Patients believe in adherence but don’t act on it

Medication nonadherence costs the U.S. healthcare system about $290 billion per year, according to New England Healthcare Institute. That big and scary number — the kind whose sheer enormity can make one’s eyes glaze over — is now even bigger.


According to the most recent drug trend report by pharmacy benefit manager Express Scripts, patients failing to take their medications as prescribed cost the country $317 billion. Included in that is the $105.8 billion in waste that results from nonadherence among patients with the three most common chronic disease states: diabetes, high cholesterol, and hypertension and heart disease.


The reasons why nonadherence is such a crisis remain unchanged: Patients who don’t take their drugs as prescribed face higher risks of complications. For the top three disease states, that means higher risks of heart attacks, strokes, heart failure, amputations, blindness and kidney disease, among others. But while nonadherence is a serious medical problem, it’s also a social problem that results from a variety of causes, and thus isn’t as simple as a miracle-pill panacea. Fortunately, patients are taking it as seriously as pharmacy retailers, PBMs, prescribers and drug makers. According to a recent survey of 40,000 adult patients taking a medication to treat at least one chronic condition, 90% agreed that taking medications as prescribed was important, while 81% agreed that skipping doses was bad for their health. In addition, respondents ranked taking medications as prescribed as the most important health behavior, above not smoking, eating healthily, getting enough sleep and getting enough exercise.


But just because patients say adherence is important doesn’t mean they themselves are adherent, even if they think they are. The ESI survey found that 85.2% of respondents reported taking their medications as prescribed at least 80% of the time, but other research has indicated adherence rates may be less than 50% in some cases. In another survey, the PBM measured adherence using patients’ medication possession ratio, a measure estimated by dividing the days’ supply of medication that a patient has on hand by the number of days for which it should be available. The least adherent patients in the survey reported perceived medication possession ratios of 90.3%, but their actual MPR was 24.3%. 


Meanwhile, in late March, CVS Caremark released results of its own medication adherence studies, with one focusing on state-by-state performance. States were ranked as gold, silver or bronze depending on a mix of adherence measures, including MPR, percent optimal MPR, first-fill persistency rate, generic dispensing rate and mail dispensing rate across the top three disease states, as well as depression, in addition to including various demographic and healthcare access measures. The “State of the States: Adherence Report” was based on a review of CVS Caremark’s pharmacy benefit management claims data.


Walgreens also released its own adherence studies in April, presenting results at the Academy of Managed Care Pharmacy’s annual meeting in San Francisco. The studies focused on three programs, including the Prescription Savings Club, pharmacist-led patient counseling and the Walgreens HIV Centers of Excellence pharmacies. The studies found that Prescription Savings Club members were 77.9% adherent to diabetes medications, compared with 68% among nonmembers. Meanwhile, patients with new statin and thyroid drug prescriptions who received pharmacist-led counseling saw their medication possession rates increase from 44% to 56% in the space of one year, while 62% of HIV patients who went to Walgreens’ HIV Centers for Excellence had adherence rates of 85% or more, compared with 57% of patients using community pharmacies.