The cost of medication non-adherence

For many Americans, taking a daily medication is a way of life. In a study from the Health Policy Institute, 66% of all adults in the U.S. take prescription drugs. The CDC says that 24% of the population uses three or more medications each month, and this increases to greater than 66% over the age of 65. But being medication adherent by filling a prescription when instructed by a prescriber and then taking that prescription as directed is sometimes a struggle. One study indicates that as many as one-half of patients are non-adherent. This non-adherence is a costly burden for health systems. A review by the Annals of Internal Medicine estimates that medication non-adherence causes nearly 125,000 deaths, 10% of hospitalizations, and costs the U.S. healthcare system between $100 billion to $289 billion a year.

Medication adherence is complicated

The reasons for non-adherence are complex but usually fall into two buckets: those related to the patient and those related to the prescriber. Suboptimal health literacy, mistrust of the prescriber or treatment plan, fear of potential side-effects or medication dependency, lack of symptoms, lack of access to or education around health mobile apps, and medication costs are some of the ways non-adherence is attributed to the patient. Medication complexity, communication barriers, and ineffective communication around medication outcomes are all prescriber factors to non-adherence.

Collecting non-adherence data is also complicated. Patients are usually reluctant to admit to missed doses and have an inherent bias in believing they take their medications regularly, as prescribed. Although prescription refill history is helpful, it may not tell the entire story as some prescriptions are never filled. Thankfully, a strong patient-pharmacist relationship can solve many of these challenges and bridge the non-adherence gap.

Better health literacy equals better health outcomes

Improving a patient’s health literacy is critical to better medication adherence. Pharmacists play a large role in that education through patient counseling on medications, both prescription and over the counter, as well as conversations to fully understand the needs of the patient. Our Converge Rx™ platform uses powerful analytics to help guide the pharmacist to the root of adherence issues, freeing up time to work on adherence solution and putting their patients on the path to better health outcomes.

High out-of-pocket costs lead to medication abandonment

Due to cost constraints, some patients are left to choose between food and lifesaving medications. This should never have to happen. Recently, medication costs have gained the media spotlight, sparking action from legislators. Federal and state governments are enacting legislation to lower out-of-pocket prescription costs, with some states even going as far as producing their own insulin. Surprisingly, pharmacists can play a big role here as well by using Change Healthcare’s tools such as Rx CardFinder™ Services and Rx Assist, which includes Voucher on Demand, AutoRedeem™, and Inform.

Change Healthcare’s tools to improve medication adherence

Rx CardFinder allows the pharmacy staff to locate the patient’s prescription insurance card if the patient does not have a copy, thus improving customer service as well as reducing medication abandonment. The cost of brand medications can be a deterrent to patients beginning a new therapy. Voucher on Demand and AutoRedeem both address that issue. Voucher on Demand automatically reduces the brand copay for patients on claims returned from payers to a more reasonable amount, based on the brand’s business rules. This process is seamless for the pharmacy, which receives a real-time alert to inform them of the reduction. AutoRedeem enables prescriptions rejected as “not covered” under a patient’s existing benefits to nevertheless be filled by the pharmacy in cases where the brand chooses to subsidize all such scripts. This conversion ensures that the patient leaves the pharmacy with their medication in hand even when a brand has payer challenges or is still building payer access through launch. Converting a patient’s maintenance medication from a 30-day supply to a 90-day supply has been shown to increase medication adherence. The Inform 30-to-90-Day Conversion tool prompts the pharmacy to extend a script fill to 90 days, as allowed by the payer, by displaying an alert within the pharmacy’s existing workflow—before sending any claim to the payer. The Inform Lapsed User Reacquisition tool monitors patients to identify those who fail to fill a script within a defined time limit. Patients exceeding that limit are flagged as an “opportunity” for the pharmacist, who can then act on that opportunity by filling the lapsed script when the patient comes to the pharmacy for any other medication, making this seamless for the pharmacist to help improve the patient’s medication adherence.