Medication Adherence: A Hard Pill to Swallow

An action oriented analysis on the current state of medical adherence

Medication Adherence Defined

As defined by The Centers for Disease Control and Prevention: Medication adherence is the Patients conformance with the provider’s recommendation with respect to timing, dosage, and frequency of medication-taking during the prescribed length of time.

Non-adherence can be broken up into three categories Non-Fulfillment Non-Persistence Non-Conforming

Consequences of non-adherence

Non-adherence leads to higher hospital readmission rates. The lack of proper control over chronic conditions such as

hypertension and cardiovascular disease. The overall cost of non-adherence estimated around $290 billion

in avoidable medical spending. $100 billion in hospitalizations

Insurance, hospitals, and patients all lose out in some way due to non-adherence.

On an individual basis, a study found that medication adherent diabetes patients, had annual healthcare costs of $8,886, whereas the non-adherent patient had an annual cost of $16,498.

The extent of non-adherence in the United States

20-30% of prescriptions are never filled. Medication is not properly consumed as prescribed 50% of the

time. Adherence much lower in chronic diseases.

Lower over time. Statin drugs (used to lower cholesterol) adherence estimated at 80% for first three months, 56% after 6 months

Only 25% maintain adherence level of 80% or greater after 5 years.

Affects communities disproportionately Lower adherence rates in black Medicare recipients compared to

white Medicare recipients

Causes of Medication Non-Adherence

Relational and organizational factors Patient-provider relationships, follow up, patient education

Condition Related Factors The importance of adherence perceived by the patient based off of

their personal and cultural view of their illness

Characteristics of therapies Complexity of treatment plan as well as side-effects associated

Patient related factors Self-efficacy, socioeconomic status, health literacy of patient

Current Efforts

Care coordination/ case management Improvement of reminder technology

Phone applications and prescription bottle alarms

Simplifying drug regimens Drugs that need to be taken once a day that historically

needed to be taken twice a day

Patient education

Proposed Legislation(720 ILCS 570/316) Sec. 316. Prescription monitoring program. (a) The Department must provide for a prescription monitoring program for Schedule II, III, IV, and V controlled substances that includes the following components and requirements: (1) The dispenser must transmit to the central repository, in a form and manner specified by the Department, the following information: (A) The recipient's name. (B) The recipient's address. (C) The national drug code number of the controlled substance dispensed. (D) The date the controlled substance is dispensed. (E) The quantity of the controlled substance dispensed. (F) The dispenser's United States Drug Enforcement Administration registration number. (G) The prescriber's United States Drug Enforcement Administration registration number. (H) The dates the controlled substance prescription is filled to be sub.

(I) The patient self-reported measure of medication adherence. When acquiring this measure, the patient must be informed of the confidentiality of his answer, and that his answer will be exempt from penalty from his healthcare provider and/or insurer . (J) The payment type used to purchase the controlled substance (i.e. Medicaid, cash, third party insurance). (K) The patient location code (i.e. home, nursing home, outpatient, etc.) for the controlled substances other than those filled at a retail pharmacy.(L) Any additional information that may be required by the department by administrative rule, including but not limited to information required for compliance with the criteria for electronic reporting of the American Society for Automation and Pharmacy or its successor.

Sample Questionnaire

Did you take your prescription according to the provided directions?*Your answer will only be viewed by the pharmacist and prescribing physician and will remain confidential from other entities such as insurance

[ ]Yes [ ] Somewhat [ ] No

Why the prescription monitoring program?

National Alliance for Model State Drug Laws (NAMSDL) identifies the prescription monitoring program with the following goals:

1. Support access to legitimate medical use of controlled substances,

2. Identify and deter or prevent drug abuse and diversion,3. Facilitate and encourage the identification, intervention

with and treatment of persons addicted to prescription drugs,

4. Inform public health initiatives through outlining of use and abuse trends, and

5. Educate individuals about PDMPs and the use, abuse and diversion of and addiction to prescription drugs.

Policy Paramours Senator John G.

Mulroe (D) 10th District Chair of Public

Health Committee J.D. from Loyola

and certified public accountant

Representative Robyn Gabel (D)

18th District (Former)Medicaid

Subcommittee MSPH from UIC Master of

Jurisprudence (MJ) in Health Law

Representative Mary E Flowers (D)

31st District Health Care

Availability Access Committee (Chairperson)

Health and Healthcare Disparities Committee

Sponsor of House Bill 108• Illinois Universal Health Care Act• Has introduced it in the House

every year since 2007• Bill focuses on centralized records

system, choice of providers, and reducing health care costs.

