Some 54% of Americans don't take their medicines or follow a treatment plan as prescribed by their health care provider.[1] And given that 61.1% of Americans under 65 years of age are insured through their employers,[2] there's a significant opportunity for employers to help their workers improve their health and stay well through better adherence to their prescribed treatments.
Both of the statistics I cite above are gaining resonance with employers who are recognizing the importance of medication compliance, which is sometimes referred to as medication adherence. This simply means following a medication treatment plan developed by an individual's health care provider, filling prescriptions, and taking the medications as indicated.
This sounds simple enough, so why do more than half of us become "non-compliant?" A few reasons for lack of compliance, according to recent patient surveys, include concerns about side effects, medication expenses, and ending the use of medications early because patients felt better [1].
According to a recently released survey of 75 large U.S. employers funded by the National Pharmaceutical Council (NPC), 89% of employers acknowledge that medication compliance is a top health management objective, and a large percentage of those surveyed are taking steps to analyze health data and implement compliance programs.
Only preventive care and lifestyle behaviors were rated more highly.Medication compliance has long been acknowledged as a serious problem for the American health care system, costing billions of dollars in lost productivity, additional doctor visits, preventable hospitalizations and nursing home admissions, and even premature death. In fact, a New England Healthcare Institute (NEHI) study found that non-compliance, along with suboptimal prescribing, drug administration, and diagnosis could result in as much as $290 billion per year in avoidable medical spending or 13 percent of total health care expenditures.[1]
Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease, A NEHI Research Brief - August 2009, p. 1. NPC survey respondents - who included benefit directors, medical directors and other health management professionals with health management and pharmacy benefit decision-making authority or influence in large, self-insured corporations are particularly concerned about chronic diseases, which is why diabetes is a key focus of medication compliance initiatives.
Other chronic conditions that warrant employer attention are high cholesterol, blood pressure, cardiovascular disease, congestive heart failure, and chronic obstructive pulmonary disease. To improve compliance, 95% of employers surveyed for the report say they are taking action, and the trend is toward more sophisticated interventions including employee education and additional prescription reminders by e-mail.
Employers are often using their vendors to play a key role in analysis and intervention, with pharmacy benefit managers (PBMs) and employee benefit consultants (EBCs) most often cited. Additionally, employers believe that focused and more sophisticated interventions from vendors are the most effective, with the highest ratings coming from those that focused on individuals with compliance issues and Value-Based insurance Design (VBID) programs, which lower compliance barriers for high-value services.
As a result, there is growing interest in VBID programs, which build specific consumer incentives into plan design benefits or premium contribution structures to steer consumers to make high-value decisions. High-value decisions are ones that research has demonstrated to have a direct positive impact on health outcomes. VBID incentives relate to use of specific medical services or medications, adoption of healthy lifestyles, or use of high-performance providers.
VBID takes into account the bigger picture, beyond just medical and pharmacy costs, and acknowledges the benefit of having healthy employees and the serious drawback of having unhealthy employees. With well-designed VBID strategies, employers can take an active role in directly promoting positive health decision making and utilization of health services based on what's most valuable.
This recognition that compliance can stave off more serious and costly health consequences has led employers to drive the creation of programs that help employees manage chronic and costly conditions. With the right approach, employers can incent the right utilization for the right reasons, and promote value and better health and productivity in their employees.
Note: The NPC survey, Employer Medication Compliance Initiatives: Executive Summary, and an accompanying slide deck are available on NPC's website at www.npcnow.org.
About the National Pharmaceutical Council
The National Pharmaceutical Council is a policy research organization that sponsors, participates in and promotes scientific analyses of the appropriate use of biopharmaceuticals, and the clinical and economic value of improved health outcomes through innovation. NPC actively participates with a variety of health care stakeholders to demonstrate and communicate the value of biopharmaceuticals and vaccines though practical, evidence-based applications and tools.
Recent research has included studies on value-based insurance design to raise awareness and understanding of its value as health reform initiatives progress, and on health and productivity as a business strategy, which will contribute to understanding the full costs of healthcare for employers. To learn more about NPC's research and view our publications, visit www.npcnow.org.
Sources
New Survey: More Than Half of Americans Do Not Take Prescription Medicines as Instructed, Pointing to Growing Public Health Problem, http://www.talkaboutrx.org/documents AdherenceSurveyMediaRelease.pdf, accessed March 15, 2010.
[2] Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2009 Current Population Survey, September 2009, EBRI Issue Brief #334, http://www.ebri.org/publications/ib/index.cfm?fa=ibDisp&content_id=4366, accessed March 18, 2010
