying medication adherence. Further, PBMs can team up with specialty pharmacies that provide in-depth patient consultation and education, increasing medication adherence.

Drug adherence directly impacts not only the “quality and length of life [and] health outcomes, [but also] overall health costs.” By implementing low-cost adherence programs and interventions, patients, employers, and medical professionals alike can find significant cost savings while seeing better health outcomes. But, it will take a team approach. It’s not—and it should not—be left to patients alone.

To help curb healthcare costs and increase adherence, make sure you have detailed, actionable data to help manage your pharmacy spend. With Xevant, you can identify non-adherent patients, intervening with patient management solutions while saving you money. Whether you’re a PBM, TPA, or benefits manager, Xevant provides the data you need before you need it.


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The New PBM Playbook

Date: March 30th, 2023
Time: 2:00pm EST

Brandon Newman

Chief Executive Officer

Sahily Paoline

Chief Clinical Officer

Pete Tantillo

Chief Financial Officer

Pete is an accomplished technology executive who has led many organizations through high growth and profitability stages and has worked with some of the world’s largest companies. Pete most recently completed an exit for RapidRatings, a highly successful data and information analytics company in the risk management and supply chain analytics space where he was both CFO and COO for the business. Prior to RapidRatings, Pete spent ten years working for private-equity and venture backed technology companies in both SaaS and traditional software solutions. Pete also spent 13 years at powerhouse technology company SAP where he led field services for SAP America. Pete started his career in public accounting with Arthur Andersen & Co and is a licensed CPA. He graduated with a business degree from the College of William & Mary in Virginia. 

Ashwin Patel

SVP, Data

Ashwin (Ash) has more than 20 years leadership experience in data warehousing and business intelligence practices within the healthcare sector. At Xevant, Ash leads the data and business intelligence teams and is responsible for future state expansion of Xevant data technology platforms and processes, partnering with the organization’s product teams to develop best-in-class products and solutions. Prior to Xevant, Ash was VP Business Intelligence for HealthSmart Benefit Solutions based in Irving, TX, a third-party administrator (TPA) of medical, pharmacy, and clinical data. Ash earned a Bachelor of Science degree in computer science and operations research from Leeds Becketts University in Leeds, England.

Sahily Paoline

Chief Pharmacy 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.

Megan Foster

Manager, People Operations

Todd Rode

VP, Revenue Operations

Todd served as an Artillery officer in the U.S. Army before a disability turned his focus to the business world. He’s carried a bag, led multiple sales operations and sales development efforts, and run a sales team in complex selling environments. The son of small business owners, Todd enjoys helping business leaders grow by using proven, repeatable processes. He holds a BS from the United States Military Academy at West Point and an MBA from the Kellogg School of Management at Northwestern University. Todd lives in Nashville with his wife. He spends as much time outside as possible and co-founded a brewery in 2019.  He’d love to tell you the full story over a pint sometime.

Greg Abram

VP Sales

Greg is a results-driven sales professional with more than 12 years of experience in the PBM and healthcare markets. As VP of Sales, Greg leads the Xevant sales team focused on growing revenue and expanding market reach. Prior to Xevant, Greg served in multiple leadership and growth positions with Myriad Genetics, Navitus Health Solutions, Catamaran, and CVS Caremark Corporation. Greg’s passion to create long-lasting, aligned partnerships has delivered tremendous value for PBMs, health plans, large purchasing groups, and fortune 500 organizations throughout the country.

Jaylyn Palmer

Chief of Staff

Jaylyn is a dynamic Chief of Staff who thrives on helping create workplaces that go beyond the ordinary to achieve a culture of belonging, empowerment, and improvement. Proving to be a culture ambassador, strategic advisor, and relationship builder, Jaylyn supports the organization with versatility and innovation. When she’s not wearing one of her many Xevant hats, you can find Jaylyn planning a party, attending live music and theater, or playing Dungeons and Dragons.

