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May 28, 2014
Prescription non-adherence undermines drug plans

Roughly one-third of patients taking popular medications do not adhere to their prescription regimes, according to data published by Express Scripts Canada (ESC).

According to the pharmacy benefit management and drug research firm, non-adherence rates of patients using high blood pressure, high cholesterol and diabetes medications were particularly high, at 28.2 per cent, 29.4 per cent and 35.5 per cent respectively.

Not taking medications as prescribed can lead to medical complications and increased health care costs, ESC says.

Understanding why so many patients do not fill their prescriptions, or veer from the regimes  prescribed by their medical practitioners, could result in better outcomes for both patients and plan sponsors who pay for the drugs through their group drug plans.

In discussions hosted by the Canadian Leadership Council on Drug Plan Partnerships this past December, Bessie Wang, director of professional services at Telus, noted that the lack of communication between medical practitioners, plan sponsors and plan members is resulting in both cost inefficiencies and non-adherence by plan members.

“Every stakeholder has their own agenda and interest,” Ms Wang told the forum.  “For instance, while the job of a plan sponsor is to contain costs, a physician doesn’t have to worry about that.”

The result is that all parties work in silos, often resulting in confusion for plan members and duplication of effort among medical practitioners, she suggests.

An example of working in silos occurs when a plan member is prescribed a medication based on what a doctor may think is best for the member without considering the cost of the medication or whether it is covered under the member’s group benefits plan.  

“Due to lack of communication, doctors have no information about what drugs are covered for patients.  This means that plan members may have to pay out-of-pocket, which, in turn, could result in them not taking the drug and not addressing the health problem,” she says.

The non-adherence issue and its financial impact on drug plans is one area that insurers, benefits consultants and plan sponsors could explore together, the forum was told.

“We need to translate the benefits of adherence into financial terms,” says Manulife Financial Director of Pharmacy Benefits Connie Wong.  “It’s not readily available from carriers.  And, if we can’t measure it, there’s no way to establish that it’s actually delivering value.”

Establishing mechanisms whereby pharmacies, insurance carriers and benefits consultants promote or remind members to take their medication should be encouraged, Ms Wong concluded.

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