The Role of Medication Adherence in Health Outcomes

When it comes to improving population health outcomes, access to the most common prescriptions--used to treat common and costly conditions like diabetes, heart disease, hyperlipidemia, and hypertension--is only half the battle.

The other half? How compliant your workforce is in taking those medications correctly.

The U.S. sees 3.8 billion prescriptions written annually. That's across more than 131 million Americans, or 66% of the adult population. However, roughly 1 in 5 are never filled. Of those that are filled, half are taken incorrectly, whether due to timing, dosage, frequency, and/or duration.

In sum, this chronic nonadherence contributes to anywhere from $100-$300 billion annually in the U.S., including nearly 125,000 deaths and 10% of hospitalizations.

If a working population is struggling to remain compliant with their medication(s), it's impacting more than their long-term health. It's impacting their organization's health benefit bottom line.

The reasons for nonadherence

The reasons why a patient may not be compliant in taking their prescribed medications--or simply not fill their prescription at all--can be complex. It's often simply due to cost.

According to a 2017 NPR-partnered health survey, the high cost of prescription drugs is what drives 67% of patients into medication non-adherence. For those who make under $25,000 per year, that percentage jumps to 94%.

Research from the Health Policy Institute found that, among adults who report poor health, 1 in 4 between the ages of 51 and 64 report they've taken less medication than prescribed in the past two years due to cost.

Marathon Health Regional Medical Director Dr. Kelly DeMeyere-Coursey says, "Affordable access is key to a patient’s ability to obtain their prescriptions. I can prescribe a medication all day, but if the patient can’t afford it, there’s little chance they’ll go to pick it up."

But pricey prescription fills are not the only reason American workers fail to take their medications correctly. It's often related to forgetting or misunderstanding prescription instructions, forgetting refills, lack of engagement in treatment decisions, adverse side effects, and mental health conditions that impair compliance.

A CDC study found, of self-reported reasons for nonadherence, the three most commonly given were "forgot," "ran out," and "away from home." This indicates that providing affordable access to prescriptions within a workforce, while vital, only addresses one side of the nonadherence puzzle.

Cost, convenience, and counseling

If you're in charge of a health benefit for a workforce, consider whether you have a pharmacy management solution that answers the three C's of medication adherence:

1. Cost - does my working population have affordable access to the most common medications needed for effective condition management?
2. Convenience - Is picking up or refilling a prescription easy for an employee? Can it be picked up during a lunch break, or does it require a commute across town? Is home delivery available?
3. Counseling - do my workers know how and when they need to take their medication(s)? Do they have time with a healthcare provider to ask questions? Are they engaged in their care plan?

While cost and convenience are easy-to-understand benefits of an effective pharmacy management solution, the importance of counseling is often understated. Why does it matter?

"My patients are more likely to trust me and take their medications when they feel as though I’ve shared all aspects of the medicine with them," explains Dr. DeMeyere-Coursey. "I will routinely schedule a follow-up appointment with my patients two to eight weeks after [a new medication] to make sure they are tolerating it appropriately and meeting their goals."

Avoiding unnecessary (and costly) care elevations

Having access to a medication in the same place it's prescribed can have a powerful impact on a patient's health journey. Dr. DeMeyere-Coursey provides a real-life scenario to highlight the significance, in which a patient is diagnosed with severe anxiety and is scheduled to follow up in six weeks.

Traditional Rx pick-up: "I have limited options of where to send their medication. I send it to a preferred pharmacy, which is 20 minutes away from the clinic. The patient leaves my office and in the 20 minutes it takes to drive to the pharmacy, they have talked themselves out of taking it and never pick it up. They go home and continue to suffer from anxiety.

After 3 weeks, they suffer a panic attack and go to the emergency room for a full, very expensive cardiovascular work-up, only to be told they have anxiety and be sent home feeling dismissed and dissatisfied."

On-site medication management: "I have the medication in the office and they can leave with it in hand. Since they already have it, they are more likely to take it once they get home. After three weeks, they begin to feel some decrease in their anxiety.

After six weeks, at our follow-up, they report their anxiety is cut in half and we can work together on further adjusting the medication to help them improve further."

Consider what you're paying for with traditional Rx management

Whether it's due to high costs, inconvenience, or a lack of counseling, consider how many members of your workforce are neglecting or improperly taking their prescriptions--and whether that's resulting in costly hospital visits and unnecessary work-ups. Are those high cost drivers impacting your health benefit's bottom line?

TotalRx^TM by Marathon Health is a comprehensive formulary for a working population that drives better outcomes across the board:

• Meaningful costs savings for clients and patients, including affordable access to the most effective medications
• Convenient distribution, including dispensing, retail and home delivery to ease patient burden
• Direct-to-patient education ensures medication adherence and helps eliminate overmedication
• Specialty medications to help patients live better and stay healthier
• Reduced risk and higher retention rates with a healthier, more engaged workforce
• Advanced analytics provide actionable insights, helping you fine-tune efficiency as needed

Learn more about our TotalRx by Marathon Health™ solution.