Improving Adherence in Patients with Chronic Conditions

San Francisco—Poor adherence to medication regimens is a growing problem in the United States. At a Managed Care Essentials session at the AMCP meeting, representatives from CVS Caremark presented a session titled Advancing Adherence and the Science of Pharmacy Care.

Aydin Sekili, MBA, manager, analytic consulting services, and Joy Nguyen, PharmD, manager, analytics and outcomes, discussed the value of investing in adherence, presenting the latest research and insights, and offered innovative ways to improve adherence, including use of an adherence calculator.

They began by identifying lack of adherence as “America’s other drug problem,” and added that “chronic conditions drive health costs and nonadherence drives the cost of chronic conditions.” It is estimated that among US patients with chronic conditions, 17% are adherent to their medication regimens, 19% are adherent with gaps, 24% are not adherent, 16% are not prescribed medications, and 24% remain undiagnosed.

The rapid changes occurring in the healthcare arena are creating new challenges and opportunities. They noted that there is a disproportionate growth in healthcare spending, due in large part to an aging population.

The key challenge in addressing the rising costs of healthcare is the management of chronic conditions. Chronic conditions drive >75% of healthcare costs and 25% of people with chronic conditions have ≥1 limitations on daily activity.

Noting that prescription drugs are first-line therapy for many chronic conditions, they said that 50% of patients with chronic conditions are not on all of the medications needed to manage their condition and <50% adhere to the medications they have been prescribed.

“In addition, 32% of hospitalizations are attributed to medications and 10% of those are the result of suboptimal medication therapy,” the speakers said, adding that nonadherent [health plan] members cost up to $3800 per patient per year more than adherent members.

In November 2009, CVS Caremark, Harvard University, and Brigham and Women’s Hospital in Boston, Massachusetts, began a 3-year partnership to better understand why people do not take their medications and to use the results of the research to improve pharmacy care and adherence. The initial phase of the project (11/2009-5/2011) was devoted to understanding the patterns of adherence and assessing the effectiveness of intervention strategies. The aim was to identify the rates and predictors of adherence, assess the evidence about which interventions worked to improve adherence, and evaluate how the coverage expansion in Medicare Part D affected medication use, adherence, and health.

In the second phase (6/2011 and forward), the project developed comprehensive strategies to improve adherence and pharmacy care. Using a data-driven approach to target interventions, the project aims to improve communication with patients, employ comparative effectiveness research to develop and replicate successful treatment methods, and utilize personalized care to improve adherence rates.

The session continued with an overview of strategies identified in the project for “best-in-class” adherence rates: (1) employing a value-based benefit design can increase as much as 73% in groups with a poor baseline adherence rate (medication possession ratio [MPR] of <60%); (2) basic member education repeated consistently (contact every 3 months is twice as effective as monthly contact); and (3) clinical support programs with ongoing counseling and communication (there was a 60% gap closure with telephone advisors and up to a 90% gap closure improvement with face-to-face counseling).

The research also found that the most influential advisor was the retail pharmacist, who was 2 to 3 times more influential in improving adherence than a family member or nurse at a hospital.

The speakers illustrated an adherence calculator, using baseline data on MPR, gaps in adherence, average age, sex, member share, and generic dispensing ratio. Based on these data, recommendations for interventions such as 90-day pricing for mail-order medications, use of the Pharmacy Advisor^™ (increasing member communication), and a generic copayment alignment created an 8.1% increase in MPR and savings of $3.8 million in healthcare costs.

In conclusion, the speakers highlighted the importance of making improving medication adherence a national goal. They advocated a “continued focus on research about how to improve the healthcare system so patients can make the right decisions for their health.”