Quality ManagementMedicare AdvantageMay 27, 2025

Bridging the gap: Enhancing medication adherence for better health outcomes

Did you know 40 to 50% of patients are non‑adherent to their medications for chronic conditions, leading to 100,000 preventable deaths and $100 to $300 billion in avoidable medical costs per year?1 Medications are the primary intervention in treating and preventing disease. For most conditions, medications need to be taken at least 80% of the time to see an improvement in clinical outcomes. Please review the guidance below for ways to understand and support effective usage of your patients' medication.

Understanding the potential challenge

Medication adherence is not just about patients remembering to take their pills — it is a multifaceted issue influenced by several factors, including:

  • Adherence challenges: Cognitive impairment, history of non‑adherence, and confusion or misunderstandings
  • Barriers and concerns: Fear of side effects, perceived lack of benefit, and complex medication regimens
  • Logistical or financial issues: Transportation difficulties and high medication costs

Implementing Solutions

Standardized identification process
Identifying adherence issues can be challenging. We recommend the following strategies:

    • Discuss adherence at each appointment using open‑ended questions
    • Analyze claims or non‑adherence reports to find at‑risk patients
    • Use electronic health records for proactive identification

Tailored and proactive approaches
It is essential to tailor solutions to each patient’s unique needs:

    • Simplify regimens: Use once‑daily doses and 90‑day supplies with refills
    • Patient education: Clearly explain medication benefits and risks
    • Streamline prescribing: Use real‑time prescription benefits and e‑prescribe to CarelonRx® for home delivery to reduce pharmacy visits

Spotlight on success

When a patient struggles with controlling their condition, consider medication non‑adherence as a potential reason. By employing these strategies, you can significantly improve patient outcomes and reduce healthcare costs.

References:

  1. Kleinsinger F. The Unmet Challenge of Medication Nonadherence. Perm J. 2018;22:18‑033. doi: 10.7812/TPP/18‑033. PMID: 30005722; PMCID: PMC6045499.
  2. Gooptu A, Taitel M, Laiteerapong N, Press VG. Association between Medication Non‑Adherence and Increases in Hypertension and Type 2 Diabetes Medications. Healthcare (Basel). 2021 Jul 31;9(8):976. doi: 10.3390/healthcare9080976..
  3. Brown M, Sinsky CA. Medication Adherence. Improve Patient Outcomes and Reduce Costs. American Medical Association Steps Forward. 5 June 2015.https://edhub.ama‑assn.org/steps‑forward/module/2702595. Accessed 23 Feb 2025
  4. Eight reasons patients don’t take their medications. American Medication Association. Feb 22, 2023. Accessed 23 Feb 2025.https://www.ama‑assn.org/delivering‑care/patient‑support‑advocacy/8‑reasons‑patients‑dont‑take‑their‑medications
  5. 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
  6. Kini V, Ho PM. Interventions to Improve Medication Adherence. JAMA. 2018;320(23):2461. doi: https://doi.org/10.1001/jama.2018.19271

Blue Medicare Advantage is the trade name of Group Retiree Health Solutions, Inc., an independent licensee of the Blue Cross Blue Shield Association.

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