How to successfully manage medication adherence
By Karen McCray, value-based care manager, DataLink
Medication adherence refers to whether patients take their prescribed medications as directed. Patients are considered adherent if they take at least 80% of their prescribed medications. If they take less than 80%, they’re considered non-adherent.
Medication adherence is a triple-weighted measure that impacts both Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems measures. These measures are an essential part of the Centers for Medicare & Medicaid Services pay-for-performance Star Ratings system.
How to improve medication adherence
- Consider medication non-adherence as a primary contributing factor if a patient’s clinical condition isn’t controlled.
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- Often, a patient’s condition may not be under control due to non-adherence.
- Approximately a quarter of new prescriptions are never filled.
- Patients typically don’t take their medications about half of the time.
- Most patients who decide not to fill a prescription or take a medication don’t inform their doctor.
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- Develop a routine inquiry process to assess a patient’s medication adherence.
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- Regularly ask patients about their medication adherence.
- Create a shame-free, blame-free environment for these discussions.
- Identify reasons for non-adherence by asking open-ended questions.
- Identify any social determinants of health or socioeconomic issues that may contribute to the patient’s medication non-adherence.
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- Involve patients in their treatment plans.
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- Engage patients in creating their treatment plans.
- Tailor solutions to individual patient needs. For instance, if cost is a barrier, consider prescribing a lower-cost generic medication that the patient can afford and is willing to take.
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Tips for successful management of medication adherence in the Medicare population
- Maintain continuous communication
Ensure ongoing communication between the patient, their primary care physician, and pharmacist. - Consider extended-day supplies
When clinically appropriate, prescribe extended-day supplies, such as 90 or 100 days, to improve adherence and reduce pharmacy visits. - Encourage mail order prescriptions
If accessing a pharmacy is difficult, suggest the patient use a mail order pharmacy to deliver medications to the member’s home. - Prescribe low-cost generics
When clinically appropriate, prescribe low-cost generics to reduce out-of-pocket costs. Some health plans offer $0 copays on Tier 1 drugs, with some extending this to Tier 2 drugs. - Confirm prescription instructions
Ensure that the directions on prescriptions match the instructions given to the member. If there are dose or frequency changes, void the old prescription and send a new one to the pharmacy. - Educate patients
Provide thorough education on the importance of medication adherence and proper use of medications. - Use prescription benefits
Remind patients to use their health plan ID card at the pharmacy to obtain the best value. Only prescriptions processed with a patient’s health plan ID card will be reported for medication adherence. - Encourage consistent use of programs
If patients are using the VA or discount programs like GoodRx, encourage them to continue using these resources throughout the year to maintain adherence. - Limit sampling of medications
Whenever possible, avoid giving samples of medications to ensure that adherence is accurately tracked.
By addressing the various factors that contribute to medication non-adherence and implementing targeted strategies, healthcare providers can significantly improve patient outcomes and overall medication management.
Datalink tools to help with medication management
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- GDR/MOR utilization report
- Month-to-month comparison of generic dispense rate, mail order, and 90-day supply rates
- Rx quality opportunity reports
- HEDIS® summary and detail reports
- Member scorecard