By AJ Loiacono, co-founder & CIO, OneRx LLC
When a doctor dispenses a medication, the expectation is that it will be taken exactly as prescribed. But most patients don’t follow their doctor’s orders. Justifications like, ‘The medication was too expensive’, ‘If one pill is good then two pills should be twice is good’ or ‘I didn’t understand the directions on the label’ are unfortunately common.
Non-adherence is the number of doses not taken or incorrectly taken, which jeopardizes a patient’s therapeutic outcome. This trend is becoming more pervasive, with rates ranging from 30 to 60 percent. Truveris, the health information technology firm, processes 300 million medication claims per year and has seen adherence rates for anti-diabetic drugs, for example, hover at around 52%.
The noncompliance phenomenon has health-related implications as well as serious financial impact, costing our nation’s health system $290 billion every year. For instance, medication non-adherence causes 10 percent of hospital readmissions and up to 25 percent of all nursing home admissions.
There are many reasons why patients fail to take medication as prescribed but, broadly, they fall into three categories:
- Behavioral. This includes not understanding the medication or regimen
- Attitudinal. Encompasses forgetfulness or a desire to avoid unwanted side effects
- Economical. Many patients simply cannot afford their medication
According to a study by the Boston Consulting Group, the top reasons for non-compliance include forgetting to use the medication or refill it, a desire to avoid unwanted side effects, and high costs.1
While improved patient-provider and patient-pharmacist communication may increase compliance rates, technology – including apps – can also play an important role in addressing barriers to medication adherence.
But the majority of apps available today tackle behavioral or attitudinal barriers to medication adherence. Pill reminder systems and health education apps, including tailored mobile interventions, for example, are popular in this market.
Economic barriers to medication adherence, however, are discussed less frequently, even though it’s the third biggest driver of noncompliance. Meanwhile, as we have all recently seen in the news, patient costs for drugs are only increasing. As drug costs continue to rise, so does medication non-compliance. But there are solutions available.
On the whole, medication costs are increasing for brand, generic and specialty drugs. Truveris’ National Drug Index, which provides a holistic measurement of the price pharmacy stakeholders are paying for drugs, increased about 11 percent over the past year.
Meanwhile, on the patient side, more employers are shifting costs to workers in the form of higher premiums and co-pays.
There is a reason this is occurring –– employers will face the Cadillac tax in 2018 and many have no choice but to start taking measures to curb their health benefits costs. The Cadillac tax was created as part of the Affordable Care Act. Starting in 2018 employers will pay a 40 percent tax on costs of health plans that are above $10,200 for individuals or $27,500 for families. The Kaiser Family Foundation estimates this will affect one out of four companies. To control or at least mitigate costs, employers are migrating a growing percentage of their workforce to high deductible health plans, which places a greater burden on employees to shoulder more of the cost.
To navigate this increasingly complex landscape, consumers, employers and insurance companies require more transparency around how much medications actually cost. The logic goes that if a consumer doesn’t know what a drug costs, he won’t know if he’s overpaying.
We are seeing a rise of mobile tools that aim to combat this trend – and promise to display drug prices, or provide pharmaceutical coupons and discounts. However, most apps only fill in part of the equation. However, some apps do provide a robust, unbiased solution that meets employee and employer needs, whether users have insurance or not.
It’s important to weigh your needs and find the tool that’s right for you.
With the Affordable Care Act, 90 percent of Americans now have health insurance. It’s critical that cost-savings solutions are available to insured and uninsured consumers in order to boost medication adherence. Enabling insured individuals to find prescription savings on their mobile devices is a step in the right direction. The result is a healthier and more productive workforce.