Adherence to Drug Therapy for Three Chronic Disease States

Why is CMS targeting adherence? There’s a lot of room for improvement. Today, only 25–30% of prescriptions are taken properly and only 15–20% are refilled as prescribed. The World Health Organization estimates that the average nonadherence rate is 50% for patients with chronic diseases. A study published in 2012 in the Annals of Internal Medicine estimated that nonadherence is costing the U.S. healthcare system in the range of $100 billion to $289 billion a year. In addition to higher healthcare costs, the consequences of nonadherence include worsening condition, increased comorbid diseases and death.¹

MEASURE DESCRIPTION

WHAT?	WHO?
These measures look at improving adherence in three key medication groups: 1. RAS Antagonists 2. Oral Diabetic Agents 3. Statin Medications	Adherence is measured by proportion of days covered (PDC), which assesses the percentage of patients covered by prescription claims for the same drug or another drug in the same therapeutic class within a calendar range. Specifically, these measure the percentage of plan members who have prescription of an oral diabetes medication, a hypertension medication (RAS antagonist) or a cholesterol medication (statin) and filled their prescription often enough to cover 80% or more of the time that they are supposed to be taking medication.²

WHAT?

WHO?

These measures look at improving adherence in three key medication groups:

1. RAS Antagonists
2. Oral Diabetic Agents
3. Statin Medications

Adherence is measured by proportion of days covered (PDC),
which assesses the percentage of patients covered by prescription
claims for the same drug or another drug in the same therapeutic
class within a calendar range.
Specifically, these measure the percentage of plan members who
have prescription of an oral diabetes medication, a hypertension
medication (RAS antagonist) or a cholesterol medication (statin) and filled their prescription often enough to cover 80% or more of the time that they are supposed to be taking medication.²

Suggested Adherence Action Steps

1. Identify opportunities for improvement. Daily, check EQuIPP for patient outliers as well as OutcomesMTM™ for MTM opportunities. Participate in both targeted interventions and comprehensive medication reviews where patient adherence can be accessed and addressed. These programs help identify patients for you. Monthly, monitor your pharmacy’s overall and payer specific EQuIPP quality measures for improvement.

2. Practice behavioral coaching. Use motivational interviewing and behavioral coaching to reinforce medication adherence with each fill and to determine potential reasons for nonadherence.

Adherence is a personal behavioral choice; therefore, the first step to improving adherence is having an open conversation with the patient to determine her/is reasons for not being adherent. Based on the cause, you can then select the right tool or action.
A motivational interviewing quick reference guide is provided in here to help you with conversation starters and handling common objections.

3. Match the solution to the cause. Select the right tool or action based on the cause of nonadherence.

Common Causes for Nonadherence	Solutions
Do not know why I need to take the medication.	Disease-state medication counseling using motivational interviewing approach.
Forgot to order refills.	Use electronic refill reminders including IVR, calls, text messages, and email (e.g., Your Pharmacy Online).
Forgot to take each day.	Dose reminders, or if multiple meds, dose reminder (compliance) packaging.
Inconvenience of multiple medications and multiple trips to pharmacy.	Medication Synchronization Go to the Clinical Services section of the Toolkit and click on Medication Synchronization for resources.
Intolerable side effects.	Therapeutic interchange/prescriber collaboration.
Cost.	Therapeutic interchange, formulary review, patient assistance programs.

REFERENCES

1. Viswanathan M, Golin CE, Jones CD, et al. Interventions to Improve Adherence to Self-Administered Medications for Chronic Diseases in the United States: A Systematic Review. Accessed April 25, 2015.
2. Centers for Medicare and Medicaid Services. Medicare 2015 Part C and D Star Rating Technical Notes. Accessed April 25, 2015.

REFERENCES