Medication Non-Adherence: Solving an Eternal Challenge

By Matt Phillion

Medication non-adherence costs us a half-trillion dollars per year. Sixteen percent of U.S. healthcare spending goes toward unnecessary costs associated with patients not taking their medications. But when you take a step back, it’s easy to see that the root issue is “not a genetic problem, it’s a ZIP code problem,” notes Jason Rose, CEO of AdhereHealth. The industry needs to focus on the right tools to help guide these patients toward better adherence for higher-quality outcomes and improved healthcare spending.

“When you dig deeper into who’s at highest risk, predominantly you’ll see the focus on underserved communities,” says Rose. “Patients who live in pharmacy deserts, food deserts, who have lower health literacy, who aren’t able to pay for the drugs—all the social determinants of health that cause these issues.”

Zooming out to a broader context, Rose notes, the pharmacy process today is very much reactive. The doctor sees the patient, diagnoses them with a medical condition, and prescribes the meds—but after that, the doctor may never know whether the patient has filled that prescription or whether they’re taking it adherently.

“The providers don’t have the data to understand the current adherence level, or if they took the prescribed drug at all,” says Rose.

Healthcare plans for the underserved markets, which include patients using Medicaid, Medicare Advantage dual eligibles, or a healthcare exchange, offer limited options under the current pharmacy setup; there is also limited technology focusing on which patients are best served by which type of pharmacy.

“Digital pharmacies really focus on ensuring good connectivity with the patient—Amazon PillPack is king of the hill in terms of digital pharmacy today—but Amazon PillPack and pretty much all the other digital pharmacies are not focusing on Medicaid and Duals,” says Rose. “They may not even have [the] licensure to dispense to a Medicaid population.”

This situation presents two major problems: high-risk populations may not be getting their meds, and healthcare lacks technology that focuses on these populations’ additional needs, like food, water, shelter, and transportation.

AdhereHealth is working with health plan providers to address this challenge with AdherePack™.

“The health plans have timely access to medical diagnoses, eligibility for benefits, and also know what medications their members filled and how often they’ve filled them,” says Rose. “They have all the data, and it comes through in a timely manner. Within a day or two it’s adjudicated, and it’s a robust data set.”

What the plans don’t do, however, is broad-based analytics: identifying a patient who was diagnosed with a particular condition but never filled their prescription, for example. For better medication adherence, healthcare providers need to know which patients with certain diagnoses have started their medications; which patients are taking them adherently; and whether patients are stopping a medication appropriately when they receive a replacement medication or have a similar change in their drug regimen.

“The lack of analytical firepower to diagnose those areas for medication adherence is one of the causes of unnecessary costs,” says Rose.

Room for improvement

AdhereHealth identifies those issues and provides a list of patients to the healthcare plan management team. “It’s a very dynamic situation for each patient,” says Rose. “Our analytics identify which patients are high risk and high cost.”
The analysis identifies patients who would benefit from some kind of compliance packaging: patients on eight or more drugs; patients who change their medications with some frequency; and patients who work with multiple providers, multiple pharmacies, or multiple caregivers. All of these subsets can struggle with medication adherence.

“It’s a challenging environment for anyone, let alone the underserved market, to get all the drugs they’re supposed to take, and to obtain those drugs on a single day rather than an entire month of refills,” says Rose. “Compliance packaging can help them self-manage their drugs.”

Rather than have various prescriptions called in over the course of a month, requiring multiple trips to one or more pharmacies, matching patients with a delivery service that meets their needs can significantly help with compliance.

“I can have a private courier come to my doorstep with all the drugs I need for an entire month,” says Rose. “The patient can get on a routine, with dosage packaging, all of which overcomes many social determinants of health that most pharmacies never touch.”

The patient is enrolled, through a caregiver or some other method, and they receive four one-week sets of medications in blister packages or dosage strips. “It’s very similar to the Amazon PillPack, but the difference is it is for the underserved market,” says Rose.

Technology’s role

Pharmacies may try to assist underserved patients with many social determinants of health, but may not have the technology or data they need on a daily basis to effectively do so.

“For example, an organization focusing on Medicaid or Duals might send a specialist to do an inventory of the patient’s cabinet—which can be intrusive, and delays care,” says Rose. “And this inventory may or may not be the full list of medications that they should be taking.”

With the help of AdhereHealth, because the analytics are connected with the payer’s data, the organization will have the most up-to-date diagnoses and the meds the patient should be on, without sending a clinician to the patient’s home.

“We’re talking with the patients with a perspective of understanding them more deeply,” says Rose. “Understanding their ZIP codes, their pharmacy desert, we can talk with them to make sure they’re getting what they need and anchor all those drugs to a single data source.”
This enables reaching out to providers and caregivers for medication synchronization to avoid multiple, unconnected refills.

“This is really important stuff,” says Rose. “For example, a blind or disabled patient may not even be able to get to their mailbox, so having a private courier to their door is a big deal. Or if you have a mail-order prescription but may not have enough money for copays for 90 days.”

There’s also a lot of time and energy involved in medication adherence, he notes. Patients might be taking as many as 20 pills a day, and their caregivers do the brunt of the prep work, making multiple trips to the pharmacy every week and measuring out doses.

“When we talk with patients, we use motivational interviewing. What’s their world like?” says Rose. “Tell us about the medications you’re on, the diagnoses you’ve been prescribed medications for. Do you take these medications adherently? And they say, ‘Yeah, most of the time.’ But they might be splitting pills because they can’t afford the copay.”

The potential for error is high, too; a patient moved to a different statin may not know to stop taking the old one, for example. “Studies show 40% of readmissions are caused by medication adherence issues,” says Rose. “And it comes down to three areas: a new diagnosis but never filled the drug; if they did, were they adherent; and did they stop when they were supposed to.”

While the technology helps on the provider and pharmacy side, the idea behind AdhereHealth’s work is to focus on technology-enabled clinical workflows rather than force technology onto patients. “It’s not an app that sits on someone’s phone,” says Rose. “It’s on the back end, on fulfillment, making sure the right drugs go to the right patients.”

AdhereHealth touches about 30 million patients per year and stresses the importance of addressing these underserved patient needs. “It’s a major gap. I saw recently that there are 80 million Medicaid patients nationwide, and enrollment is at its highest ever,” says Rose.

Underserved groups of all kinds will need more help maintaining their health now and in the future. “As they grow older, as they experience new needs especially post-pandemic, there will be patients who will have issues with making ends meet to pay for their medications,” says Rose.

All of this builds into a growing trend in the healthcare industry to help patients get the care they need at home, reducing the need for assisted living or institutional, long-term care settings and hospital visits.

“The more we can make this transition—telepharmacy, telehealth, remote devices in the home—the better. The missing piece of that is, how do you get the right pharmacy for those patients to be treated at home?” says Rose. “And if you don’t have the underserved market covered, that’s a major gap. Fifty percent of Americans don’t take their chronic long-term therapy medications as prescribed … you’ve got all this high-tech equipment, but what about the drugs that are supposed to be taken easily, self-managed in a precise way?”

Patient experience, regardless of where a given patient is on the spectrum of social determinants of care, should continue to be a growing focus.

“My point of view is you have to look at things both qualitatively and quantitatively,” says Rose. “Obviously, it makes sense to improve patient health and experience, but these aren’t just stats. It’s someone you know who is hospitalized or worse because they weren’t adherent to their medications. It’s critically important for quality of life.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.