The Role of Specialty Pharmacy in Medication Adherence

ADHERENCE TO MEDICATION REGIMENS BY PATIENTS has always been, and continues to be, an area of great concern to the health care community.

Nonadherence to drug therapy can result in an alteration of the risk/benefit ratio, and can literally be a matter of life and death. The impact of noncompliance is staggering in terms of both health care outcomes and cost. It is estimated that the cost of nonadherence in the United States totaled $337 billion in 20131.

Up to 30% of prescriptions are never filled,2 and poor compliance has been linked to increased mortality and hospitalization across various disease states.

Consider these statistics:
  • nonadherence causes ~30% to 50% of treatment failures and 125,000 deaths annually2
  • medication is not continued as prescribed in approximately 50% of cases2
  • medication rates of compliance drop off after 6 months2
  • only 51% of Americans treated for hypertension are compliant with their therapy2
  • 25% to 50% of patients discontinue statins within one year2
Even for those prescriptions that are filled, the patients are often noncompliant with prescriber directions by missing doses, taking the incorrect dose, not following instructions, such as taking the medication with or without food, and failing to complete the prescribed days of therapy.

There are a host of dynamics that influence a patient’s lack of commitment to adherence, including simply forgetting to take the medication, disease states that have no symptoms, such as hypertension, cost, and side effects, to name a few. Those patients treated for multiple conditions, for which they are often prescribed concomitant medications with varying intervals throughout the day, can face additional complications in adhering to instructions.

What is Adherence?
There is often confusion between the terms that float about regarding adherence. It is important to understand exactly what “Medication Adherence” is.

The CDC2 uses the following definitions:
  • Medication adherence: The patient’s conformance with provider recommendation with respect to timing, dosage and frequency of medication taken during the prescribed duration.
  • Compliance: Patient’s passive following of provider’s orders.
  • Persistence: Duration of the time patient takes medication, from initiation to discontinuation of therapy. 
Additional buzzwords around this topic include abandonment, which applies when the patient fails to fill a prescription, or prematurely discontinues therapy. Another term used by manufacturers is “time to fill,” which refers to the period from the time the provider prescribes the medication to the start of therapy.

Related Articles

An independent review of pharmacy benefit managers (PBMs) in Ohio indicates that PBM pricing practices likely contribute to rising health care costs.
2019 Pharmacy Quality Alliance Annual Meeting included discussions on measures to improve medication services and how pharmacists can play a larger role in the multidisciplinary care team.
Cohesion among key stakeholders, which will lead to an evolution in care, is clearly on the rise, and the growth of those relationships will only benefit patients in the end.
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