Payor, Provider, and Pharmacist Collaboration: Improving Medication Adherence

Medication adherence continues to be a serious public health issue in the US, with about 67 percent of patients being non-adherent with prescribed medications.¹ Non-adherence accounts for about 50 percent of treatment failures, 125,000 deaths each year, and increased healthcare costs, especially when it comes to the management of chronic conditions.²

Payors, providers, and pharmacists can work collaboratively to ensure patients adhere to timing, dosage, and frequency for prescribed medications. 

Factors Impacting Non-Adherence

The first step in improving adherence is understanding and acknowledging the contributing factors. Common reasons patients do not adhere to prescribed medication regimens include:

1. Affordability/insurance coverage: One in four Americans taking prescription medications cite affordability as a reason for non-adherence.³ The high cost of prescriptions and copays results in some patients skipping or delaying filling a prescription, missing or reducing doses, or using someone else’s medication. Plus, about 30 percent of prescriptions are never filled.⁴ Additionally, underinsured adults were more likely not to take prescribed medication due to cost, as compared to those with some type of insurance.⁵

1. Health literacy and social determinants of health: A lack of understanding of a disease or condition, the medication’s purpose, or the consequences of nonadherence may all contribute to poor adherence.⁶ Additionally, health literacy is closely tied to social determinants of health, such as income, education, cultural beliefs, and lack of family/community support. Related to these may be challenges like a lack of transportation or being unable to take time off from hourly-wage jobs to pick up prescriptions reliably and consistently.⁷

1. Adverse events and medication regimen complexity: Side effects can play a major role in nonadherence, and fear of side effects may impact even filling or starting a medication. The complexity of the medication regimen can also be a challenge; patients have many medications to remember at different times throughout the day, only take certain medications on certain days of the week or have a condition that requires frequent dosing changes. ^8,9 Unpleasant methods of administration (such as self-injections or infusions) may also contribute.¹⁰

1. Personal factors: A patient’s physical, mental, and psychological condition, along with the progression and severity of their condition, may make some patients unwilling or unable to adhere consistently. Physical and intellectual disabilities, substance abuse, and simple forgetfulness must also be taken into consideration.¹¹ Mistrust of providers or the medical system or hesitation to use medications may also play a role.
2. Lack of communication with or support from care teams: Patients who don’t have open and honest relationships and two-way communication with their provider may be less likely to adhere to treatment regimens. Likewise, a lack of personal connection with pharmacists, who can be an invaluable community resource, can also affect adherence. 

Specialty pharmacies, payors, and providers who foster collaboration can positively impact non-adherence, which is extremely costly for the healthcare system due to unnecessary complications and their associated expense.  

How Collaboration Helps

Payors, providers, and pharmacists working together and proactively communicating – with one another and with patients – can reduce medication non-adherence through:

• Patient education and engagement

Strong communication, easy-to-understand information, and patient engagement in the care plan may increase patient satisfaction, compliance, and payor and provider loyalty.^12,13 Payors, providers, and pharmacists opening lines of communication among themselves about patients’ care and therapy/treatments is the first step to improving medication adherence. Then, collaborative decisions can be shared with and explained to the patient, creating an accessible environment where the patient feels confident in the care plan and therapy/treatment.

• Financial and personal concern assistance

Helping patients afford and promptly receive their medication should be part of an adherence strategy.¹⁴ Providers, pharmacists, and payors who work together to identify the most affordable medication options and the proper dosage help streamline prior authorizations, access to financial assistance programs, and other issues. Specialty pharmacies typically offer support for these services, removing some of the burden from providers while collaborating with payors. Specialty pharmacies can also help expedite the filling and renewal of important medications, home delivery, hands-on injection training, and patient education and support.

• Reducing medication regimen complexity

Non-adherence may increase when patients are taking multiple medications and when dosing frequency is high.¹⁵  Providers and pharmacists can work with payors to select long-lasting and/or combination drugs that help simplify treatment regimens. Providers and pharmacists can adjust medication schedules so that multiple medications can be taken at the same time and coordinate efforts on refill reminders and necessary patient education. They can also synchronize refills of multiple medications to the same day and automate refills for patients with chronic conditions (as allowed by state and federal regulations). 

• Monitoring and addressing non-adherence

Medication adherence programs like those provided by specialty pharmacies include patient monitoring, proactive education and counseling, and medication refill synchronization to enhance compliance and reduce overuse or underuse. For payors, disease management programs that help patients manage chronic conditions like diabetes, heart disease, and asthma can flag medication noncompliance, which is then communicated with the provider and/or pharmacist. 

