Stepping up to the medication adherence plate
This piece is a joint effort by Healthcare Dive and our sister publication, BioPharma Dive.
Both hospitals and the pharmaceutical sector have a large part to play in making sure that patients remain compliant to their drug regimens. It's a considerable challenge, as evidenced by studies such as a Duke University analysis from earlier this year finding that nearly a third of heart attack patients don't adhere to their regimens.
This is also a costly reality that's estimated to lead to about $300 billion in wasteful healthcare spending every year (as well as causing patients' health to deteriorate). But in recent years, industry players have ramped up their efforts to get sick consumers to stick to their drug regimens.
The readmission problem
Sometimes, pills cost money upfront. However, if upfront costs aren’t paid, the resulting costs down the line end up costing more money and, to a greater extent, someone’s health. It’s been estimated that hospital readmissions can lead to $41.3 billion in additional healthcare costs, according to The Network for Excellence in Health Innovation (NEHI). Poor medication adherence can be related to preventable readmissions.
"Poor adherence to prescribed medication is associated with reduced treatment benefits and can obscure the clinician’s assessment of therapeutic effectiveness," wrote The American College of Preventative Medicine (ACPM), adding, "Nonadherence is thought to account for 30% to 50% of treatment failures."
According to the American Heart Association, poor medication adherence can cost the healthcare industry about $300 billion annually (doctor visits, ED visits, and hospitalizations) and takes nearly 125,000 of American lives yearly.
There are myriad reasons why individuals don’t take their pills, according to the American Heart Association, including:
- They may forget;
- They may not understand the importance of taking the medication or unconvinced of its effectiveness;
- They may be afraid of side effects or have difficulty taking the meds; and
Fewer pills, better patient health
When it comes to the final reason, costs, pharma companies and payers tend to point fingers at each other as the source of the problem. Pharmaceuticals argue that high drug prices are necessary to fuel R&D and that insurers should make it easier for their customers to access drugs (they also play up patient assistance programs aimed at reducing co-pays), while insurers say high drug costs put pharma profits over patients.
That's a more extensive and difficult problem to solve. But one of the simplest ways that pharma companies try to get patients to stay on their meds (and out of the hospital) is by simplifying drug delivery and treatment courses. That may mean reducing the overall lifespan of a therapeutic cycle or creating a formulation that necessitates fewer pills.
For instance, fixed-dose combinations (FDCs) of two or more active pharmaceutical ingredients (APIs) have heralded a sea change for hepatitis C and HIV/AIDS treatment. Gilead's Harvoni, which combines the blockbuster hep C med Sovaldi with ledipasvir, has been seen to induce higher rates of a complete cure in patients and requires fewer pills.
HIV/AIDS treatment presents one of the most potent examples of howinnovation in fixed-dose combinations can boost drug compliance and, consequently, patient health. What was once a near-certain death sentence that involved cocktails of dozens of pills (at best) has now become a far more manageable condition.
And that's thanks to the advent of game-changing meds such as Gilead's 3-in-1 HIV tablet Atripla (efavirenz/emtricitabane/tenofovir), which was heralded by the FDA as a "landmark achievement" upon approval, or Viiv Healthcare's Triumeq (abacavir/dolutegravir/lamivudine), which was cleared last summer as the fourth single tablet regimen for HIV.
These drug combos have major compliance implications across the therapeutic spectrum. A 2014 study published in the Journal of the American College of Cardiology found that the use of FDCs and "polypills" boosted heart attack patients' compliance to their treatment regimens by nearly 25%, significantly cutting down these people's risk of another heart attack or re-hospitalization.
The 'smart bottle'
Innovation comes in many forms and is by no means limited to drug delivery mechanisms—a tech upgrade may be coming for the pill bottle, too.
AdhereTech, which describes itself as a manufacturer of "smart wireless pill bottles," warns patients if they've missed a dose by monitoring pill use in real time. That means that if you forgot to take that statin or other medication during the morning rush, the bottle will send you a personalized alert via phone call or text message.
The firm is currently trying to gin up enthusiasm for its product throughout the pharmaceutical sector and envisions itself as a future mass producer of this type of technology.
Let's play a game
And then there are the more... intriguing efforts to boost adherence. For instance, West Pharmaceutical Services, Inc., a manufacturer of packaging components and delivery systems for injectable drugs and healthcare products, has been working with HealthPrize Technologies to "provide electronically-connected drug delivery systems that track when patients take their medication, educate and engage patients to increase adherence and medical literacy, and reward them for compliance with their prescribed regimen."
In essence, this strategy seeks to monitor patients' use of biologics and injectable drugs and "reward" patients for taking their medicine through prizes in mobile games and other platforms. The companies claim that patients who use this system experience an adherence boost of up to 50% compares to baseline.
What can hospitals do?
To cut down on hospital readmissions and improve medication adherence in the short term, NEHI recommends that hospitals can:
- Encourage adoption of evidence-based transitional care;
- Screen for patients at highest risk for medication management and adherence challenges upon arrival at the ED;
- Re-energize discussions on how to improve the quality of medication reconciliation;
- Make real-time patient medication prescribing available as well as adherence and formulary data at all points of care;
- Utilize pharmacists throughout the care process; and
- Explore evidence-based, practical changes to prescription coverage payment policy among all payers.
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