September 18, 2015
Americans receive nearly four billion prescriptions each year. That’s a big number.
But they fail to properly use at least half of those prescriptions, or even take them at all. That’s also a big number -- and a big problem for health care. Studies have found a high degree of non-adherence to medications intended to treat a range of conditions from depression to heart attack, according to Medscape.
Non-adherence – sometimes called non-compliance – wastes limited health care resources. It frustrates doctors. It often leads to poorer outcomes, including death.
Health insurers, pharmacy benefit managers (PBMs) and affiliated companies are becoming more proactive in dealing with non-adherence. They’re now trying to predict who will skip their doses so they can address this problem before it even occurs.
Patients deviate from the plan for many reasons that neither they nor their clinicians can necessarily anticipate. Common issues linked to non-adherence include:
But more surprising factors linked to non-adherence are emerging. According to Express Scripts, the nation’s largest PBM, men whose physicians are female are less likely to fill prescriptions. People with young children have a higher risk of skipping doses. And within couples, partners can “catch” non-adherence from each other.
In 2012, Express Scripts announced a tool called ScreenRx that, the company claimed, takes into account more than 400 factors to predict non-adherence a year in advance with up to 98 percent accuracy.
When the company predicts that patients may veer from adherence, it “actively engages patients to figure out how they can be made to comply with their medication regimens,” according to MedCityNews. Steps could include a phone call, letter or email; a refill reminder device; or a conversation with a pharmacist.
Other companies that have launched initiatives to predict non-adherence include:
Independent review organizations (IROs) – such as Advanced Medical Reviews – are in a unique position to address non-adherence. IROs consider patients’ entire medical history in the review process, and patterns of use or non-adherence sometimes emerge in a patient’s history.
Dr. Lousine Alpern of Advanced Medical Reviews explains that “A case involving non-adherence may prompt a peer-to-peer call in which the reviewer physician speaks with the patient’s physician -- referred to as the prescriber -- regarding the non-adherence and what can be done to remedy the issue.”
The health care industry continues to develop innovative technology to predict non-adherence that, ultimately, will improve health care as a whole. “Any of the new innovations addressing non-adherence will be a welcome addition to assisting health care providers in giving patients the best care possible. It will be interesting to see what impact this will make on patient care,” Dr. Alpern adds.
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