Only half of patients take the drugs as prescribed for them by their physicians.
So what happens to the other half? And why does this costly problem continue despite efforts to improve patients’ adherence to prescription medications?
My understanding of this frustrating problem increased when I attended a recent conference and heard a presentation by Larry Merlo, president and CEO of CVS Caremark Corporation. CVS Caremark is the nation’s largest pharmacy health care provider and makes improving adherence part of its corporate mission.
Failure to adhere to prescriptions is:
Harmful. A study published in December 2012 by the Annals of Internal Medicine found that lack of adherence in the U.S. is estimated to annually cause approximately 125,000 deaths, at least 10 percent of hospital admissions and a "substantial increase" in morbidity and mortality. In other words, more people get sick and more people die.
Costly. The same study, titled "Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States," noted that nonadherence is estimated to cost the U.S. health care system between $100 billion and $289 billion annually. Given that total health spending is around $3 trillion, you get a sense for the magnitude of the problem.
Complex. You would think, "Hey, take your meds, how tough can it be?" If it were only that simple. Improving adherence requires addressing how patients and physicians interact with the U.S. health system, how to simplify the way patients are told to take medicine, and how to communicate about treatment risks and benefits. Studies show that this issue has been consistently observed with different settings, different diseases, different drugs and even different geographic areas.
There are many potential solutions, but not all of them are likely to become available. For example, personal visits from a nurse are helpful, yet they are also costly and require changes in the health care system.
Some people may benefit from technology since electronic reminders can improve adherence by 67 percent. These reminders may include text messages, emails or electronic pill bottles that use sound or light to alert patients when it’s time to take medication.
Employers who self-fund their health benefits have several takeaways to keep in mind when designing pharmaceutical benefits:
Improved access to medication can help. Generic medications help reduce costs and improve adherence, for example, as does lowering copays for medication, particularly for prescriptions to treat chronic conditions. Some Alliance members with onsite clinics have helped their employees gain access to medications with steps such as dispensing common, non-narcotic medications onsite or arranging with pharmacies to make deliveries to the workplace. Many employers have designed effective mail-order programs to ensure prescriptions are received timely and regularly.
Information can be vital. For example, counseling by a pharmacist, either in a store or by telephone, can improve adherence. Yet 20 to 30 percent of medications are never filled, which means education must also occur in the physician’s office.
Multifaceted approaches show promise. Combining information, access, reminders and other strategies can result in significant improvements.
Ask for help. Your benefit consultant and your pharmacy benefit manager can offer vital information about the latest strategies.
It's clear that complex solutions will be required to address this relatively straightforward problem. It all comes down to one issue, as summed up by Dr. C. Everett Koop, U.S. surgeon general from 1982 to 1989:
"Drugs don't work in people who don't take them."
This blog originally appeared on August 29, 2013 on The Alliance blog.
CFAH President Jessie Gruman has written extensively about adherence from the patient's perspective, including:
- No Magic Pill to Cure Poor Medication Adherence
- I'm Not Taking That Drug if it Makes Me Itch! More on Medication Adherence
What have your experiences been like? Have you ever found it difficult to follow your doctor's recommendations?