United States: The Medication Non-Adherence Healthcare Epidemic - Potential Med Tech Solutions

Gloria Skigen is a Partner in Holland & Knight's Stamford office

The New York Times has described American's nonadherence to prescribed medications as an "out-of-control epidemic that costs more and affects more people than any disease Americans currently worry about." 

Prescription medicines, when used appropriately, allow patients to avoid other costlier services, such as emergency room visits, hospital stays, surgeries and long-term care, and provide substantial savings in avoided health care costs.1 Studies of patients with asthma,2 diabetes,3 cystic fibrosis4 and heart disease5 have all demonstrated that patients with lower medication adherence are more likely to require emergency room visits or hospitalizations than those with better adherence.6 Poor medication adherence, suboptimal prescribing, and medication errors have been suggested to result in an estimated $100 billion to $290 billion in avoidable health care costs each year,7and lost revenues to the pharmaceutical industry in 2015 alone in excess of $600 billion.8 Patients, on average, take only half their prescribed doses,9 and nearly one-quarter of new prescriptions are never filled.10 A study has found that health plans with low patient medication adherence rates could save $4 billion (heart failure) and $19 billion (diabetes) annually by improving adherence of their enrollees.11

The economic implications of medication nonadherence have driven the market to look for software/hardware tech-enabled solutions to address this complicated problem.  The reasons for medication nonadherence (and therefore how to address the problem) are multifactorial and complex.  The most frequently identified causes for nonadherence are costs to patients of prescription medications;12psychological and behavioral variables (such as negative beliefs of patients); and complexity in managing multiple medication regimens.  In a recent blog published by Boston-based venture capital firm Flare Capital Partners, the authors identified over 25 medical adherence tech companies addressing one or more of these factors.  Below is a summary of how the med tech companies highlighted by Flare Capital Partners are addressing the issues:

Out of pocket costs.  Companies are offering consumer coupons for medications, real-time cost information (so patients can better shop for the lowest cost provider), and pharmaceutical discount and rebate cards.

Behavior modification. Offerings include mobile apps that identify when a dose has been missed, Companies addressing patient behavior through elements of gamification and rewards, Companies offering engagement and management tools, and smart pill bottles.

Medication fulfillment.  Companies include vertically integrated mail-order pharmacies and on-demand delivery services.  Both seek to synchronize prescription refills for patients with multiple conditions, and avoid multiple trips to fill prescriptions.

Footnotes

1 Expansion of prescription drug coverage through the Medicare Part D program has increased medical adherence, resulted in healthcare cost savings, and extended the lives of millions of American seniors.  Since the implementation of the program, on average, 22,100 lives were saved each year between 2006 and 2014, and nearly 200,000 Medicare beneficiaries have lived at least 1 year longer, with an average increase in longevity of 3.3 years.  Semilla AP, Chen F, Dall TM.  Reductions in mortality following the implementation of Part D.  Am J Manag Care.  2015; 21 (9 Suppl):s165-71.

2 Children on Medicaid who had lower adherence to long-term asthma controller medications had 21% higher emergency department visits and 70% higher hospitalization within three-months of initial prescription.  Rust G, Zhang S, Reynolds J.  Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma.  J Asthma.  2013; 50(7): 769-75.

3 Gibson TB, Song X, Alemayehu B, et al.  Cost sharing, adherence, and health outcomes in patients with diabetes.  Am J Manag Care. 2010; 16(9):589-600.

4 Patients with low adherence to pulmonary medication are 35% more likely to be hospitalized.  Quittner AL, Zhang J, Marynchenko M.  Pulmonary medication adherence and health-care use in cystic fibrosis.  Chest. 2014;146(1):142-51.

5 Ho, PM, Bryson, CL, Rumsfeld, JS.  Medication Adherence:  Its Importance in Cardiovascular Outcomes.  Circulation.  2009;119:3028-3035.  See also Pittman DG, Chenm W, Bowhn, SJ, Foody, JM.  Adherence to statins, subsequent healthcare costs, and cardiovascular hospitalizations.  Am J of Card 107(2011):1662-1666.

6 Lack of adherence is estimated to cause approximately 125,000 deaths and more than 10% of hospitalizations per year.  https://www.ncbi.ilm.hih.gov/pmc/articles/PMC3711878/.

7 IMS Institute for Healthcare Informatics.  Avoidable costs in U.S. healthcare:  the $200 billion opportunity from using medicines more responsibly.  http://www.imshealth.com/en/thought-leadership/webinar-library/replay/avoidable-costs-in-us-healthcare-the-200-billion-opportunity.  Published July 2013.  http://www.nejm.org/doi/pdf/10.1056/NEJMp1307084.

8 Whitepaper by Capgemini Consulting and HealthPrize Technologies.  https://ss-usa.s3.amazonaws.com/c/308452206/media/5829ee776ef7c/Revenue-Loss-Due-to-Nonadherence-2016.pdf

9 National Council on Patient Information and Education.  Accelerating Progress in Prescription Medicine Adherence.  The Adherence Action Agenda,  A National Action Plan to Address America's "Other Drug Problem."  October 2013.  http://bemedicinesmart.org.

10 https://wire.ama-assn.org/practice-management/8-reasons-patients-dont-take-their-medications.

11 Seabury SA, Lakdawalla DN, Dougherty JS, Sullivan J, Goldman DP.  Medication adherence and measures of health plan quality.  Am J Manag Care. 2015;21(6):e379-89.

12 For every $10 increase in out-of-pocket costs for prescription drugs, adherence decreases by approximately 4%.  Eaddy MT, Cook CL, O'Day K, Burch SP, Cantrell CR.  How patient cost-sharing trends affect adherence and outcomes:  A literature review.  PT. 2012;37(1):45-55.  See also https://cvshealth.com/thought-leadership/cvs-health-research-institute/cost-biggest-barrier -medication-adherence.

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