Non-compliance with prescription medications is a huge concern for drug plan sponsors who worry about wasting money and worsened outcomes for their members. A panel at the recent Face to Face in Drug Plan Management conference in Vancouver explored the reasons for non-adherence and offered up solutions.
“No. 1 for us is making sure that cost isn’t the reason that plan members don’t fill their prescriptions,” said Carol Craig, director of human resources, benefits and pensions at Telus Communications Co. “But we must also ensure the plan is sustainable so it’s there when members need it. We want our team members to be at work, healthy and productive.”
To help improve adherence, Telus’ drug plan includes a trial program for drugs known to have a potential for side-effects. Instead of a full prescription, the patient receives enough of the drug for seven to 10 days. If the patient tolerates the drug and it appears to work, the person then returns for the whole prescription. The company also encourages adherence through 100-day refills of maintenance drugs that make it easier and more convenient for patients to fill prescriptions for chronic medications.
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Simmie Smith, president of the Canadian Psoriasis Network, stressed that helping people understand the importance of taking their medications as directed can also boost adherence. “When drugs don’t seem to work or have severe side-effects, some people become discouraged. But patients need to be involved in their treatment and when they know others care about them, there is a higher tendency to be adherent.”
While non-adherence is an issue with all kinds of prescription drugs, it’s particularly high for psychiatric medications, said Dr. Diane McIntosh, psychiatrist and clinical assistant professor at the University of British Columbia. She noted that 50 per cent of prescriptions for antidepressants don’t get filled initially and about 70 per cent of those who do fill them stop taking their medication after three months.
“Stigma around mental illness is a huge issue and it comes from all over the place, including physicians,” she said. “Non-adherence in psychiatry is another serious issue because depression, anxiety and other mental illnesses are inflammatory illnesses that progress over time. If someone isn’t being adequately treated, their illness can progress and become more difficult to treat.”
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Mark Rolnick, vice-president of payor partnerships and plan sponsor innovation at Shoppers Drug Mart, pointed out that non-adherence is a problem that arises with many chronic diseases and can run the gamut from not filling or stopping prescriptions to missing a pill or showing up late for a refill.
“There are some great programs on the specialty side that have shown progress with respect to managing adherence, but the biggest opportunity exists for chronic diseases treated with traditional therapies because of the sheer volume of patients,” said Rolnick. “Data we’ve seen shows that face-to-face interaction with a pharmacist can increase adherence two to threefold.”