Industry Trends: Prescription Adherence

Industry Trends: Prescription Adherence

It is common sense to many that prescription medications are a key component in the treatment of both common chronic conditions such as heart disease, asthma, diabetes, depression, and COPD (chronic obstructive pulmonary disease) as well as illnesses such as HIV/AIDS and cancer. But surprisingly, of the more than four billion prescriptions written each year in the United States, more than 50% of them are taken incorrectly or not at all.

Prescription adherence is a growing issue that has not only a big impact on an individual’s health, but ultimately on an employer’s finances as well.  Not taking medications correctly (or at all) has been linked to 30- 50% of treatment failures and up 125,000 deaths a year according to statistics gathered by the American College of Preventive Medicine. Non-adherence also has been linked to $290 billion in annual health care spending, $100 billion of which is linked to hospitalizations and re-admissions that could have been avoided if medications were taken as prescribed.

The lack of adherence for individuals not taking their medicine can range from the basic barrier of cost to the fear of side effects to the overall lack of understanding of why the medication is prescribed. Another big reason that patients stop taking medication is when they do not have symptoms or feel better, even though the underlying health problem still requires medication to treat the disease.

What can you do as an employer to help facilitate an individual’s medication adherence?

The first suggestion is to evaluate your health plan claims or utilization data, if available. This information can help reveal some of the highest dollar claims and conditions and can help pinpoint which employees are not following their regiment, of course in a completely HIPPA compliant manner.

Below are some additional suggestions and recommended courses of action that can be discussed with your Kistler Tiffany Benefits’ Employee Benefits Consultant or Account Executive:

Coaching and Support—Encourage and market the use of case managers (at carrier) who can work directly with the member to ensure they understand why taking their medication is important and how to take it correctly. In addition, a case manager can help someone understand how to manage any potential side-affects and what they can do to improve their lifestyle and health to aid in managing their condition.

Financial Incentives—This is a little more complicated, but waiving or setting lower copays required for drugs needed to treat chronic health problems can encourage employees to stick to their prescription regimen.

Specialty Pharmacies—Many of today’s breakthrough medications are high-cost drugs. Many insurance carriers and/or Pharmacy benefit managers (PBM) can partner to make sure the most appropriate medications are provided at the best price available.

Prescription Management—Making sure support services (carrier or PBM) are available to gather, review, and recognize employees’ health records and prescriptions to avoid duplication, interaction, or overdosing of prescription drugs. This is especially important for employees who seek care from primary care physicians and specialists who manage their conditions and may prescribe multiple scripts.

Our team is experienced and prepared to evaluate your prescription plan and inform you of how it can help your employees manage chronic conditions and your overall financial spend. Please contact your Benefits Consultant or Account Executive today if you have further questions.