Three reasons for nonadherence

People have a hard time keeping their different medications straight and taking them as directed. This problem is exacerbated when medications are due to be refilled on different dates. For the patient, this means more trips to the pharmacy and doctor, increasing the chance that they will forget to pick up a medication or will deviate from a care plan. This is a serious problem for patients with chronic conditions: According to the CDC, hospital admission rates increase for nonadherent patients with chronic illness by up to 69%. For managed care organizations this has a number of consequences, from diminished treatment effectiveness to adverse health outcomes for their members and increased costs associated with disease progression.

This should come as no surprise to managed care executives. Many managed care organizations are likely to have programs already under way to prevent gaps in medication regimens. Yet, the problem, it would seem, continues to evade an effective solution. The scale of this issue is staggering: Some estimates point to about 125,000 deaths per year in the United States due to medication nonadherence alone. In addition, poor medication adherence is estimated to have a “resultant cost of approximately $100 billion a year.”

A recent study conducted by Humana and the University of Pennsylvania may help to shed light on at least one dimension of this challenge. But first, it’s important to review why so many patients today remain nonadherent.

What causes nonadherence?

There are many, varied reasons why patients might not be taking their medication as prescribed. Here are three reasons for nonadherence:

• Cost barriers. Sometimes, they can’t afford it. According to the CDC, “Some adults offset the cost of prescription drugs by reducing the dosage and frequency of the recommended pharmacotherapy.” These patients take their medication less frequently than recommended in order to make their prescription last longer and save them money.
• Negative beliefs. Others hold negative beliefs about their medication. Negative beliefs could encompass thoughts that the patients’ doctor does not understand them, fear of becoming dependent on the medication, and thinking that their medication is ineffective, or that taking it could disrupt their life. Whether caused by negative beliefs, issues with cost, or simply forgetting to take the medication, nonadherence affects more than just a small group of people-in fact, some research estimates that up to 50% of patients are medication nonadherent. 
• Behavioral economics. While we may be aware of some of the specific reasons why patients are not taking their medication as prescribed, we can take this a level deeper by exploring the field of behavioral economics. This can be described as “A theory stating that there are important psychological and behavioral variables involved in the economic decisions of consumers or countries.” 

Put simply, people often take actions or make decisions that conflict with their long-term interests-for example, skipping a gym session, eating pizza for lunch instead of a salad, texting while driving, or not taking their medication as prescribed. Through behavioral economics, we can consider these psychological and emotional factors and help guide patients to better outcomes. Understanding behavioral economics also helps us create solutions that make it easier for people to take their medication when and how they’re supposed to.  

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