Driving medication adherence is a persistent challenge in specialty pharmacy. Often, patients are managing complex chronic conditions with high-cost therapies that can leave patients struggling to keep up. Patients needing specialty medication may also be dealing with knowledge gaps, treatment fatigue or low motivation resulting from the ongoing burden of living with chronic illness.
Each year in the United States, medication nonadherence can account for:
- 50% of treatment failures
- 125,000 deaths
- Up to 25% of hospitalizations
Clinical support via digital health tools and a patient-centered communication approach can have a positive impact on adherence and health outcomes.
Research goal
Recognizing the needs for enhanced, comprehensive patient support, Accredo Specialty Pharmacy launched a clinical study to better understand the adherence impact of providing patients with multi-modal engagement opportunities for clinical support.
Multi-modal refers to the use of multiple communication and support channels to engage and assist patients. In this clinical study, support includes both telephonic contact from a clinical staff member and digital support via a smart sharps container with companion app. A multi-modal approach provides patients with personalized support in different ways across various platforms throughout their care journey.
Study background
The study focused on the specialty drug dupilumab, a self-injectable biologic approved to treat asthma, atopic dermatitis, nasal polyps, eosinophilic esophagitis, prurigo nodularis, and, recently, chronic obstructive pulmonary disease (COPD) and chronic spontaneous urticaria (CSU). Adherence can be complicated by factors like storage requirements, injection concerns, side effects and taking time to experience full effect. The first several months of treatment are a critical period for adherence. Ensuring early consistency gives patients the best chance to experience symptom improvement. Optimized adherence makes it easier on prescribers to accurately assess treatment response at follow-up.
Study objective
Accredo’s study assessed whether providing more than one mode of clinical support could improve patient engagement and make a quantifiable impact on adherence. Patients studied had access to multiple medication management solutions. They could use telephonic (telephonic education and coaching), digital (a smart sharps device with a companion digital app), or both clinical support offerings.
The hypothesis: Driving higher engagement through multi-modal support programs would correlate with better medication adherence.
Research design and methodology: Observational cohort with lead-in enrollment methodology
The Evernorth Research Institute in partnership with the Accredo research team observed 14,552 adult patients (ages 18-89), who initiated dupilumab therapy between July 1 and December 31, 2023, and were eligible for Accredo’s multi-modal clinical support pilot program.
Researchers tracked engagement for the first six months of treatment to sort patients into three cohorts:
- Unengaged: No participation in either offering
- Moderately engaged: Participated in either digital or telephonic support
- Maximally engaged: Participated in both digital and telephonic support
After six months of treatment, adherence was measured. The results presented here are drawn from this six-month observation window. Adherence for each cohort was measured in Proportion of Days Covered (PDC), a calculation of the percentage of days a patient has medication on hand. A PDC of 80% or higher is typically considered optimally adherent.
Researchers used bivariate statistical tests to compare differences among cohorts and applied multivariable linear and logistic regression to control for demographic group differences, like age and gender mix.
Key findings: Multi-modal clinical support participation encourages medication adherence.
Maximally engaged patients achieved (in comparison to unengaged patients):
- 9.4% higher average PDC
- 1.8x higher likelihood of achieving optimal adherence
Moderately engaged patients (in comparison to unengaged patients):
- 5.4% higher average PDC
- 1.4x higher likelihood of achieving optimal adherence
Patients taking dupilumab who participated in both clinical support modes (i.e. digital and telephonic) showed greater improvement in adherence than those using only one offering. However, any level of clinical participation resulted in significant adherence improvement over those patients who never engaged.
The percentage of patients maintaining optimal adherence (a PDC ≥ 80%) during their first six months of treatment was also better for patients engaged in clinical programming, with 70% of maximally engaged patients and 64.3% of moderately engaged patients remaining above the optimally adherent threshold. Only 57.1% of patients unengaged in clinical programs remained optimally adherent at six months. The improvements in PDC for dupilumab patients when engaged in one or both clinical support offerings suggests that multi-modal clinical support strategies can meaningfully improve adherence outcomes.
The role of multi-modal support strategies in specialty adherence
This research demonstrates that providing accessible tools for clinical patient support — and combining telephonic and digital modes of patient adherence communications — leads to stronger medication adherence.
Our findings indicate that leveraging both technology and empathetic human interaction is key to effective, scalable improvements in medication adherence. Accredo’s use of robust multi-modal clinical support offerings represents a path toward improving care and maximizing medication adherence for patients.
Key takeaways
Accredo’s findings signal to providers and health plan partners the value of multi-faceted adherence programs. Payers should prioritize partnerships with specialty pharmacies that offer a variety of clinical support modalities accessible to diverse patient populations.
Partnering with a specialty pharmacy that is actively testing and refining its clinical model to improve patient adherence offers substantial value to health plans. This continuous innovation leads to better health outcomes, particularly for complex or high-cost conditions, by ensuring patients consistently take their medications as prescribed. As a result, health plans benefit from reduced hospitalizations and emergency room visits, improved quality metrics (such as STARS ratings), and more accurate risk adjustment. Additionally, enhanced adherence contributes to higher member satisfaction and retention, ultimately driving down total cost of care and strengthening the plan’s competitive position.
Specialty pharmacies, like Accredo, are uniquely positioned to help patients succeed in their therapeutic journeys. Accredo’s multi-modal clinical support offerings meet patients where they are to drive better engagement and improve adherence.
See Accredo’s clinical research posters for details on this and other studies.
