13% of the $2.4 trillion U.S. health economy could be saved by improving adherence to medication, according to an analysis from the New England Healthcare Institute (NEHI).
Poor medical adherence leads to poor outcomes and increased medical costs, as described in NEHI’s report, Thinking Outside the Pillbox: a System-wide approach to improving patient medication adherence for chronic disease..
NEHI identified poor medication adherence as a key component in the overall waste and inefficiency in American health care, where poor adherence leads to preventable worsening of disease and increasing health risks — especially among people with chronic disease(s). Since 1 in 3 patients, minimally, do not take their meds as prescribed, the Rx adherence challenge is huge — 13% of total health spending in the U.S., or about $290 billion.
What is medication adherence? NEHI uses the World Health Organization definition: “any deviation from the prescribed course of medical treatment.” This can include a patient’s lack of Rx fill or renewal; failure to take medications at the prescribed dosage or interval; or failure to persist (that is, to continue to take the medication over time).
The barriers to adherence are well documented, including side effects, challenges in taking many meds to address multiple chronic conditions, peoples’ own belief systems, their ability to navigate the health system, lack of self-efficacy, avoidance of dealing with asymptomatic conditions like high blood pressure, and — as regular readers of Health Populi know — cost, cost and cost.
NEHI has come up with “three pillars of improved adherence:” reducing cost barriers, improving drug regimens, and addressing patient behaviors, which together deal with the various barriers detailed in the previous paragraph.
Health Populi’s Hot Points: One of the important and often overlooked stakeholders who can support the health citizen in managing medication adherence is the drugstore and retail pharmacy channel. The largest of these is CVS/pharmacy, with over 6,900 storefronts. This company needs to be trusted, up-close and personal with health consumers. To learn more about their core customer base, CVS just completed its 2009 CVS Caremark Health IQ Study, a web-based poll of 2,000 consumers who report taking at least one maintenance medication.
The survey quantified the reasons so many people fail to adhere to medication regimens; these included:
  • 43% who admit to simply having forgotten, on occasion, to take their meds
  • 21% of women who take five or more prescriptions each month and must remember to fill all of them on time
  • 47% of women who say they are more likely to forget to take their own meds than they are to forget to give meds to another family member
  • 34% (1 in 3 Americans) who sometimes stop taking meds if they feel worse while taking them
  • 26% of people who stop taking meds when they feel better
  • 21% who say they’re “careless” about taking their meds as prescribed.
13% of the interviewed respondents were not covered by a prescription drug insurance plan. About 1 in 10 consumers did not obtain annual check-ups overall — but 26% of those without prescription drug coverage did not seek an annual physical exam.
CVS Caremark has developed its ReadyFill program to help its customers with better adherence – particularly as it relates to filling prescriptions on time and picking them up (that is, avoiding Rx “abandonment”). This is one important piece of the medication adherence puzzle that NEHI admits is best served through multiple channels and strategies.