Anthem Blue Cross and Blue Shield | Medicare AdvantageJune 1, 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?
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.
Understanding the potential challenge
Medication adherence is not just about patients remembering to take their pills. Adherence is a multifaceted issue influenced by several factors, which can include:
- Adherence challenges such as cognitive impairment, history of non‑adherence, and confusion or misunderstandings.
- Concerns for the fear of side effects, perceived lack of benefit, and complex medication regimens.
- Logistical or financial Issues such as transportation difficulties or high medication costs.
Implementing solutions
Identifying patients with adherence issues can be challenging. We recommend incorporating the following strategies into your practice:
- Discuss adherence with patients 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 of at‑risk patients.
Tailored and proactive approaches
Once identified, it is essential to tailor solutions to each patient’s unique needs:
- Simplify regimens using once‑daily doses and 90‑day supplies with refills.
- Educate patients by clearly explaining medication benefits and risks.
- Streamline prescribing with real‑time prescription benefits.
- Reduce pharmacy visits using e‑prescribe to CarelonRx for home delivery.
Spotlight on success
When patients struggle with controlling their condition, consider medication non‑adherence as a potential reason. Care providers can significantly improve patient outcomes and reduce healthcare costs by employing these strategies.
References
- 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). 2021 Jul 31;9(8):976. doi: 10.3390/healthcare9080976.
- 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
- 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
- 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
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123, are 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 2025 Provider Newsletter
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