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

  1. Consider medication non-adherence as a primary contributing factor if a patient’s clinical condition isn’t controlled. 
      • 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.
  1. Develop a routine inquiry process to assess a patient’s medication adherence.
      • 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. 
  1. Involve patients in their treatment plans.
      • 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.

Tips for successful management of medication adherence in the Medicare population

  1. Maintain continuous communication
    Ensure ongoing communication between the patient, their primary care physician, and pharmacist.
  2. Consider extended-day supplies
    When clinically appropriate, prescribe extended-day supplies, such as 90 or 100 days, to improve adherence and reduce pharmacy visits.
  3. 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.
  4. 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.
  5. 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.
  6. Educate patients
    Provide thorough education on the importance of medication adherence and proper use of medications.
  7. 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.
  8. 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.
  9. 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

    • 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

Learn more about DataLink’s offerings.