NEJM: Despite Efforts to Conquer Nonadherence, Challenges Remain

NEJM: Despite Efforts to Conquer Nonadherence, Challenges Remain

11.14.11 | By Kate Connors

In The New York Times Prescriptions blog today, writer Reed Abelson looks at a study in the New England Journal of Medicine finding that co-pays for prescription medicines can discourage patients from adhering to their prescribed treatment regimens.
The study, which evaluated heart attack survivors with prescription drug coverage, found that those who had to pay a reasonable co-pay (between $10 and $25) were less likely to fill their prescriptions.
Conversely, the blog post says, "when those co-payments were waived, patients' adherence to their medications went up by four to six percentage points...without increasing the total amount being spent on these patients' care."
The improved adherence due to lack of co-pays also led to improved health: "While there was no statistically significant reduction in the number of patients who had another major vascular event, including those patients who had additional procedures like angioplasties, there was a significant decline in those people who returned to the hospital for care."
Nonadherence is a significant problem throughout the healthcare system, so it's interesting to read a study that seeks to directly tie co-pays to the issue. However, it should be noted that co-pays are just one of many potential causes of nonadherence.
In fact, the study found, even among those who received their medicines for free, without co-pays, more than half of the patients monitored did not take their medicines as prescribed.
Abelson writes: "The low level of adherence 'is an ongoing disappointment,' said Dr. Lee Goldman, a professor of medicine and epidemiology and a dean at Columbia University Medical Center who was one of the authors of an accompany editorial" in NEJM. "'So far we've not found anything approaching a magic bullet to increase adherence,' he said."
Recently, many different players in the healthcare system have made efforts to improve adherence. For example, The Wall Street Journal recently highlighted how physicians and pharmacists can more closely monitor patients, while the National Consumers League's Script Your Future campaign provides patients themselves with tools to better adhere to their regimens, especially if they take multiple medicines. And, of course, the Partnership for Prescription Assistance represents a joint effort by biopharmaceutical research companies to provide access to uninsured and underinsured patients throughout America.
For more in-depth coverage of this interesting study, see the Associated Press (which notably quotes a non-affiliated Duke University physician as saying "'A drug only works if it's taken,'") and U.S. News and World Report.

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