Increasing Medication Adherence in America

Q. What is medication adherence? . . .

  • A. Medication adherence occurs when a patient takes his/her medications according to the prescribed dosage, time, frequency, and direction. A breakdown in any one of these elements has the potential to reduce the effectiveness of medications in treating conditions, managing symptoms, or preventing disease progression. Studies show that:
    • Two out of three patients prescribed medication to do not adhere to their care plan.[1].
    • More than 1 in 5 new prescriptions go unfilled.[2].
    • Patients are non-adherent due for a broad range of reasons including cost sharing, treatment complexity, mental or cognitive limitations, and a lack of access to or communication with their physician.[3].

Q. What are the effects of poor medication adherence? . . .

  • A. Poor medication adherence, or non-adherence, limits effective management and control of chronic illnesses. Non-adherence increases the likelihood of preventable disease progression, increased hospitalizations, avoidable doctor and emergency room visits, and other problems arising from poor health, which can significantly increase costs. For example, it is estimated that:
    • 125,ooo Americans die annually due to poor medication adherence[4].
    • More than 1 in 5 new prescriptions go unfilled.[2].
    • Non-adherence is associated with an additional $2,000 per year per patient in physician visit costs[5].
    • Non-adherent patients with high blood pressure have a 5.4 times greater risk of hospitalization, rehospitalization or premature death than adherent patients[6].
    • Non-adherent patients with diabetes have a risk of hospitalization that is 2.5 times higher than adherent patients[7].
    • As many as 40 percent of nursing home admissions are due to non-adherence[8].
    • Poor medication adherence results in 33 to 69 percent of medication-related hospital admissions in the United States, at a cost of $100 billion per year[9].

Q. Why don’t Americans adhere to prescription medications? . . .

  • A. According to the Greenberg Quinlan Rosner/Public Opinion Strategies national poll, the most common reason for non-adherence is when patients forget to take their medication as prescribed. Other reasons for non-adherence include patients finding it inconvenient to take their medication, patients not taking their medication regularly once they start feeling better and confusion over how to follow their treatment plan.

Q. Tell me more about the Partnership. . . .

  • A. Prescriptions for a Healthy America: A Partnership for Advancing Medication Adherence is comprised of leading health care, consumer, patient, and industry organizations with the goal of bringing greater awareness to the value of medication adherence. The partnership also works to advance public policies that support improved adherence.

Q. How will medication adherence improve through this initiative? . . .

  • A. Medication non-adherence occurs for a number of reasons including complex social, financial and behavioral issues. Additionally, interventions that work for one subset of patients may be ineffective for another. An integral part of any solution to improve medication adherence is the use of incentives to reward a broad range of providers (e.g., physicians, nurses, pharmacists) and health plans for improving outcomes and lowering costs. The partnership will work to ensure that policymakers have the information they need in making decisions to promote medication adherence, reduce avoidable health care spending and help to improve the lives of patients and their families.

Q. What does the partnership support? . . .

  • A. The partnership supports practical policy solutions that address the range of challenges related to non-adherence. The partnership supports:
    • Incentives for care coordination and comprehensive medication management.
    • Improved quality measurement and healthcare provider and plan performance improvement.
    • Better use of health information technology.
    • Robust patient/provider education and engagement.
    • Additional research into which interventions work and which do not.

Q. What can Congress and the administration do to improve medication adherence? . . .

  • A. A recent national poll by Greenberg Quinlan Rosner Research and Public Opinion Strategies shined a light on possible tactics that could help improve medication adherence. Patients said the following actions would be very or somewhat effective:
    • Encouraging increased discussion between patients and doctors specifically about their medications, the risks associated with not taking them as prescribed and how to address any challenges to taking their medications (89 percent).
    • Changing how health plans pay for medications to allow pharmacists to sync a patient’s prescriptions so all prescriptions can be filled on the same day (87 percent).
    • Providing tools to help patients keep track of taking their medications, such as pill boxes, electronic devices or apps on their phones (86 percent).
  • Congress and the administration could pursue these approaches or use other tools at their disposal to improve medication adherence. For example, the administration might use its regulatory authority to expand comprehensive medication management, to build on the use of adherence quality measures in determining quality bonuses for Medicare health plans, and to facilitate the collection and tracking of adherence data through health information technology. Congress should pass laws to increase incentives for providers or health plans to promote care coordination and help patients access adherence resources with information about their medicines. Congress could also direct more funding towards research about how to improve adherence.
  • Small investments in medication adherence have the potential to produce big savings in federal and state health programs, while significantly improving the health of patients across the nation.

Q. Some of these approaches sound expensive. How much will all this cost? . . .

  • A. Last November, experts at the Congressional Budget Office documented the relationship between prescription drugs and medical spending in the Medicare program. They found that improved use of medicines lowers spending on health services. Going forward, the CBO will assume that an increase of 5 percent in prescriptions used by Medicare beneficiaries will result in a 1 percent reduction in medical spending. In addition, NEHI has estimated that improving adherence and related disease management would save $290 billion per year. Small increases in medication adherence could mean big savings for Medicare.

[1] Greenberg Quinlan Rosner Research. “Medication Adherence: A survey of adults nationwide.” Apr 2013.

[2] Fischer MA, Choudhry NK, et al. “Trouble Getting Started: Predictors of Primary Medication Nonadherence.” Am. J. of Med., 2011 November; 124(11): 1081.e9 – 1081.e22; See also, Fischer MA, Stedman MR, Lii J, et al. “Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions.” J. Gen. Intern. Med., 2010 April; 25(4): 284–290.

[3] L. Osterberg and T. Blaschke. “Adherence to Medication,” NEJM, Aug 2005; and M.R. DeMatteo, “Variation in Patients’ Adherence to Medical Recommendations: A Quantitative Review of 50 Years of Research,” Medical Care, March 2004.

[4] McCarthy R, “The price you pay for the drug not taken.” Bus Health. 1998;16:27-28,30,32-33.

[5] American Pharmacists Association, Medication Compliance-Adherence-Persistence Digest, (2003).

[6] Gawdry-Sridhar FH et al. “A Framework for Planning and Critiquing medication Compliance And Persistence Using Prospective Study Designs.” Clinical Therapeutics, 31, no 2(2009):421-435.

[7] Lau DT and Nau DP. “Oral Antihyperglycemic Medication Nonadherence and Subsequent Hospitalization Among Individuals with Type 2 Diabetes.” Diabetes Care. 27, no. 9 (2004): 2149-53.

[8] American Pharmacists Association, Medication Compliance-Adherence-Persistence Digest, (2003).

[9] Osterberg L, Blaschke T, “Adherence to Medication,” New Engl. J. Med., 2005;353(5):487-497; and NEHI. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. Cambridge, MA: NEHI; 2009.