• Primary Sponsor of a lot of bills• Focus on prevention/ screening

legislation• Eg. Senate Bill 1410• Tightens exceptions on vaccinations• Passed in Senate, now in House• Also sponsored by Robyn Gabel in

the House

Sponsor of House Bill 2915

• Sponsored by Gabel, Bellock and Reitch

• Creates the Caregiver Advise, Record, and Enable Act

Policy Paramours Representative

Patricia R. Bellock (R)

47th District Health and

Healthcare Disparities Committee

Formerly in Medicaid Committee (co-chair) in 96th GA

Representative David R. Leitch (R)

73rd District Deputy Republican

Leader Health and Health-

care Disparities Committee

State Legislator of the Year in the U.S. by the AMA

Senator Mattie Hunter (D)

3rd District Majority Caucus

Whip Public Health

Committee

Public Act 97-0689 / SB2840

• Program Integrity for Medicaid and Children’s Health Insurance Program Act

• Mulroe sponsored this bill in the Senate

Sponsor of House Bill 3285

• Protects rights of Medicaid recipients to be able to choose their own physician

• Sponsored with FlowersCurrently interested in mental health reform

Sponsor of Senate Bill 1792

• Medicaid Diabetes education• Attempts to start a pilot program

for diabetes self-management training in Medicaid recipients.

Governmental Stakeholder Analysis

Healthcare and Family Services

Health Information Exchange Authority, Illinois

Illinois Department of Human Services

Illinois Department of Public Health

Illinois Department of Healthcare and Family Services

Illinois Board of Pharmacy

Illinois Comprehensive Insurance Plan

Prescription Monitoring Program Illinois

University of Illinois Hospital System

Center for Medicare and Medicaid Services

Private Stakeholder analysis

National Consumers League

American College of Physicians Foundation

American Pharmacists Association

American Society of Health-System

Pharmacists

Intelecare Compliance Solutions, Inc.

Kaiser Permanente

National Association of Chain Drug Stores

National Community Pharmacists

Association

National Council for Patient Information

and Education

National Family Caregivers Association

National Health Council National Research

Center for Women and Families

The Pharmacy Quality Alliance, Inc.

Society for Women’s Health Research

Accreditation Commission for Health Care

American Medical Association

Illinois Pharmacists association

Pfizer

 

Future Directions

Small picture Better targeted case management

More precise data surrounding medication adherence

Follow up opportunities for pharmacists and physicians

Big picture Healthcare savings by all parties

Infrastructure for prescription compliance for patients of all demographics

Better treatment of chronic conditions

Resources

Centers for Disease Control and Prevention. (2013, March 13). Medication Adherence. Retrieved April 28, 2015, from http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf

Chisholm-Burns, M., & Spivey, C. (2012). The 'cost' of medication nonadherence: Consequences we cannot afford to accept. Journal of the American Pharmacists Association, 823-823.

Gerber, B. S., Cho, Y. I., Arozullah, A. M., & Lee, S.-Y. D. (2010). Racial Differences in Medication Adherence: A Cross-Sectional Study of Medicare Enrollees. The American Journal of Geriatric Pharmacotherapy, 8(2), 136–145. doi:10.1016/j.amjopharm.2010.03.002

Health Affairs. (2001, December 19). Patient Medication Adherence: The Next Act. Retrieved April 28, 2015, from http://healthaffairs.org/blog/2011/12/19/patient-medication-adherence-the-next-act

Health Care Financing and Organization. (2011). Does Medication Adherence Lower Medicare Spending Among Beneficiaries with Diabetes?

Ho, P., Bryson, C., & Rumsfeld, J. (n.d.). Medication Adherence: Its Importance In Cardiovascular Outcomes.Circulation, 3028-3035.

Illinois General Assembly. (n.d.). Illinois General Assembly - (720 ILCS 570/316). Retrieved April 28, 2015, from http://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=072005700K316

Illinois Prescription Monitoring Program. (n.d.). Retrieved April 28, 2015, from https://www.ilpmp.org/index.php

Marcum ZA, Sevick M, Handler SM. Medication Nonadherence: A Diagnosable and Treatable Medical Condition. JAMA.2013;309(20):2105-2106. doi:10.1001/jama.2013.4638.

National Conference of State Legislatures. (2012, November 1). Medication Adherence: Taking Pills as Ordered. Retrieved April 28, 2015, from http://www.ncsl.org/research/health/medication-adherence-taking-pills-as-ordered.aspx

National Health Council. (2009, July 17). Letter to Congress. Retrieved April 28, 2015, from http://www.nationalhealthcouncil.org/sites/default/files/NHC_Files/Pdf_Files/medicationadherence_08-12-09.pdf

New England Health Institute. (2009). Thinking Outside the Pillbox A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease. New England Health Institute.

Prescriptions for a Healthy America. (n.d.). Prescriptions for a Healthy America - Medication Adherence: A $300 Billion Problem. Retrieved April 28, 2015, from http://adhereforhealth.org/who-we-are/medication-adherence/