WASHINGTON -- Physicians and health plans need more financial incentives to spur greater medication adherence, experts said Thursday at a panel discussion here.
Without such a push, the healthcare community will continue to struggle with the issue of getting patients to take their medication as prescribed, they agreed.
An estimated three-fourths of patients either stop their medication, don't use it, don't refill it, or don't take their medication often enough. Non-adherence costs the healthcare system between $100 billion and $289 billion a year in direct costs, according to the Agency for Healthcare Research and Quality.
But current programs are fragmented or not wholeheartedly supported by providers, plans, and patients.
One example of a successful adherence effort is found in Medicare Advantage. Starting last year, the program's Star Ratings system began incorporating patients' medication adherence into its quality system, giving bonus payments to those with higher star ratings.
In only the first year, the change has led to dramatic improvements in adherence, said Josh Benner, PharmD, president and chief executive of RxAnte, a private company in McLean, Va. that is seeking to better medication adherence.
"What's really going to be exciting is what the 2012 data look like," Benner said at the panel, which was hosted by the National Coalition on Health Care. "This calendar year is the first where a full year of effort will be able to be monitored, and we're, of course, hoping to see continued success."
If the program shows improved adherence and improved patient outcomes in the long run, "I think there will be a lot of calls to expand it to Medicaid and to the rest of Medicare," Benner told 番茄社区.
Plans are mobilizing around such policy incentives, he said.
"Plans that we work with have multiplied their adherence intervention budgets from 2011 to 2012," Benner said. "They're actively going out and establishing relationships with adherence invention vendors in ways that health plans never really had a reason to do previously."
Other private companies are trying their own tactics.
Brian Solow, MD, chief medical officer at OptumRx, in San Diego, Calif., explained his company's use of reminders sent to patients via e-mail, text message, or phone call to take or refill their medication. OptumRx uses claims data to know when patients need to refill their prescriptions.
The program increased adherence by 11%, he said, and saved more than $724,000 on just 1,000 members.
Part of the struggle is getting health plans to spend more on interventions or drug plans now to realize savings by preventing costly hospital stays or procedures later from not taking medication, panelists said.
However, Will Shrank, MD, director of the Rapid-Cycle Evaluation Group at the Centers for Medicare and Medicaid Services, in Baltimore, spoke of a study involving filling prescriptions for free -- rather than traditional cost-sharing such as co-payments -- to patients who recently had a heart attack.
Results showed a 5% improvement in adherence and 14% fewer subsequent cardiovascular events. The cost was $5,000 less per patient, he said.
Patients stop or don't take their medication for a variety of reasons including high out-of-pocket costs, side effects, and being unconvinced of the need or effectiveness.
To be successful, adherence interventions need a number of qualities, Benner said, including needing to:
- Be delivered by a trusted source
- Reinforce the medical need for the drugs
- Target at-risk patients
- Reward maintenance
A solution needs to be multifaceted, panelists said. Part of the problem has been a quick reaction to try simple solutions, but that hasn't seemed to work.
"We really ought to leave it all on the table to try to come up with a strategy," Shrank said. "We're going to have to target different approaches to different people to try to figure out what's the right kind of target for a particular patient."