“Take two pills and call me in the morning.”
This cavalier saying is attributed to doctors, in times past, who may have been on call 24 hours a day and made house calls. If a doctor got a late-in-the day message from a patient suffering from what the doctor perceived to be a non-critical issue, they would suggest a couple of aspirin to help the symptoms abate. This saved the doctor the trouble of a late house call—and helped reduce patient worry.
Each patient has specific reasons for not refilling a prescription or taking a medication. Reasons can range from medication cost, forgetfulness, or even transportation issues. By addressing patient-specific compliance barriers, doctors can improve outcomes and help lower overall healthcare costs. Let’s discuss some barriers to compliant medication adherence and how PHP has made specific efforts to help members with medication adherence, specifically assisting with prescription refills.
Five reasons patients don’t take medications
Most non-adherence is intentional with patients making a rational decision not to take their medicine based on their knowledge, experience and beliefs. Below are five reasons for intentional non-adherence.
1. Cost
A major barrier to adherence is often the cost of the medication that has been prescribed. The high cost of a prescription may lead patients to not fill a prescription at all. Checking to see that a medication is included in a member’s insurance plan formulary can be very helpful to motivate patients to take their medication, because medications in the formulary have already been approved by an insurance plan. Also, doctors can help address the cost barrier by prescribing generic drugs as well as pointing patients toward coupons, vouchers, patient assistance programs, and helpful websites that direct patients to cost-saving measures.
2. Misunderstanding or lack of symptoms
When a patient does not understand the need for a medication, or if the medical condition does not seem to be urgent, or life-threatening, medication might not be taken seriously. Sometimes, the length of time it takes to see results make patients feel as if the medication is not helping them.
3. Too many medications
Sometimes non-adherence happens when a patient is taking multiple medications and they are simply tired of “swallowing pills.” The more medications a patient takes, the more likely they are to become non-adherent.
4. Fear of side effects
Patients may be frightened of potential side effects of various medications.
5. Mistrust of doctor recommendations
News coverage of marketing efforts by pharmaceutical companies that influence physician’s prescribing patterns can make patients suspicious of the medications they’ve been prescribed.
Building patient trust to support medication adherence
PHP has made medication adherence a priority to address in our quality improvement program.
Monitoring members and their prescription adherence is one of the most effective ways to manage chronic disease conditions. Medications can:
- Help control symptoms
- Save money on healthcare costs
- Avoid trips to visit a doctor
- Help members live longer
- Improve quality of life
Last year, PHP specifically focused on members that were prescribed long-term medications for chronic disease diagnoses such as asthma, diabetes, hypertension, or high cholesterol. Our goal was to assure members that we were available to them to answer their questions regarding medications, help them find resources, and to remind them that we truly care about their health outcomes.
Gentle communication was sent to members stating: “We've noticed you haven't yet filled your regularly-scheduled prescription and we want to help. PHP’s customer service and pharmacy staff are available to answer questions related to your medications and prescriptions. We understand there are many factors that may contribute to prescriptions not being filled, and we would like to know if we can help you.”
Outreach was extended to members through text message, email, or a mailed letter to determine what barriers they had faced in filling their prescriptions. Members responded with the following answers:
- Thank you for the reminder
- I had an adverse reaction
- I recently filled my prescription
- I cannot afford my medication
- I am changing my medication
- I need further assistance
- My physician discontinued my medication
- Other reasons
PHP offered to sign members up for prescription reminders and directed members to wellness tools that might assist them in managing their health and health plan benefits. PHP also has resources and tools to address situations such as adverse reactions, options for prescription discount resources, and communicating with a provider to make sure our records and their recommendations are aligned.
Remember, following your medication treatment plan can help you stay healthy and symptom-free. Here are a few helpful tips that can help you remember to take your medication:
Measureable Results
As an outcome of this communication plan, PHP member prescription adherence showed improvement with several medication refills including:
Additionally, PHP compared our adherence ratios with other health insurance carriers (who are considered peer organizations with PHP by size and services).
Overall, PHP medication adherence rates are much better than our peer organizations. PHP saw an improvement across all disease states with the highest being an asthma medication compliance improvement of 9% over peer organizations.
Continual Improvement
A better health outcome is the most significant benefit of taking/using medications as prescribed. Doctors prescribe medications to treat symptoms and to help patients manage or overcome certain health conditions. Failing to use medicines as prescribed can result in worsened health, longer recovery, unwanted side effects, substance use disorders, and other serious health conditions.
Using medication correctly can help save money that would otherwise be spent on healthcare costs related to medication mismanagement, such as hospitalization, emergency room visits, and addiction recovery treatment.
PHP intends to continue to monitor our members’ prescription medication adherence and to assist our members whenever possible to help them remain on their prescribed medications. Future goals include regular communication with members, increasing the adherence threshold to assist more members, and to increase adherence.
Our members’ health and wellness is important to us.
- Chat or call: Monday-Friday, 8 a.m.-5 p.m.
- Customer Chat at: phpni.com (member login)
- Voice: 260-432-6690, ext. 11; Toll Free: 1-800-982-6257, ext. 11
- Email: custsvc@phpni.com