Products & Programs PharmacyMedicare AdvantageJune 1, 2024

Addressing medication adherence gaps

Medications are the primary intervention in treating and preventing disease. For most conditions, medications need to be taken 80% or more of the time to see an improvement in clinical outcomes.

Forty to fifty percent of patients are non-adherent to their medications for chronic conditions, leading to 100,000 preventable deaths and $100 to $300 billion in preventable medical costs per year.*

How can we prevent and close adherence gaps?

Be aware of contributing factors that influence non-adherence:

  • Cognitive impairment
  • Fear of side effects
  • Too many medications
  • History of non-adherence
  • Lack of perceived benefit
  • Confusion
  • Transportation
  • Cost

Implement a standardized process to identify patients with non-adherence:

  • Ask about adherence at every appointment.
  • Incorporate patient questionnaires or patient interviews using open-ended questions into existing workflows.
  • Analyze non-adherence reporting or claims to identify patients.
  • Leverage your electronic health record to identify patients at risk for non-adherence.

Be proactive: Tailor the solution to the patient’s needs or concerns:

  • Simplify the medication regimen by considering once daily dosing.
  • Always educate patients on benefits and risks of taking or not taking their medications.
  • Leverage real-time prescription benefit to select lower cost and formulary medications during the electronic prescribing process.
  • Consider home delivery (mail) and 90-day supply to prevent refill gaps, avoid long waits at the pharmacy, and minimize transportation barriers.

Consider medication non-adherence first as a reason when a patient’s condition is not under control.

*Kleinsinger F. The Unmet Challenge of Medication Nonadherence. Perm J. 2018; 22:18-033. doi: 10.7812/TPP/18-033. PMID: 30005722; PMCID: PMC6045499.
Gooptu A, Taitel M, Laiteerapong N, Press VG. Association between Medication Non-Adherence and Increases in Hypertension and Type 2 Diabetes Medications. Healthcare (Basel). July 31, 2021; 9(8): 976. doi: https://doi.org/10.3390/healthcare9080976.
Brown M, Sinsky CA. Medication Adherence. Improve Patient Outcomes and Reduce Costs. American Medical Association Steps Forward. June 5, 2015. https://edhub.ama-assn.org/steps-forward/module/2702595. Accessed May 16, 2023.
Eight reasons patients don’t take their medications. American Medication Association. Feb 22, 2023. Accessed May 17, 2023.
https://ama-assn.org/delivering-care/patient-support-advocacy/8-reasons-patients-dont-take-their-medications.
El Halabi J, Minteer W, Boehmer KR. Identifying and Managing Treatment Nonadherence. Medical Clinics of North America. 2022; 106(4): 615-626. doi: https://doi.org/10.1016/j.mcna.2022.02.003.
Kini V, Ho PM. Interventions to Improve Medication Adherence. JAMA. 2018; 320(23): 2461. doi: https://doi.org/10.1001/jama.2018.19271.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: June 2024 Provider Newsletter