Some patients could use help from pharmacists in medication adherence

The research, conducted by Langer Research Associates, found that Americans 40 and older with a chronic medical condition requiring prescription medication receive on average a C+ when it comes to taking their medications correctly. Additionally, one in seven adults who meet the same criteria—approximately 10 million people—receive an F.  The grades were based on an average of answers to questions on nine non-adherent behaviors: whether or not in the past 12 months patients failed to fill a prescription; neglected to have a prescription refilled; missed a dose; took a lower dose than prescribed; took a higher dose than prescribed; stopped a prescription early; took an old medication for a new problem without consulting a doctor; took someone else's medicine; or forgot whether they'd taken a medication.

These behaviors can have dangerous consequences such as costly trips to the emergency room or worse. In fact, previous studies have shown that prescription non-adherence adds $290 billion of what would otherwise be preventable costs to our nation’s health care expenditures annually.

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While these findings are both disheartening and unacceptable, there were some encouraging results. For instance, the biggest predictor of medication adherence was patients’ personal connection with a pharmacist or pharmacy staff. This suggests that much can be done to leverage the patient-pharmacist relationship as a tool to improve adherence. Patients of independent community pharmacies reported the highest level of personal connection (89 percent agreeing that pharmacist or staff “knows you pretty well”). This number decreased to 67 percent for chain pharmacies and a dismal 36 percent for mail order. The survey also found that patients who feel strongly that their medication is working for them (three-quarters of this population) and that it helps them live a better life (seven in 10) also are more likely to be adherent than their counterparts. This underscores the importance of pharmacists and other health care professionals talking to patients early and often about the importance of their medications as a way to prevent a progression of their disease and reduce complications.

These findings show that there are opportunities for prescription drug plans and policymakers to increase the nation’s overall adherence grade. On a federal level, NCPA urges Congress to pass the Medication Therapy Management Empowerment Act (S. 557 in the U.S. Senate and H.R. 1024 in the U.S. House of Representatives) to expand medication therapy management (MTM) services to Medicare Part D beneficiaries. This would not cost the government a dime; previous MTM programs have been shown to lower overall costs as increased pharmacist engagement with patients has avoided costlier health care treatments and procedures. Additionally, plan sponsors should examine their plan designs to ensure they are supporting activities that promote strong adherence such as allowing patients to choose a pharmacy that best suits their individual needs and allowing refill synchronization, which enables patients to have all of their medications refilled on the same day each month. Both of these activities facilitate a stronger patient-pharmacist relationship and promote safer medication use.

There is a vested interest for all to increase adherence rates in patients, and enacting the aforementioned changes will help to reach that goal. By implementing common-sense reforms, we can help improve the adherence grade. After all, when it comes to safe medication use, anything less than an “A” is unacceptable.

Hoey is CEO of the National Community Pharmacists Association. The research referred to was commissioned by NCPA as part of the association’s Pharmacists Advancing Medication Adherence (PAMA) initiative, which is sponsored by Pfizer, Merck, and Cardinal Health Foundation.

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