Is the real drug problem medication non-adherence?
Drug cost containment strategies such as mandatory generic substitution and prior authorization rightly dominate discussions about trends in the health benefits industry. But is this preoccupation with cost containment distracting the industry from getting at one of the fundamental causes of poor plan member health and the enormous costs?
When plan members fill their prescriptions, plan sponsors can’t assume they are compliant in following “doctor’s orders.” By addressing medication non-adherence, sponsors can tackle an issue that significantly affects plan member health. In fact, it may be the best cost management strategy yet. After all, according to the Canadian Institute of Health Information, more than $32 billion is spent annually on prescription drugs in Canada, and more than half of that is paid for by private payers.
Non-adherence Is the Norm
Plan members who are adherent take the right drugs, in the correct prescribed dosages, at the optimal time each day, for the appropriate length of time. Non-adherent plan members do not. The result? Non-adherent members experience a reduced quality of life—which has an impact on work and home life—and, at the most extreme, face a decreased lifespan. The outcomes for plan sponsors with non-adherent members are reduced productivity, increased absenteeism and numerous disability claims. These consequences compound and lead to additional health program costs associated with the untreated condition or suboptimal therapy, including additional care, as the initial unmanaged diagnosis worsens.
The degree of non-adherence is especially high in patients with chronic illnesses. The results of the Green Shield Canada (GSC) 2012 Drug Study show that plan members with high blood pressure cost their plans three times as much as those without it—and almost 40% of those sufferers are non-adherent with their medications. Plan members with high cholesterol cost their plans 3.5 times as much as those without—and more than 40% are non-adherent. While there is so much focus on wrestling with high-cost drugs, such as biologics, non-adherence to everyday medications for chronic diseases is where the real opportunity to save on costs exists.
The New “Eat Right”
Just like any type of behavioural change, the underlying reasons for medication non-adherence are complex. For instance, each stage in the healthcare process can influence adherence, as can each plan member’s attitudes. The solution? All stakeholders must get involved at all stages—from receiving a prescription, to filling it, to taking it properly.
Health management programs typically include key messages such as “Exercise regularly” and “Don’t smoke.” But what about “Take your medication properly”? Messages emphasizing the importance of medication adherence must become a standard component of health management initiatives. For example, after publishing its drug study, GSC developed a range of key messages—which it began distributing to plan members through educational materials in early 2013—in straightforward terms: “Fill your prescription and then take the right dosage at the right time for the right length of time” and “Start it…Take it…Finish it.”
The health benefits industry must break the silence on medication non-adherence. It’s the best bet for motivating adherence and positively affecting plan member health. Plus, putting the spotlight on medication non-adherence is actually a long-term cost management strategy delivered as a health management message.
David Willows is vice-president, strategic market solutions, with Green Shield Canada. david.willows@greenshield.ca
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