Medication Adherence: The $300 Billion Problem

By Infinx
June 21, 2017

Healthcare forums around the world, including the World Health Organization, have been talking about deficiencies in medication adherence for years. Despite efforts to better habituate patients to follow prescription instructions, these problems have continued to grow throughout the United States. An article in Forbes’ Pharma & Medicine section entitled, Why Medication Adherence Needs To Be A National Priority illustrates how these issues continue to soar out of control, with costly consequences for seniors and the healthcare system at large:

  • Medications cost the healthcare system approximately $325 billion annually.
  • Medication adherence problems, taking too much or too little, leads to avoidable annual healthcare costs totaling $300 billion.
  • People who don’t take their medicines as directed are more likely to end up returning for additional medical care than those who do.

You would think that solving the problem of people not taking their medications correctly would be relatively simple. However, the causes are deeply routed in a complex web of personal, lifestyle, financial and cognitive issues. More effective solutions require insight into the behavior of patients beyond the physician’s office. Laws need to be changed to make it easy to support patients in proper adherence, while healthcare professionals need to coordinate better collaboration and communication.

Prescriptions for a Healthy America and Duke University’s Medication Adherence Alliance are leading the charge on finding a solution for the US medication adherence problem and they are focusing on four priorities:

Change the law: Although tactics can be employed to help patients take their medications properly, federal anti-kickback statutes are having a chilling effect, discouraging providers from enforcing them for patients covered by Medicare and Medicaid. The Alliance wants the law amended so that providers can give patients stronger tools like patient refill reminders and disease management coaching. These can help improve adherence, outcomes and reduce costs.

Pro-patient communication: The siloed, fragmented healthcare system is still far from fully effective. In fact, it’s causing dangerous gaps in the communication of important patient information. This can leave dire consequences when it comes to medication. The Alliance wants to improve communication between the clinical facilities where patients receive care and the pharmacy setting where they receive their medications. The first step is improving information sharing between Medicare Parts A and B, which cover hospital and doctor visits, and Part D, which covers prescription drugs.

Establish integrated, multidisciplinary teams: Those aforementioned silos impede care as well as communication. The Alliance wants to get rid of this structure to fully integrate patient care. When teams communicate across specialties, and include the patient’s primary care physician, specialists and pharmacist, a more holistic context is created for care. That leads to better sharing and integration of data, information, and medications.

Take advantage of leading-edge technology: Patient behaviors and risk for medication adherence issues can be mitigated through the use of smart technologies, like wearable devices that detect blood pressure and other clinical issues. Predictive analytics can improve patient health by predicting risk of medication related problems. When physicians are willing to adopt smart technologies and encourage their patients to use them, insights improve and so can medication adherence.

Pharmacies are an integral partner in the effort to improve medication adherence in the US. Pharmacy operations that are accurate, dependable and highly efficient will be part of the solution. Those that employ technology and support services to ensure error-free processing, accurate dosing and day supply calculations into their systems will be ahead of the game in adherence reform.

Learn more about Infinx and our comprehensive pharmacy management solutions.

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Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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