How to Improve Patient Drug Adherence from the PBM Level

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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Laura Phillipson

Director, Client Success

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.

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