Pharmacists know the cost of patient non-adherence. In addition to negatively affecting the health of patients, there’s also the business impact in terms of pharmacy performance and DIR fees. Typically, a patient is considered adherent at 80% PDC, which means that not focusing on non-adherence at the right time could be detrimental to the business long-term.
Non-adherence takes a variety of forms, from patients not refilling prescriptions to not even starting treatment altogether. The reasons for this behavior differ by patient but there are some common factors pharmacists typically see driving non-adherence. Thankfully, pharmacists have a few methods to successfully address the major causes of non-adherence and get patients back on track.
Reason 1: Forgetfulness
Forgetfulness remains one of the main reasons why patients become non-adherent. In these cases, investing in technology solutions can help patients stay on track with their medications. One popular option is scheduling automated calls and text messages to patients with refill reminders. These communications inform patients when refills are ready or past due and encourage them to come into the pharmacy.
At Hazel Green Pharmacy, a rural pharmacy in Hazel Green, Alabama, MedSync has also been instrumental in helping with adherence. “Our MedSync program is one of the most effective ways we are able to maintain compliance,” says Mike Powers, RPh, owner and pharmacist at Hazel Green. “Another positive way is by enlisting patients in our Medication Review Program as well as compliance packaging.”
With MedSync, pharmacies are able to synchronize refills of a patient’s prescriptions so they pick them up at one time. This eliminates the need for multiple trips to the pharmacy and makes it more likely that patients don’t stop their medications because they don’t have them on hand. Compliance packaging serves a similar function by providing patients with 60- to 90-day supplies of their medications at one time. Both of these options limit the frequency with which patients have to visit the pharmacy, thereby reducing the likelihood they forget a refill.
Jessica Hung, Pharm.D., consultant pharmacist and clinical services manager at Semmes Pharmacy, has seen similar benefits in incorporating a MedSync program at her pharmacy. “I find that MedSync is extremely effective when utilized appropriately,” she says. “I think it does involve some additional work on the front end for the pharmacy, but if the patient understands the program and communicates with the pharmacy staff, it ends up saving both the patient and the pharmacy a lot of time.”
Semmes also offers compliance packaging and free pill boxes to patients, and Hung talks to patients about missing doses. “I find that patients are unaware what to do if they miss a dose of their medications,” she says. While counseling patients, she makes sure to provide advice on what they can do if this happens.
Reason 2: Insufficient Education
Another underlying cause of non-adherence comes in the form of a lack of understanding among patients, specifically around the importance of adherence, the purpose of the medication, or how to take it appropriately.
According to Dennis Song, owner of Flower Mound Pharmacy, this lack of understanding often breeds fear, particularly given patients’ tendencies to go online and find out about possible side effects. “We’re drowning in information but starving for knowledge,” he says, adding that counseling from pharmacists is crucial to combating this issue. “Without counseling and education, they are going to believe whatever they read.”
At Flower Mound, he consults with patients to mitigate their concerns and help them understand the value of the medications they are taking. This also has the added benefit of helping to demonstrate to patients that the pharmacist can do more for them than only drug dispensing, a common misconception many patients have.
Counseling is also a key tactic for Powers at Hazel Green Pharmacy. “We have patients that have communicated that they only take it when ‘I feel my blood pressure or sugar is too high,’” Powers says, noting that even after consultations, there are still patients who will choose to take their medications at their leisure. “We try to educate patients on the importance of adherence as far as effective control of their disease state as well as the results that can develop over time if the medication does not control their hypertension, glucose levels (their sugar), and overall cholesterol level.”
Reason 3: Cost
For many patients, the high cost of prescription medications can be a deterrent to filling their medications. One way to address this is by helping patients compare plans before they enroll in a plan. According to one study, 90% of Medicare beneficiaries are not on the lowest cost plan for their medications. Plan comparisons help patients understand their options so they switch to more affordable plans and are aware of expected copays on their plan of choice. Pharmacists are also able to educate patients on special enrollment periods and help them navigate the plan selection process.
When cost becomes a debilitating factor for patients at Semmes Pharmacy, Hung discusses alternative therapeutic equivalents with them. “Sometimes this involves calling their insurance company to determine if a similar product would save the patient money then discussing these alternatives with the patient and their physician,” she says. “We do use the Amplicare formulary alternative tool to help with this as well.” The tool compares drugs across formularies, which comes in handy as drug formularies change each year and coverage for a patient’s medication may change.
Hazel Green Pharmacy also offers a no-cost delivery service for patients who participate in its MedSync program, and counsels on the cost benefit of adherence. “We discuss with them how Medicare and their insurance requires us to monitor their adherence and how non-compliance could ultimately cost them more money in the long run,” Powers says.
Implementing Solutions
Hand-in-hand with executing tactics to improve adherence is the need for adequate communication between pharmacists and physicians.
“Physicians are often unaware that their patients are not taking their medications,” Flower Mound’s Song says as he recalls an example of a time a physician called in refills for a patient but didn’t realize the patient hadn’t been filling all their prescriptions because of cost.
“The patient was only filling three medications, so I asked what they wanted to treat first.” This information helped him better counsel the patient when they came in for refills. “Only some [doctors] know that patients aren’t adherent,” he continues. “The solution is to increase communication between physicians and pharmacists. Adherence is only as good as physician education and pharmacist education.”
As pharmacists implement solutions to solve adherence issues, Song advises that there is no one-size-fits-all answer. “The effectiveness of your solution will depend on your pharmacy and your patient population,” he says. “Find the problem in your population or demographic first.”
Powers also emphasizes the importance of relationship development with the community in order to gain their confidence. “I tell all of our team members that ‘people do not care how much you know until they know how much you care,’” he says. “With these approaches, we have been able to minimize as much as possible the DIR fees that are assessed to us and to help patients maintain their health.”
