Why medication non-adherence is a big problem — and what employers can do about it

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Prescription medications are usually a key element in the treatment of both common chronic healthcare conditions such as diabetes, heart disease, asthma, depression and chronic obstructive pulmonary disease as well as illnesses such as cancer and HIV/AIDS. But patients cannot benefit from medications that they do not take or fail to take as prescribed. Of the more than four billion prescriptions written every year in the U.S., more than 50% of them are taken incorrectly or not at all, according to some researchers.

Medication adherence is a large and growing issue that has an impact not only on patients’ health, but also on employer finances. Not adhering to medications has been linked to 30-50% of treatment failures and 125,000 deaths each year, according to statistics gathered by the American College of Preventive Medicine. In addition, non-adherence results in $290 billion in annual healthcare spending, $100 billion of which is due to hospitalization and rehospitalization that could have been avoided if medications were taken as prescribed.

Employers bear the brunt of lost productivity when employees are hospitalized due to non-adherence or are too ill to work. Non-adherence also can increase health insurance utilization and the utilization of more expensive services, such as emergency department visits and in-hospital care to manage the health crises that occur when employees do not take their medications as prescribed.

There are a variety of reasons that employees fail to take or even fill their prescriptions. For some, the barrier is cost, a problem that becomes even more acute as the list of extremely expensive medications to treat a range of health problems grows, from hepatitis C medications that cost from $73,000 per year to nearly $88,000 per year to new cancer drugs for leukemia, metastatic prostate cancer and some types of lung cancer that cost from more than $12,000 per month to more than $64,000 per month.

Side effects, fear of side effects or lack of understanding of why the medication is prescribed and how and when to take it is another problem, especially for the more than 42% of Americans who are living with multiple chronic conditions and take multiple medications according to statistics from the Rand Corporation. Another reason for non-adherence is that patients stop taking medications when they do not have symptoms or feel better, even though the underlying health problem still requires medication to treat the disease.

How to build a plan to increase medication adherence

Because the causes of non-adherence vary, a plan to increase medication adherence needs components that address each of these causes. Before starting to build a plan, however, employers should examine their insurance claim data to pinpoint which employees are not following their physician’s medication plans and which conditions have the highest dollar claims for both the medications prescribed and treatment for complications caused by failure to take the medications as prescribed. Population health analytics tools can provide employers with the information needed. With that information in hand, insurance providers or other vendors can develop a HIPAA-compliant plan to reach out to these employees and help improve adherence.

Some of the key components of an employer plan to increase medication adherence, decrease the risk of complications or worsening health problems that may result when employees do not take prescribed medications, and lower costs associated with the health and productivity problems that arise from non-adherence include:

Employee coaching and support teams. When employees have access to case managers who work one-on-one with them to ensure they understand why taking their medication is important, how to take the medication correctly, how to manage side effects, and what lifestyle changes they can make to improve their health and better manage their condition, they are more likely to take the medications they need.

Financial incentives to encourage medication adherence. Incentives designed to encourage employees to take their medications, for example waiving or lowering the co-pays required for drugs needed to treat chronic health problems, can encourage employees to stick to their prescription regimen.

Ensuring that the most appropriate medications are prescribed. In the case of very high-cost drugs, employers can partner with specialty pharmacies or consultants that can help ensure that the most appropriate medications are being prescribed and that medications are provided at the best price available.

Prescription management to avoid interactions and other dangers. Providing case management or employee support services that gather, review, and reconcile employees’ health records and prescriptions can reduce the risk of duplicate prescriptions, the prescribing of medications that may interact, and the over prescription of medications. This is especially important for employees who see not only a primary care physician, but also specialists to manage their conditions.

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