Moving the Needle: How Are We Doing with Patient Adherence to Drug Therapy?

The problem of non-adherence to medications, especially for chronic conditions, is widely recognized as one of the most confounding and intractable obstacles to improving patient outcomes and reducing healthcare costs.

• According to the World HealthOrganization, medication adherence canhave a more direct impact on patientoutcomes than the treatment itself.1
• Nearly $300 billion is lost in additionalavoidable medical spending eachyear when patients don’t take theirmedicines as prescribed.2

Another important, often unrecognized, aspect to non-adherence is that it may lead prescribers to doubt the efficacy of medicines when they don’t obtain the outcomes seen in clinical trials.

• Nonadherence can account for up to 50 percent of treatment failures, approximately 125,000 deaths and up to 25 percent of hospitalizations each year in the United States.

Current methods of improving medication adherence for chronic health problems are mostly complex and have not yet been shown to be widely effective, making the full benefits of therapy difficult to demonstrate in realworld clinical practice. When all is said and done, a pharmaceutical company may spend twice as much getting the patient to the retail pharmacy counter as it spent on inventing and testing the drug to begin with. But then what happens?

• As many as 30 percent of people don’t pick up their prescribed medications.
• Among those who do pick up that first prescription, as many as 30 percent stop taking their medicine within 30 days.
• Up to 60 percent stop taking their medicine within six months.6,7

Focus on interventions to address thisn problem has intensified in recent years, however, aided by advances in technology that have opened up new channels for reinforcing adherence behaviors. In addition, quality-ofcare models are forcing change, evolving to be more patient-centric and outcomes-focused, with improving adherence a top priority.

For our second annual Patient Influence Adherence Report, Syneos Health™ set out to understand the factors currently influencing patient adherence behaviors at the retail pharmacy level and compare this with prior years’ data to understand adherence trends over time.

For the third year in a row, we leveraged data from Adheris Health, a provider of dynamic patient performance programs that activate patients, improve outcomes and elevate brand performance. Adheris Health has one of the nation’s largest comprehensive networks for patient and prescriber access, with insight into 2.24 billion prescriptions each year, 35 pharmacy chains, over 29,900 pharmacies and 194 million people. For this report, we looked at the top 100 most prescribed retail pharmacy branded drugs for chronic conditions across 20 different therapeutic categories, and we followed over 200,000 “new-to-the-brand” patients—patients who filled a brand for the first time in the first quarter of 2017.

We collected a range of demographic data that outline key characteristics of the retail pharmacy patients (Fig. 1). Then we followed these new-to-the-brand patients over the next nine months in 2017 (Fig. 2).

We assessed their prescription utilization (refill behavior) against more than 30 product, patient, prescriber and payer variables to understand the most influential factors driving patient adherence or non-adherence, as measured by average patient days on therapy (PDOT or compliance)—that is, the number of days during the nine-month period when the patient had the prescription medication on hand. As this is the third year, we then took the data from all three years to understand how these factors have trended over time.

Patient adherence for new-to-the-brand patients, as measured by patient days on therapy (PDOT), has increased over the three years (2015-2017) we have been collecting this data. Average PDOT climbed from 92.8 in 2015, to 94.1 in 2016, and again up to 99.5 in 2017 (Fig. 3). In addition, the adherence trend line improved for both men and women. We continued to see that a gender gap in PDOT persists, although the gap narrowed somewhat in 2017.

The overall average improvement (5.7 percent from 2016 to 2017) is encouraging, as is the upward trend in PDOT for chronic conditions. Digital patient engagement tools; mobile health tracking technologies; healthcare IT (e.g., electronic medical records, e-prescribing); better coordinated, patient-centered care; and healthcare industry involvement and collaboration (including payers) are among the adherence strategies increasingly taking aim at the medication adherence challenge and, overall, may be having some impact.

When we looked at adherence within individual categories, we again noted some gender differences (Fig. 5). In the asthma category, PDOT rates for men and women have climbed similarly over time; in 2017 they were virtually the same (74.9 and 74.2, respectively). In contrast, PDOT rates for men and women in the diabetes category trended similarly but PDOT was consistently higher for men than for women each year, with rates of 126.0 vs. 121.9, respectively, in 2017.

Since we began collecting this data in 2015, the top 15 factors influencing adherence have remained consistent (Fig. 7), and the patient copay is still the most influential factor overall. Each year we have found that, in general, higher copays lead to lower consumption of branded drugs (with the exception of $0 copays, which we found do not automatically lead to maximum consumption). Copays in the range of $.01-$15 (at 113.9 PDOT in 2017) still yield the highest rates of adherence.

We have previously shown that a drug with even just one authorized refill is associated with an increase in PDOT of 20 days, and that in fact it does as much for consumption as bringing the copay down to $0.8 In 2017, we again found the impact of refills has a significant effect on adherence—an effect that increases along with the number of automatic refills authorized (Fig. 9).

Gender differences are also evident here. In every refill category, PDOT for men has climbed from 2015 to 2017 and has been consistently higher than for women. When we look at the behaviors of women among the same refill categories, we see one anomaly in the year 2016 where the trend is not as high for compliance; yet in 2017, women seem to catch back up in slope.