Medication adherence efforts demonstrate quantifiable impact

Half of the 3.2 billion prescriptions dispensed annually are not taken as prescribed. Pharmacy benefit leaders must reconsider the financial context of medication adherence and medication possession, according to industry leaders presenting at a recent online seminar for the Pharmacy Benefit Management Institute.

“We have this thought of medication adherence as something that’s nice to do, but we wouldn’t want to do it too aggressively because it might be a budget buster,” said James Notaro, president and founder of CSS, a medication therapy management firm. “We have learned that medication adherence isn’t just a nice thing to do.”

Specifically, Notaro said, medication adherence can demonstrate overall cost reductions as well as reduced hospital readmissions and improvements in Medicare star ratings for Part D plans. The strategy reflects competency and quality, but also results in quantifiable impact.

He said keeping patients on track with their medications after a hospital stay is key to reducing readmissions, which Medicare is examining closely. Hospitals are now penalized financially for readmissions of Medicare patients that are considered avoidable.

For Part D plans, the Centers for Medicare and Medicaid Services includes evaluation of medication adherence under the drug pricing and patient safety measures in the star-rating program. More stars translate to bonus payment for Part D plans.

Data is needed to support outreach efforts aimed at reducing non-adherence. For example, information for each patient should include comprehensive prescription information, insurance eligibility and the list of primary care providers to ensure thorough tracking and follow up.

Barriers that cause patients to get off track with their medication regimens might range from a lack of motivation to attitude to financial concerns. Notaro said motivation can be addressed with reminder support services, but many other barriers must be addressed with clinical support. For example, a patient that shows adherence as low as 20% or 25% is probably experiencing a clinical or social issue, rather than a motivational one.

He believes the next year will bring more sophisticated tools to address non-adherence as the practice comes to the forefront.

According to Kevin Boesen director of medication management for Express Scripts, a national pharmacy benefit manager, outreach programs must closely track medication possession, using different approaches for each situation. Some patients are switched from one drug to another, for example, while others might fill a 90-day prescription early. Such situations would appear to produce gaps in adherence, but the gaps would not actually require intervention.

Also, outreach programs must consider appropriate thresholds for medication possession based on the particular drug. For example, HIV drugs must be taken consistently to prevent the disease from progressing. In this case, an intervention might be triggered when a patient’s medication possession only falls slightly-to 85% or 90%. The same is true for specialty drugs, Boesen said.

One concern among plan sponsors is the effect manufacturer coupons might have on patient behavior. While the coupons offer patients lower out-of-pocket costs and would increase adherence, they also drive the use of more costly brand drugs.

“We’re not a big fan of those programs unless you’ve incorporated them into your cost structure,” Notaro said. “Cost effectiveness should be working in conjunction with adherence programs.”

In fact, the Pharmaceutical Care Management Assn. estimates that copay coupons will add $32 billion in costs for plan sponsors between 2011 and 2021 if today’s trend continues. Further, the association notes that the programs work against formulary management strategies such as value-based designs and financial incentives to opt for generics.