Many Paths to Improving Medication Adherence - New Study

Many Paths to Improving Medication Adherence - New Study

09.14.12 | By

In case you missed it, there's a very interesting meta-analysis in this week's Annals of internal Medicine on the comparative effectiveness of interventions to improve medication adherence. Reuters ran a related article yesterday - also worth reading.

This article is based on an AHRQ funded major review of the research literature surrounding adherence improvement. Researchers from RTI International in Durham, NC, and the University of North Carolina at Chapel Hill, looked at existing research on various interventions, including evidence from randomized controlled trials and policy-related interventions, to improve adherence among patients suffering from chronic diseases in the U.S.

What was the gist of their findings? That multiple approaches to enhancing adherence - including reduced out-of-pocket expenses, improved insurance coverage, case management and patient education with behavioral support - all worked to some degree for many chronic conditions.

As one might expect, different interventions fared better for different conditions. For example, pharmacist-led hypertension management for blood pressure improvement and case management for depression symptoms stood out as particularly effective in improving adherence to medicines.

When it comes to policy-oriented adherence interventions, the research team "found robust evidence that reduced out-of-pocket expenses improved medication adherence across clinical conditions."

They go on to say: "Poor medication adherence produces large downstream health care costs. Thus, policymakers contemplating changes in health policy should take note of our assessment...that reducing patients' out-of-pocket costs improves medication adherence. Compared with other effective interventions, such as case management and collaborative care, which are relatively complex and labor-intensive, reducing copayments can potentially improve adherence for large numbers of geographically diverse patients."

We write a lot about how pharmacy benefit design and higher copays decrease adherence. A 2004 RAND study found that doubling copays for medicines lowered adherence by 25%-45%.

What's more, researchers have estimated that eliminating copayments for patients at medium to high risk for heart disease would boost adherence enough to avoid 90,000 hospitalizations and yield savings of more than $1 billion.

A recent study in Health Affairs projected that improved adherence to diabetes medication could avert nearly 700,000 emergency department visits and close to 350,000 hospitalizations annually, for a total savings of $4.7 billion. And, I'd be remiss if I didn't point to last year's study in JAMA, which suggested that improved access and adherence to medicines following the implementation of Medicare Part D saves Medicare about $1,200 in hospital, skilled nursing facility and other costs for each senior who previously lacked comprehensive prescription drug coverage.

To learn more, check out our related Adherence issues page and a recent PhRMA paper on how medicine adherence is key to better health.

Lastly, the Annals study is particularly timely in light of new Consumer Reports surveys on access to health care - including medicines - in America. Among Consumer Reports' findings, they point to the challenges faced by Americans under age 65 that lack prescription drug coverage.

Recognizing the enormous potential for better adherence to yield improved health outcomes and lower costs, it is a shared goal of our sector and other stakeholders to help ensure that uninsured or underinsured patients have access to the medicines they need.

That's why PhRMA, our member companies and partners sponsor the Partnership for Prescription Assistance. PPA helps connect financially struggling patients to assistance programs - public and private - that provide medicines for free or nearly free. Having helped roughly 7 million people since 2005, PPA is a valuable resource for patients in need. The website is and the toll-free number is 888-4-PPA-NOW.

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