It Takes a Team

Medication adherence is a multifaceted challenge and therefore must be addressed in a multifaceted fashion through collaboration and coordination. When payors, providers, and pharmacists work as a team, they can ultimately improve health outcomes and reduce healthcare costs.

References:

1. Magellan Health Insights, “Prescription Predicament: The Impact of Rising Drug Costs on Medication Adherence.” February 19, 2024. https://www.magellanhealthinsights.com/2024/02/19/prescription-predicament-the-impact-of-rising-drug-costs-on-medication-adherence/#:~:text=Medication%20adherence%20is%20a%20primary,Americans%20who%20are%20non%2Dadherent.
2. US Pharmacist, “Medication Adherence: The Elephant in the Room.” January 19, 2018. https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room#:~:text=Medication%20adherence%20can%20affect%20quality,outcomes%2C%20and%20overall%20healthcare%20costs.&text=Nonadherence%20can%20account%20for%20up,year%20in%20the%20United%20States.
3. KFF. Poll: Nearly 1 in 4 Americans Taking Prescription Drugs Say It’s Difficult to Afford Their Medicine… March 1, 2019. https://www.kff.org/health-costs/press-release/poll-nearly-1-in-4-americans-taking-prescription-drugs-say-its-difficult-to-afford-medicines-including-larger-shares-with-low-incomes/
4. Annals of Internal Medicine. “The Incidence and Determinants of Primary Nonadherence with Prescribed Medication in Primary Care: A Cohort Study.” April 1, 2014. https://www.acpjournals.org/doi/10.7326/M13-1705
5. NIH Data Briefs. Characteristics of Adults Aged 18–64 Who Did Not Take Medication as Prescribed to Reduce Costs: United States, 2021. June 2023. https://www.cdc.gov/nchs/data/databriefs/db470.pdf
6. Oman Medical Journal. Jimmy B, Jose J., Patient Medication Adherence Measures in Daily Practice. March 2023, 26(3):155-159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191684/#:~:text=Non%20adherence%20can%20also%20occur,unusual%20times%20during%20the%20day.
7. NIH. Transportation Barriers to Health Care in the United States: Finding from the National Health Interview Survey, 1997-2017. June 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204444/
8. Iuga, A. O. & McGuire, M. J. Adherence and health care costs. Risk Manag. Healthc. Policy 7, 35–44 (2014). https://www.dovepress.com/adherence-and-health-care-costs-peer-reviewed-fulltext-article-RMHP
9. Oman Medical Journal. Jimmy B, Jose J., Patient Medication Adherence Measures in Daily Practice. March 2023, 26(3):155-159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191684/#:~:text=Non%20adherence%20can%20also%20occur,unusual%20times%20during%20the%20day.
10. Kvarnstr K, Westerholm A, Airaksinen M, Liira L, Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research, Pharmaceutics, July 2021, https://www.mdpi.com/1999-4923/13/7/1100
11. Oman Medical Journal. Jimmy B, Jose J., Patient Medication Adherence Measures in Daily Practice. March 2023, 26(3):155-159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191684/#:~:text=Non%20adherence%20can%20also%20occur,unusual%20times%20during%20the%20day
12. Bussell J, Cha E, Grant Y, Schwartz D, Young L, Ways Health Care Providers Can Promote Better Medication Adherence. Clin Diabetes 1 July 2017; 35 (3): 171–177. https://doi.org/10.2337/cd016-0029
13. Schoenthaler A, Knafl, G, Fiscelle, K, Ogedegbe, G, Addressing the Social Needs of Hypertensive Patients: The role of Patient-Provider Communication as a Predictor of Medication Adherence, Circulation: Cardiovascular Quality and Outcomes, Vol 10 No 9, https://doi.org/10.1161/CIRCOUTCOMES.117.003659
14. Kvarnstr K, Westerholm A, Airaksinen M, Liira L, Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research, Pharmaceutics, July 2021, https://www.mdpi.com/1999-4923/13/7/1100
15. Oman Medical Journal. Jimmy B, Jose J., Patient Medication Adherence Measures in Daily Practice. March 2023, 26(3):155-159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191684/#:~:text=Non%20adherence%20can%20also%20occur,unusual%20times%20during%20the%20day

 

Legal Disclaimer: This article is not intended to diagnose, treat, or cure any medical condition. Individual experiences with medication adherence and treatment regimens may vary, and healthcare decisions should always be made in consultation with a qualified healthcare provider who can offer personalized advice based on a person’s medical history and condition. By accessing this article, the reader agrees to hold harmless the author and any associated parties from any claims, liabilities, or damages arising from the use or interpretation of this content. 

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