Medication nonadherence is one of the most significant challenges in healthcare. Between 20 to 30% of new prescriptions are never filled at the pharmacy, and an estimated 50% of people with chronic conditions do not take their medications as prescribed.
The impact of nonadherence is far-reaching, leading to poorer clinical outcomes for patients and staggering costs for health systems. In the United States, poor adherence contributes to an estimated 25% of hospitalizations and $528 billion in avoidable healthcare costs per year.
The CDC has identified improving medication adherence as a public health priority that must be addressed. Innovative technology solutions can help increase medication adherence to ease the economic burden and improve patient outcomes.
Barriers to Medication Adherence
The issue of medication nonadherence is complex and multifactorial. Understanding why patients don’t take their medications as prescribed is the first step toward reducing these barriers. Here are some of the leading causes:
Economic barriers. All too often, the high cost of accessing healthcare and medications prevents patients from filling prescriptions or taking them as prescribed. Insurance premiums, copays for appointments and medications, and coinsurance costs can all add up quickly, and many patients cannot afford to access the lifesaving treatments they need. Research shows higher out-of-pocket costs are associated with an increase in nonadherence — even increasing copays by $1 can reduce adherence by more than 20%.
This is especially true for patients on expensive specialty drugs prescribed to treat chronic conditions like cancer. According to the AARP, the cost of one specialty medication for chronic disease is almost three times the average income of someone on Medicare. High out-of-pocket costs put many patients in an impossible position, forced to choose between paying for their medication or other essentials, such as food and housing.
Low health literacy. Nearly 80 million adults in the U.S. have limited or low health literacy. Studies show that medication nonadherence increases when patients don’t fully understand why they need a certain medication or are not clear on dosing instructions. Economically vulnerable older adults and individuals from disadvantaged socioeconomic backgrounds are particularly at risk of nonadherence.
Communication breakdowns. Studies show that adherence rates are highly dependent on a patient’s communication and perceived relationship with the provider. Poor communication between patients and providers may account for up to 55% of medication nonadherence. Patients whose providers do not offer guidance and understanding about healthcare costs, for example, may be less likely to adhere to their treatment regimen.
The Impact of Nonadherence
Medication nonadherence impacts patients, providers, and the healthcare system as a whole. For patients, nonadherence can lead to significant health consequences, including an increased risk of disease progression, higher rates of hospitalization, longer hospital stays, and higher morbidity and mortality rates. Nonadherence is directly responsible for approximately 125,000 preventable deaths each year.
Providers see worse clinical outcomes in nonadherent patients, which can lead to unsatisfactory patient experiences and lower quality of care metrics. In the era of healthcare consumerism, providing a positive patient experience is a critical component of attracting and retaining patients.
Medication nonadherence has wider implications for healthcare systems. Nonadherent patients require more complex, prolonged care and have higher rates of hospital admissions. For patients with chronic conditions, those with low adherence have a 20% hospital readmission rate, compared to only 9% of patients with high adherence. This invariably drives up the overall cost of care. Economic costs attributed to nonadherence range from $5,271 to $52,341 per patient. In 2020, hospitals in the U.S. provided $42.6 billion in uncompensated care, and a third of healthcare organizations around the country reported bad debt of $10 million or more.
Health systems can proactively alleviate this economic burden by implementing effective interventions that address the factors associated with nonadherence.
Tackling Nonadherence with Technology-Supported Financial Navigation
A key strategy for reducing nonadherence is leveraging financial assistance to help patients overcome cost barriers to care. Research suggests that identifying patients at risk of cost-related medication nonadherence (CRN) may boost both adherence to treatment and patient satisfaction.
Fortunately, a variety of resources exist to help offset treatment costs, ranging from drug manufacturer copay assistance to disease-specific charitable funds. Financial navigation can play a critical role in connecting patients with these vital cost-saving opportunities.
However, financial navigators, care coordinators, and other staff are often tasked with manually searching for and securing financial assistance. For example, at Highlands Oncology Group, a comprehensive cancer care provider in Northwest Arkansas, the team was responsible for printing out daily schedules and manually reconciling them to identify patients in need and prepare assistance applications prior to their visits.
This inefficient, reactive process poses logistical challenges for staff who are already strained for time and resources.
Technology solutions can make this a seamless, streamlined process. Digital platforms allow health systems to use data and predictive analytics to:
- Analyze a patient’s profile and proactively assess their ability to pay their share of treatment costs throughout their entire medical journey. This allows staff to flag patients in need before they veer from their treatment plan because they can’t afford care.
- Once at-risk patients are identified, these solutions enable staff to quickly find relevant funding opportunities and automate enrollment into assistance programs–ensuring patients can access the therapies they need.
For providers like Highlands, these interventions have made a tremendous difference. During the first half of last year, Highlands increased enrollments in copay assistance by 24%, compared to the same period during the previous year. Beyond increasing productivity, the Highlands team was able to “make sure we captured every dollar to help our patients afford their treatments,” said Business Manager Elaine Lahay.
And when it comes to expensive prescriptions, every dollar secured increases the likelihood that a patient will follow through and adhere to care.
Removing Financial Barriers for Patients and Providers
Automating financial navigation and streamlining every step of the process benefits patients, providers, and the entire health system. With reduced financial hardship, patients are empowered to take an active role in their health and stay on track with therapy. Providers see higher levels of patient engagement and adherence, which leads to better outcomes and experiences, as well as improved financial performance.
As the prevalence of chronic disease continues to grow, so too will the economic burden of nonadherence. Health systems can and should use every tool at their disposal to achieve higher rates of adherence and mitigate financial strain.
When patients have the resources to seek and sustain treatment, everyone wins.