Overcoming 3 Key Challenges of Medication Adherence for High-Risk Members

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For many Americans, taking prescription drugs is a routine – and essential – part of daily life and well-being. In the United States, more than 3.8 billion prescriptions are written annually with some patients requiring eight or more daily prescriptions to manage multiple chronic conditions and maintain a healthy lifestyle.

Maintaining medication adherence to complex drug routines; however, is no easy accomplishment. Approximately 20 percent of new prescriptions are never filled at all. And even when filled, approximately half are taken incorrectly as patients struggle with timing, dosage, duration, and other social determinants of health (SDOH) barriers such as food and housing insecurity.

Unfortunately, medication nonadherence takes a significant toll on patients, their caregivers and providers, and the health system at large. For example, 50% of Americans don’t take their chronic long-term therapy medications as prescribed. And every year, poor adherence contributes to over $500 billion  in avoidable healthcare costs and more than 125,000 potentially preventable deaths.

Many issues leading to nonadherence are rooted in various SDOH barriers, and health plans – and their partners – must take a comprehensive and proactive approach to identify common challenges and develop solutions to support their members to help them achieve better long-term health outcomes.

Here are three key challenges of medication adherence and how Medicare Advantage and other health plans can help members overcome them.


Challenge 1 – Pharmacy Access

While many suburban neighborhoods seem to have a retail pharmacy on every corner, people living in dense urban areas and rural communities face the opposite problem. “Pharmacy deserts” are a real problem across the United States and they typically affect underserved populations that already experience disparities in healthcare access and SDOH barriers such as lack of reliable transportation.

In 2014, researchers in Chicago found that pharmacy deserts were more common in highly segregated Black and Hispanic neighborhoods in the city. In a separate study, the same lead researcher found that pharmacy closures in impoverished areas lead to statistically significant declines in adherence to cardiovascular drugs, especially among older adults.

Health plans can help to ensure members have continuous access to their medications by partnering with digital pharmacies and offering mail-order services or delivery by private courier. A digital pharmacy can fill and send prescriptions directly to a member’s home which removes barriers like pharmacy deserts and lack of transportation that limit adherence for residents of regions where pharmacies are hard to access.  In addition, linking the health plan payor claims to the digital pharmacy provides a more holistic view of the patient’s medication regimen.  This will ultimately provide higher quality of care, better patient experience and decreased unnecessary medical utilization.

Challenge 2 – Prescription Drug Affordability

It’s no secret that the high cost of prescription drugs is a problem for many Americans. Prescription drug expenditures topped $356 billion in 2020, continuing a steep upward trend since the 1960s. In a 2019 survey, close to a third of Americans taking prescription medications confirmed that their out-of-pocket costs had recently increased. Those who experienced price hikes were almost twice as likely to not fill a prescription, actively avoid seeking other medical care, or even cut back on groceries and other necessities to afford their medications.

Since then, the COVID-19 pandemic has hit families particularly hard with dramatic spikes in unemployment and increases in other costs of living. Since consumers cut back on medical expenses when they fall on hard times and during economic downturns, it is critical for health plans to address affordability quickly or suffer declines in value-based outcomes.

Trained pharmacists or the use of proactive telepharmacy can help your members make sure they are taking the most affordable medication for their needs. Switching to generic drugs or equivalent alternatives could save significantly on out-of-pocket costs, control overall spending for health plans, and ensure they can stay adherent to their recommended treatment plans. Using an outbound data-driven telepharmacy team to identify opportunities to switch members to lower cost drugs that have the same benefits is helpful to both the patient’s pocketbook and the health plan pharmacy cost outlay.

Challenge 3 – Education About Prescription Drug Regimens for Chronic Diseases

Health literacy is a key socioeconomic issue that is tied to medication adherence.  Appropriate understanding of the purpose and importance of prescribed medications is a crucial part of being able to correctly follow treatment instructions. Multiple studies associate higher levels of health literacy with better adherence rates, yet many members find it difficult to interpret, remember, and follow dosing directions.

This is especially true when high-risk members take multiple drugs for more than one chronic illness.  Medications may have names that sound alike or have varying and/or confusing dosing instructions. Pills may be the same, or similar, shapes and colors as other prescribed medications and over-the-counters (OTC). Further, certain drugs may produce unwelcome side effects, or the member may believe it won’t be a problem to discontinue one of several different prescriptions for the same condition.

Educating members about the importance of consistent medication adherence and consulting a provider before stopping a prescription is crucial to achieve the improved health outcomes that result from ongoing adherence.  Health plans should work with pharmacists and providers to deliver member-friendly resources matched to each individual’s educational level, preferred language, and cultural background.

Offering ongoing, personalized engagement with pharmacy educators can ensure that members feel comfortable with their regimens and have access to expert advice whenever they have a question about their treatment.

The Solution? Medication Synchronization and Compliance Packaging

Even when health plan members can access, afford, and understand their prescription drug protocols, following complicated medication routines that require numerous refills, new prescriptions, and juggling multiple pill bottles and dosage instructions can, for the average consumer, be – at best, time consuming and – at worst, paralyzing. Digital pharmacies that synchronize all monthly medication fills in a single location on the same “anchor” day each month, organize them all in compliance packaging sorted by dose date and time, and further deliver them on the same day each month to the patient’s door, can make all the difference for the patient and his/her caregivers. This is a key to making management of multiple medications simple and safe. Medication synchronization (med sync) paired with compliance packaging can virtually eliminate one of the major obstacles to long-term medication adherence – complexity of medication access and administration.

Med sync with compliance packaging is a modern, effective replacement for the traditional pill organizer box, which can be helpful, but filling them every week is time consuming and leaves room for user error, especially when identical prescription bottles are spread out everywhere and pills are being moved around. Once manually sorted, members must remember – among other things – which pills to take at what time of day, which ones should be taken with food, and which are better on an empty stomach. Missed doses or doubling up on doses is always a risk when consumers are left to manage these complexities on their own. The risk increases when members are living with cognitive issues, mental health conditions, or other daily functioning limitations.

But patients utilizing compliance packaging prepared at their pharmacy experience a 66% increase in taking medications as directed. Compliance packaging is a simple, cost-effective solution to support better adherence. Pre-organized blister or strip packs ensure patients don’t take on the challenge of designing their medication regimens themselves. Packs are often color-coded and organized by dose date and time to simplify the process and help higher-risk patients who take multiple daily medications consume the right medications at the right time and in the right manner.

Further, studies show hospital readmissions are caused by medication nonadherence 40% of the time. Ensuring changes to the medication regimen are processed within days of the hospital discharge will support continuity of care and less unnecessary medical utilization costs.

Combining all these interventions into a multi-faceted, proactive medication adherence program can bring significant positive results for health plans and their members. Providing services that address these common medication adherence challenges can improve access and affordability while keeping members educated, engaged, and organized.

With the right strategies to target high-risk members and offer comprehensive support for their clinical and socioeconomic challenges, health plans can foster better experiences and better outcomes for members living with chronic disease.

Want to dive deeper into the value of compliance packaging? Learn more about solving these challenges by reading our comprehensive white paper, “Compliance Packaging to Overcome Adherence Challenges and Improve Health Plan Performance.”