Understanding medication nonadherence in the U.S.
Up to half of Americans don’t take their medications as prescribed. Also known as nonadherence, this phenomenon is associated with approximately 125,000 deaths, 10% of hospitalizations and 16%—or $500 billion—of health care spending in the U.S. every year.
The consequences of nonadherence can be magnified with inflammatory conditions, which comprise a range of chronic disorders where a patient’s immune system attacks their own body’s cells or tissues.
More than 10 million Americans are living with at least one of the following common inflammatory conditions:1
With no known cure for the conditions, these patients will likely be on medication therapy for life. The high prevalence of diagnoses, coupled with the fact that therapies can cost an average of $4,500 or more per prescription, help explain why inflammatory condition treatments are the most costly drug class in the U.S.—as well as the highest category of specialty spending for many plan sponsors.
When inflammatory condition patients are nonadherent to their prescribed medication regimen, the disease progression typically accelerates, leading to worse symptoms and a higher total cost of care. Conversely, patients with higher adherence tend to have lower disease activity, which was shown in a recent study among RA patients.
Factors contributing to nonadherence
- Comorbidities and side effects – Patients with certain chronic inflammatory conditions are at higher risk for concurrent diseases or disorders, which can increase the probability of nonadherence. For instance, behavioral issues like depression and anxiety are increasingly common for inflammatory condition patients, particularly those with inflammatory bowel diseases.
In a study conducted by RAND Corporation, patients suffering from depression had a 76% greater likelihood of being nonadherent with their medications compared to patients who were not depressed.
- Inconvenience and safety concerns – Because some inflammatory condition treatments require specialty drug infusions, patients often must travel to high-cost outpatient facilities to have the therapy administered. In these outpatient settings, patients can face long wait times as well as increased risk of infections. Such issues are creating a higher demand for home infusions, which can be more convenient and safe than infusions administered in a hospital setting—not to mention $75,000 less expensive over the course of a year.2
- Complexity – The unique complexities of each inflammatory condition can also play a role in patients missing days of work or school, as they often need time to determine how a therapy impacts them on a daily basis. Additionally, most injectable anti-inflammatory drugs have special requirements for storage and administration, which can present challenges for patients—especially when traveling.
Acknowledging concerns and their impact on medication compliance
There are also times when a patient has a legitimate reason not to take their anti-inflammatory specialty medication as prescribed, such as when they’re concerned about a possible illness or infection. Such a scenario can confound patients because inflammatory condition drugs can suppress their immune system and lower the body’s natural ability to fight off harmful organisms. This is another adherence risk factor that reinforces the need for specialized support from clinicians who understand how to resolve inflammatory condition-specific risks, so they can help patients get and stay back on track.
Plan sponsors can effectively address these risk factors by partnering with a specialty pharmacy who proactively tracks adherence across all stages of the patient experience. Some key foundational elements of this kind of supportive care model include:
At Accredo, Evernorth’s specialty pharmacy, our Specialty Clinical Care Management program leverages proprietary protocols to deliver proactive, condition-specific training and monitoring. These proven protocols help drive an average adherence rate of 82.5% for inflammatory condition patients continuously using Accredo during 2022.3
For example, Accredo offers a WiFi-enabled syringe disposal device that tracks medication usage and sends the patient dose reminders via text message. If the patient appears to be nonadherent with their injections, a nurse with condition-specific expertise will follow up to provide one-on-one support. In a pilot program with patients taking an RA biologic, this system drove a 7% overall improvement in adherence.4
Accredo’s Adherence Course Correct is a clinical program that automatically deploys a personalized intervention once a pattern of nonadherence has been established. For instance, if a patient is becoming nonadherent for some reason, a clinical coaching expert will reach out to help them navigate the issues and get back on track. In a pilot of this program, patients receiving at least one outreach had up to 9% higher adherence.5
To help illustrate how clinical protocols can help drive adherence across an RA specialty drug patient’s journey, click here to view our infographic.
From a cost management standpoint, plan sponsors can also improve adherence by implementing a value-based program designed specifically for inflammatory conditions. By managing inflammatory condition treatment options at the indication level, these programs increase price competition among clinically equivalent medications. As a result, plans can better control costs while ensuring patients have access to the most effective treatments.
In 2022, plans enrolled in Evernorth’s Inflammatory + Atopic Conditions Care Value ProgramSM saved $2.3 billion.6
When deployed on their own, clinical protocols and value-based solutions can certainly improve adherence among inflammatory condition patients. However, a holistic strategy that combines both is optimal. That’s why it’s important for plan sponsors to work with a specialty drug management partner who can help integrate them with maximum synergies.
1 Express Scripts, Care beyond compare: An in-depth look at the patient experience in an Accredo Therapeutic Resource Center, 2017
2 Large Health Plan Site of Care Analysis, 2022
3 Accredo PDC Adherence Data (for patients continuously using Accredo during 2022), 2022
4 Accredo RAI Health Beacon Pilot Data (over 18 months), 2020-2021
5 Accredo Clinical Programs Outcomes Analysis, Q1 2021
6 SafeGuardRx Data, 2022