More Than Half of Patients in Many Disease States Are Non-Adherent

Study finds that $1 out of every $9 spent on health care is wasted due to non-adherence.

Medication adherence remains a significant ongoing problem across the US health care landscape, according to a recent study by Express Scripts.

The study found that more than half of patients across numerous disease states are not adherent to their medication regimens. In the United States, the estimated direct and indirect costs from non-adherence totaled approximately $337 billion in 2013.

At the US average of $9,255 per person in total health care spending for 2013, approximately $1 out of every $9 spent on health care was wasted due to non-adherence.

“Even when prescriptions are filled, patients may miss doses, take the wrong dose, stop treatment early or never start,” the report stated. “Any of these scenarios can lead to otherwise-preventable hospital admissions, emergency room visits, physician visits and medical tests.”

The study showed that 69% of patients are not adherence as a result of behavioral issues, such as forgetting or waiting to take their medication regimen. Patients prescribed multiple medications may also be confused by complicated dosing schedules.

Solutions to overcome these challenges include refill reminders or automatic renewals, encouraging 90-day fills, timers or specialized pillboxes to provide reminders, and setting simplified dosing regimens with pharmacists.

Home delivery may also prove to significantly improve adherence. Express Scripts found that multiple sclerosis patients who had home delivery had 32% higher adherence, 39% fewer hospitalizations, 39% fewer ER visits, and saved 31% annually on medical expenses. Rheumatoid arthritis patients with home delivery had 16% higher adherence, 9% fewer hospitalizations, 13% fewer ER visits, and savings of 16% annually on medical expenses.

Drug costs are another significant factor in medication adherence, as 16% of non-adherence is due to the high cost, according to Express Scripts. The study found that people with high-deductible health plans are more likely to be non-adherent due to a greater cost burden. Meanwhile, a value-based insurance design may increase adherence due to reducing or eliminating copayments and deductibles for drugs.

The study found that up to 32% of people on Medicare Advantage plans (Medicare Part C) take less medication than prescribed due to cost concerns. Potential remedies for cost issues include signing up for copay assistance programs.

Furthermore, 15% of patients are non-adherent as a result of debilitating side effects, which may require them to switch to a different medication or find effective coping mechanisms.

“Whatever the reasons for non-adherence, pharmacists are a resource to help patients get on track,” the report stated. “In addition to discussing issues and possible solutions, pharmacists can help patients understand why they need their medications or how discontinuing medications harms their health in the short and long term.”