When it comes to prescription drugs, patients are not following doctors’ orders. The numbers and impact are alarming: Research shows that nearly 25 percent of patients who are prescribed medications for a newly diagnosed chronic illness do not fill their initial prescription. In addition, half of patients taking maintenance medications for chronic conditions will stop taking them within the first year of starting therapy.

The situation puts patients at risk and costs the health care system billions of dollars in unnecessary care. While prescription drug abuse often dominates the headlines, nearly two-thirds of Americans who take medication are non-adherent, meaning they do not take their medication properly. Whether intentional or not, the problem is rampant and causes an estimated 125,000 needless deaths every year.

A major push for medication adherence could turn that around.

“If we can get people to take their medications, they’ll have fewer heart attacks, they won’t develop complications associated with diabetes and they won’t be going to the emergency department with asthma,” says Dr. Troyen Brennan, executive vice president and chief medical officer of CVS Caremark.

In addition to improving patient outcomes, Brennan says, medication adherence will reduce health care costs associated with these conditions.

 

Question:

If you could scale up one remarkable health care idea, what would it be? 

Answer:

"Too many patients are not taking their medication as directed, and non-adherence is a major public health problem. Patients who do not take medication as directed face deteriorating health and possible hospitalization. The problem costs the health care system approximately $300 billion annually in unnecessary care."

- Troyen A. Brennan, M.D., M.P.H., executive vice president and chief medical officer of CVS Caremark

 

Each patient with heart failure who does not take his or her prescribed medication costs the U.S. health care system an average of almost $8,000 annually, according to a 2011 analysis published in Health Affairs. The figures are high for other ailments too — almost $4,000 per patient with high blood pressure, over $3,700 per patient with diabetes and about $1,200 per patient with high cholesterol.

Dr. Brennan and a team of researchers at Brigham and Women’s Hospital, in Boston, have been studying this issue since 2010 by analyzing pharmaceutical insurance claims data. They’ve pinpointed several reasons patients don’t take their medicine:

There is a high degree of complexity for patients taking multiple drugs for a variety of conditions. There are currently around 80 million U.S. residents with multiple chronic conditions and several medications to manage. Patients who have a number of prescriptions are less likely to take their medications as prescribed because they may have difficulty managing a schedule that involves taking several different medications at various times throughout the day.

Patients cannot afford needed medication. The cost of brand-name drugs and those not covered by insurers often leads patients to “stretch” prescriptions by taking lower-than-prescribed doses. Furthermore, research has determined that patients with high co-payments are the least likely to fill their first prescription for a new medication.

There is limited coordination between the pharmacy and physicians. Dr. Brennan and his colleagues report that prescriptions handed to the patient are less likely to be filled than those sent electronically from the physician to the pharmacy or mail-order system. Moreover, sending a prescription directly to the pharmacist opens a line of communication between the two providers so they can work together for the patient’s best interest.

While pharmacist consultations can also be done by phone or online, Dr. Brennan believes that in-person conversations between pharmacists and patients can be most effective in improving adherence. “Nothing beats face-to-face counseling,” he says. “It’s an opportunity to answer the patient’s questions, explain potential side effects and introduce generics as appropriate.”

His team’s findings support this claim. In a study of 29,000 diabetes patients in a large health plan, Dr. Brennan and colleagues found that patients who were counseled directly by pharmacists were almost twice as likely to adhere to their prescriptions, resulting in a $600,000 annual saving in diabetes-care costs.

A study by the Brigham and Women’s team, published in the January 2014 American Heart Journal, adds to the growing body of evidence that adherence improves outcomes. Heart attack survivors who took their medication faithfully were less likely than other patients to suffer another heart attack, or unstable angina, stroke or congestive heart failure, during six months of follow-up.

Once the diagnosis has been made and the prescription written, following doctors’ orders becomes the next hurdle for many Americans. The Brigham and Women’s team says providers should explore options to make adherence easier, such as simplifying regimens and using tools and communications to remind and motivate patients to take medications. Interventions that promote adherence may significantly improve patient outcomes and help alleviate our health care crisis.