The Scope and Significance of Medication Adherence – Part Three

Medication adherence is one of the most complex patient behaviors. When plan members stop taking medications as directed, it can have a domino effect. Disease treatment may halt, complications may arise, and a person may end up in the ER or admitted to the hospital.¹ Tackling non-adherence requires a collaborative, patient-centric approach that considers patient needs and results in intelligent interventions.² Below, you’ll find strategies that have fostered smarter, cost-effective prescription drug adherence that promotes positive health outcomes for patients.

This is part three of three-part series on the state of medication adherence in the United States. You can find the first post in the series here.

Value-Based Insurance Design & Value-Based Benefit Design

Value-based insurance design (VBID) is an innovative approach to benefit planning to reduce long-term healthcare costs while improving health quality. It involves changing the cost structure for plan participants to promote the use of services or treatments that result in relatively high health benefits and to discourage the use of interventions with no or limited health benefits.³

Value-based benefit design (VBBD) aims to improve medication adherence through waived copayments, wellness offerings, and on-site services. As employers become more involved in improving healthcare quality and controlling medical expenditures, there is an increasing focus on developing health benefit programs that provide cost-effective, comprehensive insurance coverage and promote optimal outcomes. VBBD strategies use an evidence-based, data-driven approach to structure health insurance policies and can encompass employer-sponsored wellness programs and incentives. Often, the goal of VBBD policies is to promote the appropriate use of healthcare services by lowering the access barriers to preventive care and supporting healthy lifestyles.⁴

Copay Strategies

A study to evaluate the impact of value-based benefit design (VBBD) on adherence to diabetes medications revealed that patients with copay reductions for insulin and/or oral antidiabetic medications were more likely to continue their treatment.⁵ A VBBD showed that a 36.1% reduction in copay reduced the number of non-adherent patients by 30%.⁵ Lower patient out-of-pocket expenses can improve access and adherence leading to improved long-term patient outcomes and decreased overall costs.⁶

Lifestyle Interventions

One common and essential health goal is to reverse prediabetes, preventing disease progression and the ultimate development of complications. Adherence to intensive lifestyle interventions can reduce the incidence of diabetes by 58% among prediabetic patients, possibly diminishing the prevalence of diabetes by 8% and resulting in cumulative health system cost savings of up to $105 billion.³ Initiatives to promote weight loss in overweight and obese persons can reduce the incidence of prediabetes and diabetes, e.g., a 5% weight loss by overweight or obese individuals could translate into $45 billion in projected health system cost savings over a decade.³

The Ideal Intervention

The ideal intervention involves the payer, patient, pharmacist, clinician, and policymakers, as well as health information and other innovative technologies. The rise of new technologies gives the healthcare industry a potentially powerful way to improve medication adherence. It is important to note, however, that technology-driven medication adherence strategies and tools are most effective in combination with in-person contacts.⁷

Digital Interventions

Digital interventions refer to those that are delivered via an online or web‐based platform, a computer‐based platform, or an electronic device of any type. Some examples include websites, online forums, mobile apps, SMS message interventions, electronic adherence monitoring devices, etc.⁸

Digital interventions offer advantages in adaptiveness, accessibility, reproducibility, and reach. With the widespread use of technology, digital interventions can reach many people, particularly in settings where non‐digital materials or face‐to‐face consultations are restricted, which may promote better communication between patients and healthcare providers.⁸

The Bottom Line

Medication adherence is a complex public health issue that demands continued progress to overcome a multitude of patient, provider, and health system barriers.⁹ Patients want relief without losing quality, and payers, healthcare plans, and healthcare professionals aim to meet that challenge. Doing so begins with channeling resources toward the areas where we can make the largest strides most efficiently and cost-effectively.

Optimizing a patient’s ability to access and use their medication in safely and effectively is at the forefront of addressing medication adherence.¹⁰ When patients practice medication adherence, optimal clinical outcomes ensue, and it’s critical to determine the best course of action to initiate better adherence practices.

Sources

1. The 4 “E’s” Health Plans Need to Know to Improve Medication Adherence. Dec 2019.
2. Medication Adherence in the Real World. Cognizant 20-20 Insights. Oct 2014.
3. Greenapple R. Review of Strategies to Enhance Outcomes for Patients with Type 2 Diabetes: Payers’ Perspective. American Health & Drug Benefits. 2011;4(6):377–386.
4. Reid K, Aguilar K, Thompson E, et al. Value-Based Benefit Design to Improve Medication Adherence for Employees with Anxiety or Depression. Am Health Drug Benefits. 2015;8(5):263-271. PMID: 26380032; PMCID: PMC4567057.
5. Zeng F, An J, Scully R, et al. The impact of value-based benefit design on adherence to diabetes medications: a propensity score-weighted difference in difference evaluation. Value Health. Sep-Oct 2010;13(6):846-52.
6. Arevalo J. Perspectives in Value-Based Insurance Design for Patients with Diabetes: Assessment and Application. Am Health Drug Benefits. 2011; 4:27–33.
7. Granger B, Bosworth H. Medication Adherence: Emerging use of technology. Current Opinion in Cardiology. 2011;26(4):279–287.
8. Chan A, De Simoni A, Wileman V, et al. Digital interventions to improve adherence to maintenance medication in asthma. Cochrane Database of Systematic Reviews. 2018; (5). Art. No.: CD013030. DOI: 10.1002/14651858.CD013030.
9. Bentley D, Potts J. Medication Adherence and Compliance. Fresenius Medical Care. July 2019.
10. Organizational Toolkit on Medication Adherence. National Council for Mental Wellbeing. 2019.