Medicine non-adherence can be solved at the point of prescribing - with the right tech

Josh Weiner: ©Dosespot

A national survey found that 33% of Americans don't fill their prescriptions, and the top reason (30%) is cost. Other top reasons are the patient simply forgot (18%), medication is out of stock (17%), or the patient can’t get to the pharmacy (17%).

Unfilled prescriptions put a burden on pharmacists, who often have to call (or worse, fax) the provider and health plan to find a lower-cost alternative, a substitute for something out of stock, or overcome the dreaded prior authorization requirement.

But even the 67% of people who do fill prescriptions don't necessarily take the medicine as directed. According to WHO, adherence among patients with chronic diseases averages only 50% in developed countries. Some of the underlying causes are the same, causing people to skip, reduce dosage (stretch) or simply not take their medication at all. Among Medicare patients, with the highest percentage of chronic conditions, medication non-adherence is the cause of up to 25% of hospital admissions in the U.S. annually.

I have been working in the healthtech space for years. These challenges could be addressed at the time a provider writes a prescription - if providers and their staff are equipped with the right technology and information.

Cost: This is the biggest barrier to medicine adherence. Price transparency has been top of mind during election season and the ongoing legislation with Pharmacy Benefit Manager (PBM) reform. According to the federal government, "Over the period from January 2022 to January 2023, more than 4,200 drug products had price increases, of which 46% were larger than the rate of inflation. The average drug price increase over the course of the period was 15.2%, which translates to $590 per drug product." In office, providers can leverage their e-prescription software to view the cost of a specific drug across pharmacies, and notify a patient if, for instance, it would be less expensive to order a drug by mail or at a place other than their usual pharmacy. Often these price differences are striking. Most providers are already equipped with e-prescription software, so this doesn't require additional technology - but time constraints and information overload in their current software sometimes make it difficult to have the cost conversation with patients. While pricing information won't eliminate all cost concerns, reducing the cost of medication could go a long way towards improving adherence.

Availability: Providers can use their e-prescription software to see which pharmacies have a medication in stock. If the answer is "none," a provider can immediately pivot to a substitute medication that's accessible to the patient. Again, this can be done during an appointment by a provider or their staff in less than a minute.

Transportation: If patients don't have reliable access to transportation or have mobility issues, mail-order pharmacies can ensure medication is delivered directly to them. As a bonus, often mail-order pharmacies (affiliated with health plans or hospitals) have lower prices. Most patients won't share their inability to get to the pharmacy unprompted - they need to be asked. Tracking Social Determinants of Health data in real-time in the EHR can help avoid an uncomfortable conversation with the patient, prompting providers to fill prescriptions by mail order whenever possible.

Memory: It's very simple for providers to send automated reminders to patients about fulfilling prescriptions and taking their medication as prescribed. Some ePrescribing vendors have evolved to be able to send coupons to patients via text before they arrive at the pharmacy without provider intervention. Patient apps like Medisafe are also known to be effective.

In 2021 (latest figures available), the rate of electronic prescriptions in the U.S. was 94%, demonstrating that the vast majority of providers already have e-prescribe software. Taking a moment at the end of an appointment to ensure the patient has access to their medication at the lowest possible cost, that it's in stock and available, that they have the means to get it could go a long way towards improving medicine adherence and the billions of dollars in unnecessary health care costs associated with non-adherence.