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Improving Prescription Medication Compliance for the Chronically Ill Can Cut Back

Poor adherence to prescribed medication regimens increases the incidence of hospitalization,
especially among individuals with chronic medical conditions, and consequently adds significantly
to health care costs. This failure- along with less- than- optimal prescribing, drug administration and
diagnoses- creates as much as $290 billion each year in avoidable health care spending, or 13% of
total health care expenses. A research brief from the New England Healthcare Institute reports
these figures, along with suggested interventions to stem such unnecessary spending. Employers
can consider these suggested interventions in designing prescription benefit programs, to help
employees improve compliance with their prescription drug regimens.

Poor medication compliance includes behaviors such as failing to pick up or renew a prescription,
not taking medications in the prescribed dosage level or at prescribed intervals, stopping a
prescription before it has been completed, or abandoning a prescription regimen altogether. The
report cites a number of barriers to medication compliance, including cost, side effects, difficulties in
managing multiple prescriptions, forgetfulness, and a lack of understanding about the medical
condition being treated or the urgency for treatment when a medical condition is asymptomatic.
Individuals with chronic conditions generally demonstrate lower adherence to a prescribed
medication course of treatment than those with acute conditions, and adherence drops even lower
with the passage of time. And, among chronic patients, those not following a prescribed drug
regimen have higher hospitalization rates and higher mortality rates. Higher hospitalization rates
lead, of course, to increased medical costs.

Because individuals with chronic conditions seem to do worse following prescription drug treatment
regimens, one strategy for employers to use to increase compliance is disease management and
condition management programs. These programs target individuals with chronic conditions and
actively work with them to help them manage their diseases. Services can include monitoring
prescription drug compliance, sending refill reminders and educating members on their chronic
condition, thus addressing some of the reasons cited above for prescription noncompliance.

The research brief suggests three broad strategies to improve prescription medication compliance:

-Reduce the cost barriers to obtaining prescribed medications. Out- of- pocket
prescription drug costs can, of course, influence the extent to which a patient follows a
prescribed course of treatment, with higher costs leading to lower compliance. A prescription
benefit plan's employee copayment requirements determine an employee's out- of- pocket
costs. Designing the copayment requirement to encourage filling appropriate prescriptions is
key. The research brief cites "value- based insurance design (VBID)" plans with lower
employee contributions and out- of- pocket costs for cost- effective medications for chronic
conditions, saying this "can be linked to improved medication possession ratios."

-Address the behaviors and preferences of individual patients. Employees will vary
across a wide spectrum as to how well they understand their medical condition, how
engaged they are in their overall health care management, how willing they are to ask
questions of physicians and pharmacists, etc. Reaching employees with a chronic condition
on an individual basis- such as can be achieved through the personal contact that is part of a
disease or condition management program- can involve them more intimately with their
course of treatment and enhance the probability of prescription medication compliance.

-Design the right medication regimen for the individual patient. According to the research
brief, getting the drug regimen right in the first place could dramatically reduce prescription
medication noncompliance. Poor prescribing is a particular problem for individuals taking
multiple medications. Again, disease and condition management programs can help. The
individual contact such programs feature helps to ensure that the patient's medications are
not contra- indicated, that the patient understands the prescribing instructions, and that the
patient is, indeed, staying on top of the regimen.

In considering prescription benefit plan strategy and design, keeping these ideas in mind can help
to promote appropriate employee use of prescription drugs, and with it improved health outcomes
and more managed health care costs.