Jeff Weber

Chief People Officer

Jeff has extensive experience building and growing positive organizational culture that supports high performance, transparency, learning and growth. Jeff has implemented comprehensive talent strategy including talent acquisition, engagement, rewards, and recognition programs. Prior to Xevant, Jeff was the EVP People and Places at Instructure, a rapidly growing provider of the Canvas and Bridge learning management platforms focused on transforming online learning and employee development.Jeff also led the growth of the people function for Jeff holds an MBA with an emphasis in Organizational Behavior from Brigham Young University.

Scott Sorenson

Chief Technology Officer

Scott is an expert business leader with extensive experience scaling technology organizations. His experience includes technology leadership roles at Cedar Health Payment Solutions, Human Longevity, Inc., and 16 years at Ancestry where he was the Chief Technology Officer and played an integral role scaling the Ancestry family history business that hosts billions of historical records and serves millions of customers. He also led their technology organization as they transformed the business to include a world class consumer genomics product line. At Ancestry, Scott prepared the technology organization for an IPO and multiple PE transactions.

Marvin Roi Elvambuena

Software Development Manager

Marvin is responsible for all aspects of software development efforts at Xevant, including architecting and managing software solutions from the ground up. He brings with him a performance history of leading loosely defined enterprise software projects in rapid changing environments. He has previously worked in several industries such as HR solutions, insurance, shared services, and payroll and holds a BS in Information Technology with specialization in Web Development.

Daniel Telford

Director, Corporate Treasurer

Daniel is a financial professional with more than 15 years of financial and management experience. Having worked in multiple demanding roles including Business Banker, Licensed Investment Professional and Financial Center Manager, Daniel uses his experience to guide and inform his current role as Corporate Treasurer for Xevant. Daniel has led multiple complex cross-functional teams to sustained success in the financial services industry.

Griff McGee

Corporate Controller

Griffin is CPA and finance and accounting professional with more than 10 years’ experience in public accounting, internal audit, and consulting. Throughout his career Griffin has worked with clients to solve complex problems, improve and implement new processes and achieve public company readiness. Prior to joining Xevant, Griffin served in several audit and consulting roles with Protiviti, Change Healthcare, Genesco and Decosimo, CPAs.

Gerrit Lemmen

VP, Rebates

Gerrit is an experienced leader in the PBM, Specialty and Formulary rebate markets. As VP of Rebates at Xevant, Gerrit is responsible for managing drug rebates through Xevant’s revolutionary pharmacy benefits platform. In his previous roles at Magellan Rx Management, Gerrit led highly respected commercial rebate operations teams and focused on increasing efficiency that enabled scalability and growth.

Mike Simmons

VP, Product Management

Mike is a true product champion & ambassador with 18+ years of experience in critical product launch, strategic branding, and delivering profitable campaigns that capture market share and create growth. His vision and skills for implementing integrated, high-impact, go-to-market strategies have proven to drive increased sales and an overall improvement of marketing programs. Mike’s ability to leverage business savvy in order to align management, data intelligence, and content management generate more informed business decisions resulting in enhanced revenue for progressive, enterprise organizations.

Laura Phillipson

VP, Client Experience

Laura Phillipson is a client management expert with experience managing client services teams. Her past roles include Sr. Client Services Executive for Navitus and over a decade of experience as a Certified Pharmacy Technician. Laura’s career in client relations spans nearly two decades. An avid sports fan, Laura excels in helping clients create a strong strategy with a competitive edge. Laura’s extensive background in both customer service and the medical field provides an ideal blend to lead client management for Xevant.

Chad Davis

Director, Compliance

Chad is a credentialed and strategic audit and compliance professional with more than 10 years’ experience assisting companies with achieving their business objectives through adept governance, compliance, and risk management. Prior to Xevant, Chad served in several auditing and accountant roles for Protiviti, Intermountain Healthcare, and First Data Corporation. He is a credentialed CISM and CISA and holds a BS in Accounting.

