Minimizing Prescription Abandonment and Nonadherence with Digital Tools

Factors Associated with Prescription Abandonment and Nonadherence

According to a study published in BMC Systematic Reviews, socioeconomic factors are critical to medication nonadherence. While the data on the impact of socioeconomic factors vary depending on the study, therapeutic area, and more, some trends were identified in the review.

One of the strongest correlations was between financial status and adherence. Researchers noted that a better financial situation was linked to higher adherence rates, likely associated with the ability to afford medication costs. Financial position may also be associated with health insurance coverage, increasing the affordability of some treatments.

Additionally, the BMC study notes that, in some cases, race can be correlated with adherence, with White patients being more likely to adhere to HIV treatment than Black patients.

Beyond specific patient demographics, Burns noted that in a presentation last year, DrFirst explored the patient populations and their risk of prescription abandonment or nonadherence.

“It was the diagnosis or therapy that showed different behavioral challenges. We saw much higher adherence rates for patients on more chronic meds, like cardiovascular medications,” revealed Burns.

Multiple different factors may contribute to higher rates of adherence to cardiovascular medications. Burns postulates that the two main drivers of high adherence rates are the importance of cardiovascular drugs — communicated by physicians’ emphasis on cardiovascular health — and that those medicines are less expensive.

The Permanente Journal highlights that a patient’s perception of the importance of a particular medication or intervention is directly related to adherence rates.

On the other hand, some therapeutic areas, such as mental health treatment, have higher rates of nonadherence and abandonment.

“Mental health is certainly one area we recognize that there's greater need and demand for proper communication to that patient population,” noted Burns. “It's more difficult for those patients to understand or monitor the effects when they're on the medication versus not taking it.”

In addition to difficulties based on the patient's condition, some conditions also have higher-priced medications, making the financial barrier significantly more challenging.

Reasons Behind Nonadherence and Abandonment

Clinicians are well acquainted with prescription abandonment and nonadherence; however, the reasons behind these actions are just as important as the result of their actions. Burns provided three main barriers to adherence: finances, education, and procrastination.

Finances

Financial barriers are a significant hindrance to patient access to medicine. Many patients not covered by private or government health insurance, such as Medicare or Medicaid, cannot afford to fill their initial prescriptions, let alone their refills.

Beyond a lack of insurance coverage, even those with insurance may have high deductible health plans, which increases out-of-pocket spending and burdens the patient with the majority of cost sharing.

The IQVIA report identified additional insight on abandonment rates, noting that, as the out-of-pocket costs increase, the abandonment rate does too. The report states that prescriptions without out-of-pocket costs have an abandonment rate as low as 5%. When out-of-pocket costs are over $125, abandonment rates are nine times higher, at 45%. Furthermore, abandonment rates rise to 60% for prescriptions with an out-of-pocket cost greater than $500.

Educational

In addition to financial barriers, educational barriers are also a significant driver of medication nonadherence or abandonment.

“Especially in chronic medications, patients must understand the importance of staying on therapy,” noted Burns. “Having the appropriate education throughout the prescription journey is critical. That comes in the form of a physician communicating with a patient. But in this day and age, so much more is done virtually; it's challenging to spend as much time with the physician.”

Although the health system in the US has shifted toward virtual care, it is critical that the providers adequately provide information on the prescription, its functionality, and its side effects.

Procrastination

The final contributor to nonadherence and abandonment is one that anyone may fall victim to, regardless of their educational or financial background. Often patients will get their prescription sent to the pharmacy but need to work on picking it up.

“Maybe a patient already in their therapy has understood how to get the financial support, but they need the education to understand the chronic side,” said Burns. “Some patients with busier lifestyles or different demographic profiles may need a better nudge, or a nudge might be more important.”

Traditional Tools to Minimize Nonadherence and Abandonment

Many traditional tools are available to encourage or promote prescription adherence and appropriate medication management. For example, electronic prescribing has advanced physicians’ management of patient medications throughout the past few decades.

“Electronic prescribing and electronic prescribing solutions within electronic health records are the norms. They've been a part of healthcare for over 20 years now. That is how physicians today manage or support patients in medication adherence,” noted Burns.

Burn explained that DrFirst, like other electronic prescribing systems, predominantly focuses on connecting physicians with other parts of the healthcare system, allowing clinicians to provide their patients with additional insight into their prescriptions. Beyond that, the company offers some clinical tools that providers can use to compare the prescription history with the medications filled.

“That's where the physician can see the gap between what the patient was written in the EHR versus what was filled in that medication history,” added Burns. “The traditional way a physician would help with the adherence journey is in the prescribing experience, looking at the data.”

In addition to comparing prescriptions and filled medications, clinicians are uniquely positioned to provide patient education while prescribing. Beyond explaining the dosage or time between doses, providers can also present safety information, when to refill the prescription if necessary, and where to get support for expensive medications, including patient assistance programs and copay cards.

“Physicians can proactively offer help to the patient to get to the pharmacy and overcome that abandonment challenge,” emphasized Burns.

Additionally, the CDC notes that team-based care, characterized by the communication between pharmacists and the prescriber, has proven to improve medication adherence, with 15% higher adherence rates in the year after a hospital discharge.

Timely

Timely, a new platform by DrFirst, is focused on the time between the point of care and the point of sale. The point of care refers to the time the medication is prescribed, and the point of sale is when it is picked up from the pharmacy.

“We are a mobile execution that reinforces what the physician prescribed and communicates that to the patient in a mobile experience. Patients can click on a link via their smartphone that's engaged through a secure mobile website,” said Burns.

According to Burns, Timely delivers real-time information to reinforce prescription decisions and encourage a patient to fill their prescription.

“Patients can see what pharmacy it was sent to, the prescription, their out-of-pocket expense, if there's a discount saving, and whether it's a discount card or copay savings,” he said. “We're providing information allowing them to overcome those barriers for first fill abandonment better. We integrate educational information and savings information and then instill a reminder or contact the pharmacy so that they can overcome that barrier.”

Burns notes that patients will have all this information at the click of a button. The patient gets an SMS message with the link within ten minutes of leaving the doctor’s office. Analytic data from DrFirst estimates that roughly 65% of patients receiving the link click on it and view the content.

“Then about half of those people interact with the content we deliver. It’s helping them understand what's happening with their prescription and allowing them to fill it with the solutions we incorporate to overcome some barriers,” he said.

Another feature incorporated into the Timely platform is the ability to customize the material. Burns revealed that patients new to a particular regimen might get an educational video with instructions on administering treatment, minimizing nonadherence rates.

“We work with third parties, primarily pharmaceutical manufacturers. Once a prescribing decision has been made for that drug, we will link to the respective content sites,” added Burns. “We can direct the patient to either the English or the Spanish version of that site. It might not sound overly compelling, but that's a simple solution that, at scale, has a significant impact. And that's where that education can help in the appropriate language for the patient.”

Although the health system in the US is complicated, driving many patients toward prescription abandonment or medication nonadherence, digital tools may provide simple solutions to ease the burden on patients, providers, payers, and the healthcare system.