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Impediments to Prescription Compliance
Companies lose almost $2 billion each year in prescription noncompliance. Though the high cost of drugs is a problem, price is only one component of widespread prescription-adherence problems. Patient education -- as well as reducing co-pays for some medications -- is suggested.
High drug costs have caused many patients to cut back on their medications, creating significant direct and indirect costs for employers. Recent studies show that only 50 percent of patients typically take their medications as prescribed, according to the Bethesda, Md.-based National Council of Patient Information and Education. The study also showed that one-quarter (24 percent) of patients take less than recommended dosages of prescriptions, while 16 percent of adults surveyed said they had taken a medication less frequently than actually prescribed. Twenty percent of adults surveyed had not filled at least one prescription. Limited or poor prescription adherence costs $1.77 billion annually in direct and indirect health-care costs, according to the study. Direct costs relate to the "effects that [the] lack of adherence has on medical plans," according to John Malley, national practice leader for pharmacy benefit consulting for Watson Wyatt in New York. Indirect costs include "absenteeism, presenteeism and other related issues." The high costs of drugs, and even co-pays, "stretch the pocketbook of the patient," says Malley. The financial strain sometimes causes patients to make decisions that can impact their own health. "They're likely to disrupt or even terminate therapy at some point," he says, adding that such decisions can cause some "pretty severe issues on the medical side." The big picture in terms of adherence, however, is "much more complex than just the cost of a drug," emphasizes Tom Cordeiro, regional pharmacy practice leader for Aon in Radnor, Pa. Other significant factors influencing the way patients take their medicine include the complexity of the regimen and possible side effects related to medications, he says. Malley says that, for the last two or three years, employers have been focusing more attention on ways to reduce the barriers to prescription drugs for their employees -- particularly those needing medications to control diabetes, high cholesterol and hypertension. Employers realize, he says, that lack of adherence in such therapeutic categories "could really end up costing them a fortune on the medical side." What's needed is patient education, Cordeiro says, although the role of HR leaders in that regard is limited.
Instructions and Perceptions It's up to practitioners to instruct patients on how to take medications and ti pharmacists to inform patients of what to expect from medications and possible side effects, Cordeiro says. "They need a better understanding of the medicine they're taking in order to ensure compliance," he says. Sometimes it's necessary for practitioners and pharmacists to assess the way a patient perceives a disease. For example, high-blood pressure may be asymptomatic. In the absence of pain or discomfort, the patient for whom high-blood-pressure medication has been prescribed may feel medicine is unnecessary. Dosage and frequency issues have created a "struggle for the ages," Malley says. Although "very sophisticated programs" allow pharmacy-benefit managers to monitor patient profiles and utilization, some companies prohibit PBMs from interacting directly with patients, as employees sometimes view a reminder phone call or letter as an intrusion into their privacy. But, often, it comes down to cost. The introduction of lowered co-pays, and even zero co-pays, has had a positive impact on prescription-fill rates, Malley says. And he notes that the expectation [among employers] is that the medical costs associated with disease treatment will "simultaneously go down" along with those fill rates. Cordeiro agrees that reducing co-pays can impact patient behavior. "On average, when employers look at encouraging the use of more generics, lower or zero co-pays produce an uptick in the use of generics," he says. "It's one of the areas where employers can really influence the way their members speak to their doctors about how they are going to be treated." The cost of generic medications is about one-third cost of brand-name drugs, he says. And the number of generic medications has increased. Reducing drug costs for diabetes control has been very successful, Cordeiro says. "Studies have shown that when you reduce the co-pay or have a zero co-pay for diabetics' medication and supplies, their adherence to their treatment protocol will be much improved," he says. "It works for diabetes because it's a very specific condition with specific treatment protocols." Employers are examining the possibility of expanding such programs to include other diagnoses as well, he says. The installation of on-site pharmacies at work locations has also become an "emerging trend," in an attempt to improve compliance, Malley says. As the costs of noncompliance have become more widely known, some larger employers are now in the "infancy stages" of trying to improve drug adherence, he says.
November 7, 2007 Copyright 2007© LRP Publications |
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