Erin Glenn

Director, Data Warehouse

Erin is 20-year data warehousing and business intelligence technology leader who has conceptualized, designed, and implemented ground-breaking data-centric technology solutions. She has solved big problems, delivered operational efficiencies, and increased productivity and cost savings throughout her career by delivering enterprise class data warehouses and business intelligence solutions.  Prior to Xevant, Erin served in multiple technology leadership positions with Hampton Roads Transit, MSN, The Port of Virginia, and Innova Systems. She holds a bachelor’s degree from the University of Hawaii.

Greg Heaps

Chief Marketing Officer

Greg is an expert marketer and innovative business builder specializing in launching and building high growth companies. As a founding member and on the leadership team of multiple venture backed tech startups, Greg has extensive experience in numerous markets including software services, health and medicine, commercial real estate, and consumer focused products. His primary motivation is driving demand and growth through an omni channel, go-to-market strategy. When Greg is not neck deep building an exhilarating business, he can often be found mountain biking, fly fishing, or carving deep powder on remote mountains.

Headshot of Jace Garfield, the Chief Technology Officer.

Jace Garfield

Chief Analytics Officer

Jason (Jace) Garfield, MSW has thrived in many industries ranging from data and information technology to foster care and mental health management. In his role with the Utah State Justice Commission, he helped publish medical research on drug effectiveness. Jason’s passion for technology and data automation paved the way towards innovations in identifying new to market drugs, tracking systems to identify clinical interventions, and data automations, resulting in millions in operational cost reductions. At Xevant, Jace leads every aspect of product operations and is responsible for a diverse team of technology experts.

Jason Hardin

Chief Revenue Officer

With 20+ years of sales and sales management experience in SaaS sales and professional services, Jason is a dynamic, performance driven leader with an exceptional record of achievement in motivating sales teams to exceed quotas, while ensuring client success.  Having led many organizations in the start-up, high growth, and emerging phases, Jason brings an entrepreneurial hunger to the sales, client success, and business development organizations with the ability to penetrate new markets, produce high growth sales results, achieve adoption and retention goals, and grow market share and revenue quickly.  

Jeff Lininger

President & COO

Jeff is the Chief Operating Officer at Xevant and is accountable for operational excellence at the company. Prior to joining Xevant, Jeff successfully applied his extensive, multidisciplinary expertise in building and scaling growth and service infrastructures within start-up, mid-market, and Fortune 500 technology and services companies. He has recruited and built new leadership and functional teams within operations, sales, marketing, product development, client success, finance, and HR. The success of these business transformations also contributed to a culture of increased accountability and empowerment, contributing to significant improvement in employee engagement and overall enhanced business performance. Jeff holds an MBA from Duke University’s Fuqua School of Business in North Carolina and a Bachelor’s Degree in Finance and Economics from Grove City College in Pennsylvania.

Headshot of Lindsay Jones, the Chief Financial Officer.

Lindsay Jones

Chief Financial Officer

Lindsay Jones, CPA, is a financial executive with experience in start-up companies & mature enterprises. He has a proven track record of helping, leading, and enhancing executive management teams. He has worked with private equity groups and private investors to identify, analyze, and close acquisitions and divestitures of companies. He has founded two startup companies, owned his own business, and closed over $500 million in private and public equity and debt financing, in his twenty-year career. 

Brandon Newman

Chief Executive Officer

Brandon has a dynamic, 25-year leadership career spearheading several businesses with emphasis on growth, revenue, and sales performance. He has run many high-growth environments, including start-ups, turnarounds, and $1B+ dollar businesses. As a serial entrepreneur, he has a proven record of founding new businesses and advancing them through growth and acquisition, merger, or roll-up including ScripPoint, Veridian, and AviaraMD. He is the driving force for vision, new market strategy, revenue growth, technology development, and partner alliances.