The Scope and Significance of Medication Adherence – Part Two

This is part two of a two-part series on the state of medication adherence in the United States. You can find the first post in the series here.

In part one of our medication adherence series, we covered the basics of the significance and value of medication adherence in the healthcare system. Here, we dive deeper into evidence showing that higher levels of medication adherence are associated with improved health outcomes and lower healthcare costs, plus strategies for improving medication adherence practices.

Common Barriers

Several things can impact the likelihood of a patient adhering to a medication regimen. The factors contributing to patient non-adherence may include demographic, cultural, and behavioral barriers, plus provider and health system barriers such as disease and medication-related issues. Stakeholders first need to understand these issues that keep patients from using their prescribed medications before the healthcare system can realize the full potential of improved health outcomes and cost savings driven by higher medication adherence.³

Next Steps

Once barriers have been identified, it’s time to target strategies and tools needed to improve medication adherence. Two key requirements regarding strategy are that the approach needs to be comprehensive, targeting more than one dimension with multiple interventions, and secondly, that the approach is patient centric. In essence, the evidence largely shows that patients who are adherent to their medications have more favorable health outcomes such as reduced mortality and use fewer healthcare services, especially hospital readmissions and ER visits.¹⁴

Does Medication Adherence Really Save Payers Money?

Medication non-adherence amounts to over $300 billion in annual wasted costs in the U.S. alone,¹³ making it possible for medication adherence programs to generate annual healthcare cost savings in the hundreds of billions if implemented correctly.

We’ve watched payer-driven efforts to contain rising healthcare costs grow significantly over the last decade. As a result, prescription drugs have increasingly been subject to utilization management policies, including tiered formularies and patient cost-sharing for branded products. However, research shows that increased cost-sharing can result in unintended patient non-adherence and is associated with lower rates of prescription initiation, poorer adherence to treatment, and more frequent discontinuation of therapy.¹⁵ Furthermore, copayments, formulary restrictions, and high-deductible health plans may lead to non-adherence.

Now that we’ve acknowledged how non-adherence increases costs, let’s put into perspective how higher levels of medication adherence can improve health outcomes and lower costs. Studies have shown that for every cost increase related to prescription drug spending for adherent patients, the medical cost decreases. Furthermore, there are estimated medical cost offsets of $10 for every additional dollar spent on medicines for adherent patients.³

What Payers Can Do to Address and Improve Medication Adherence

Payers in the private and public sectors are realizing the potential economic and health benefits of better medication adherence but are increasingly challenged to provide new solutions to address the healthcare and economic impacts of non-adherence.¹⁶

Financially responsible for the medical costs of their populations and focused on long-term consequences of non-adherence, health plans are looking at a variety of strategies to cure their part of the problem.¹ Many have implemented programs that incentivize their members to take a more active role in ensuring the appropriate use of medications. Some of the most profitable and successful payer organizations have leveraged these strategies to improve adherence, and other payers can utilize the same techniques to improve beneficiary medication adherence.¹⁸

Patient Perspectives

Patients want relief without losing quality, and payers and healthcare professionals desire to meet that challenge. There is value in a collaborative approach that provides the benefit of multiple touchpoints to assess non-adherence and the factors that influence it accurately.

Collaborative interventions, including team-based or coordinated care, can increase adherence rates. In one study, patients assigned to team-based care were significantly more adherent, with patients reporting that the approach improved their comfort in asking clarifying questions, raising concerns about their medication regimen, and collaborating in developing their treatment plan.¹

The Bottom Line

All stakeholders in the healthcare system have a role in ensuring patients can appropriately access and utilize their required medications. This includes patients themselves, healthcare professionals, health systems, third-party payers, governmental agencies, and policymakers.

Continue to part three to learn more about the benefits of medication adherence and the impact of non-adherence.