Welcome to the fourth article in our series exploring the scope and impact of medication nonadherence. This week, we will focus on government- and market-based strategies to improve medication management and adherence.
The stakeholders in this effort are numerous: patients; health care professionals; federal, state, and local governmental agencies; policy makers; third-party payers: private insurers; independent consumer groups and nonprofits; pharmaceutical companies and other commercial interests, such as those who make medication-adherence products.
With so much on the line for so many people, improving rates of medication adherence is critical to the sustainable growth and operation of our national healthcare system. With our background understanding of the problem’s scope and impact, we will now turn our attention to initiatives and incentives that can help improve adherence, including specific ways that certain stakeholders can have a positive impact.
In many respects, the federal government is leading the way. The Patient Protection and Affordable Care Act of 2010 (PPACA) contains many sections that support medication management services. One of the act’s most significant steps was the gradual closing of the Medicare Part D coverage gap, known as the “donut hole,” which will eventually eliminate cost as a barrier to adherence for seniors.
The Affordable Care Act also supports implementation of medication management services in the treatment of chronic disease. The bill includes contracts and grants to allow pharmacists to provide medication management therapy services, and adds requirements for annual comprehensive medication reviews with written summaries, creation of personal medication records, and formulation of medication action plans.
Locally, both New York State and New York City have medication management programs. The Statewide Health Information for New York (SHIN-NY) plan is considered New York’s health information superhighway. The state expects that SHIN-NY will foster medication history data sharing by serving as a uniform interface to a network of systems necessary for medication management: local physician electronic health record systems; hospital record systems; Medicaid and health insurance provider systems; pharmacy prescription platforms; electronic prescriptions; and other health insurance exchange systems.
In New York City, the Department of Health and Mental Hygiene created the Medication Adherence Project (MAP) to assist clinicians and pharmacists in primary care practices. Using a training course and toolkit developed by MAP, healthcare professionals are given practical tools for treating patients with chronic diseases: “Questions to Ask” pads, Adherence Assessment pads, forms for patients to list their medications, and guidance on how best to engage and inform patients and how to train staff members.
In addition to local, state and federal government initiatives, private payers are also taking steps to curb medication nonadherence.
For example, UnitedHealthcare’s “Refill and Save Program” has reduced copays by $20 (a 40 percent savings) for patients who refill their asthma and depression medications on time. Aetna has put up cash prizes for patients willing to use computerized pillboxes to improve adherence to warfarin treatment. The Traumatic Brain Injury Network, a clinic for brain-injured patients with substance abuse problems, found that rewarding patients with $20 in gift cards to complete their first phase of treatment was an effective motivational tool.
Pharmacists and pharmacies are also assuming leadership roles in efforts to identify nonadherence and provide intervention strategies.
Leaders point to studies that show the effectiveness of MTM and comprehensive medication reviews, as well as synchronized refills. A study sponsored by the Thrifty White Pharmacy chain reported that patients in its Appointment Based Model program, which included synchronization of refills, were 3.4 to 6.1 times more likely than controls to adhere to their medications at least 80 percent of the time.
With so many stakeholders involved, it’s only natural that some have banded together to find common solutions to a common problem.
For example, Script Your Future is a national multiyear effort launched by the National Consumers League in May 2011. More than 100 stakeholders in health care, business, and government participate in this program to improve medication adherence. It is currently limited to patients affected by diabetes, respiratory disorders, and cardiovascular disease, with efforts focused in six regional target markets.
Prescriptions for a Healthy America: A Partnership for Advancing Medication Adherence was introduced in May 2013. It comprises organizations representing patients, health care providers, pharmacy groups, consumers, and health care industry leaders. The goal of the partnership is to educate lawmakers about the dangers and costs of patients not taking medication as prescribed, as well as to develop and implement public policy solutions that will reduce the level of nonadherence nationwide.
With such broad support and commitment of time and resources from government, private payers, health care organizations, and advocate groups, the moment may be at hand to start realizing tangible improvements in medication adherence across many patient populations.