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Shortfalls Causing Medication Nonaderence And How To Improve Them



Medication nonadherence is attributed to 125,000 deaths each year with 10% of hospitalizations and an estimated $300 billion in cost against the healthcare industry. With only 50% of patients taking medication as prescribed it also makes data accruement difficult to determine if treatments are effective. That’s why identifying and working to improve shortfalls that cause medication nonadherence is so vital.


Money Matters


Common factors that contribute to a patient’s lack of adherence to their treatment plan include finances, lack of understanding, and memory. These issues have only become more challenging during the pandemic with financial concerns at the forefront. In fact, a recent consumer study found that nearly 48% percent of respondents admit to not filling prescriptions strictly because of cost. Another study published in Annals of Internal Medicine reported that patients are 4 times more likely to fill a prescription priced at $10 as opposed to $50. This is especially concerning as many medications for chronic diseases are brand name with higher costs associated.


A Pharmacist’s Role Grows


Oftentimes, patients don’t feel comfortable discussing concerns of medication affordability with their providers. This is an area where it’s important for pharmacists to play a more critical role and communicate with the provider.


While some high-cost brand name medications offer additional benefits over lower-cost generic alternatives if the patient will not be taking the medication as prescribed many of these benefits are diminished.


For example, many brand name antidiabetic medications, such as Ozempic or Janumet offer additional benefits for a diabetic patient, such as reduction of CVD events or weight loss. However, if the patient is unable to afford these medications, it is important to ensure that they receive a lower-cost alternative medication to control their blood sugars adequately. Alternatives include generic metformin, glipizide, or pioglitazone, which will effectively lower HbA1c to provide good clinical outcomes and save on cost.


Additionally, where adherence is a major focus of quality metrics, such as Medicare populations, pharmacies will soon be held accountable. Medicare tracks adherence data for certain blood pressure medications (RAAS antagonists), such as lisinopril and valsartan, as well as statins and antidiabetic agents. These measures are included in star measures used to evaluate health plans as well as providers. It is expected that within the next decade, Medicare will expand these measures to also evaluate individual pharmacies holding them responsible for the adherence rates of their patients.


Compartmentalizing the Research


A major shortfall negatively affecting medication adherence is the lack of focus on specific subsets of patients. For example; implementing programs for all diabetic patients to combat non-adherence without taking into account those who are already adhering and/or socioeconomic factors is a shortsighted approach that likely won’t deliver meaningful changes.


It’s important to compartmentalize the research because what works for one set of non-adherent patients doesn’t necessarily work for another.


Many health plans are cultivating adherence programs as part of their medication therapy management (MTM) programs. Adherence programs typically reach out to patients that have a history of nonadherence, as well as patients newly diagnosed with certain chronic conditions, such as diabetes or heart failure since these conditions have significantly increased morbidity and mortality associated with medication nonadherence.


These newly diagnosed patients are a critical target since studies have found that less than 40% of patients with newly diagnosed chronic conditions are adherent to their prescribed regimen.


Leveraging Advanced Technology


Advancing technology is already being positioned to aid medication nonadherence with digital therapeutics. For example, some inhalers, such as the brand DigiHaler will provide detailed information to providers on the use of the inhaler. It is able to track not only when the patient is using the inhaler, but also how well. Inhaler technique is a critical caveat to making sure that the patient is getting all of the medication prescribed into their lungs. This will allow the provider to know which patients require additional education to effectively use their medications.


Additionally, with the availability of compliance packaging, from companies such as Amazon’s PillPack or HERO, patients with complex regimens will no longer have to remember to refill their medication boxes on a weekly basis.


  • Amazon PillPack provides medications in easy to use packages with medications grouped by day and time that they should be taken.

  • HERO is a medication dispenser that is used in the patient’s home. It will drop medications automatically at the time that they need to be taken.

Gaining an Edge with Data


Rather than solely focusing on the bottom-of-the-funnel impact of medication nonadherence, data-analytics provides a high-level view of the drug market giving PBMs, providers, and pharmacies the ability to intervene before non-adherence occurs.


By utilizing groundbreaking tools, like Xevant’s customized module for adherence, users can gain real-time insight into the adherence trends starting at the aggregate level down to individuals. For example, Xevant can help manage populations of patients and customize the strategy based on unique utilization elicited from groupings of similar patients. Xevant can also generate alerts on a number of adherence factors such as new generic options hitting the market that might significantly cut costs for the patients or reveal a trend with a specific medication that’s resulting in non-adherence.


This type of information can empower providers to prescribe the best medication for patients both medically and financially. Easy access to data analytics allows users to be proactive rather than reactive, mitigating medication nonadherence before it becomes a problem.


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