Non-adherence a concern for plan sponsors

If employees don’t take their medications as required, their non-adherence can affect not only themselves but also their employer.

Non-adherence involves many issues, Chris Goguen, strategic pharmaceutical partnerships lead at Medavie Blue Cross, said during a panel discussion at the Face to Face Drug Plan Management Forum in Toronto on Dec. 8.

“It’s not only a fill or refill question,” he said. “It’s also about trying to translate claims data into some insights about the appropriate dose being used and the appropriate interval between doses.”

About one-third of prescriptions never come into the pharmacy, according to Mark Rolnick, vice-president of payer partnerships and plan sponsor innovation at Shoppers Drug Mart. “Another 40 per cent drop off by the third refill, and 69 per cent of hospitalizations due to medications are a result of non-adherence.”

But why should plan sponsors care?

Read: Sharing the benefits burden

Barb Martinez, practice leader for benefits solutions at Great-West Life, said plan sponsors should care about the issue, particularly when it comes to high-cost drugs. “When you’re taking a high-cost drug, if you stop and start and really don’t take it the way it’s intended, you’ve wasted all of the money that’s being spent on it. It can be $10,000 or $50,000 or more a year.”

Yet non-adherence isn’t so black and white as there are any number of reasons why patients don’t take their medications as prescribed. They include cost, side-effects of medications, forgetfulness and employee engagement in their condition and treatment.

“Some patients simply don’t understand that if they’re supposed to take something twice a day and they don’t, they’re not going to get everything out of it,” said Dawn Richards, a science and patient consultant who serves as vice-president of the Canadian Arthritis Patient Alliance.

“Everyone’s journey is different, and there’s a bit of probing that has to happen to figure out why they’re not taking their meds like they’re supposed to,” she added.

Read: Lack of adherence and communication plague drug plans

But if probing isn’t an option, there are programs and services available to help patients. Insurers should have good-quality disease education programs and they should be able to integrate specialty drugs with patient support programs, said Goguen. He suggested insurers should use data more intelligently to prompt and identify opportunities either on the reimbursement or the patient education side.

“Intellectually, these engagement programs and educational programs sound wonderful but they’re all very academic and can be really scary for people,” said Richards. “Patients often simply want to go to a peer and ask: What did you do? What worked for you?”

Technology will play a big role in helping to address non-adherence. “In addition to learning about treatment from a pharmacist, if there’s a way to leverage technology to help patients better understand their medications and how to handle any things that come up [that] they may not be expecting, that will go a long way,” said Rolnick.

“Technology is advancing to the point in which what we’re going to see is linking the claims technology to an app, to have those systems talking to each other,” said Martinez.

Read: Non-adherence costs employers

While technological innovations can be helpful, they may not work for every patient. “For some people, the human element and the human touch will go much further than any kind of technology will,” said Richards.