Tackling the 3 Leading Causes of Medication Nonadherence

Medication nonadherence costs the U.S. pharmaceutical industry an estimated $250 billion annually in potential revenue. It’s time brand teams took a fresh look at the reasons for nonadherence and what they can do to prevent it. Let’s start with a brief review of the causes of this gigantic problem, then look at some emerging solutions.

What Are the Causes of Medication Nonadherence?

Medical literature is bursting with excellent reports addressing nonadherence. One of the best publications is a 2023 paper by Stewart, Moon, and Horne, which notes that nearly 800 individual factors are associated with medication-taking behavior. Some causes are outside of pharma’s influence (e.g., insurance coverage, patient age, patient culture), while others are within it (e.g., patient out-of-pocket (OOP) cost, lack of education). The authors emphasize the importance of focusing on these modifiable causes.

The American Medical Association (AMA) takes a simpler approach. In its brief “8 Reasons Patient Don’t Take Their Medications,” they list these key causes of nonadherence:

• Fear of side effects
• Cost
• Misunderstanding
• Too many medications
• Lack of symptoms
• Mistrust
• Worry
• Depression

We’ll focus on the top three causes next.

Which Nonadherence Causes Can Pharma Address and How?

Before jumping into solutions, let’s make it clear that drug manufacturers have not had their heads in the sand regarding medication nonadherence. On the contrary, brand teams typically manage their brands based on well-developed customer relationship management (CRM) “patient journeys” that are supported by a series of direct-to-patient emails, patient text messages, direct mailers, or advocacy group connections.

These touchpoints are designed to help patients stay current on adherence issues such as side effects management, the importance of staying on therapy, or a simple confirmation that patients are not alone on the path to health. And, of course, most brands provide robust copay support. Sadly, those baseline efforts are often not enough to counteract the pull toward nonadherence.

Fortunately, brand teams aren’t working alone. An array of service providers, each with established point-of-care expertise, is available to help marketers build out a full omnichannel approach to support patient adherence. The truth is that while pharma marketers and their service partners may not be able to help in every area of nonadherence, they can certainly help in some.

Now, let’s get back to those three leading causes of nonadherence and identify some of the novel messaging solutions that can help patients stay on therapy.

1. Fear of Side Effects

Thinking like a patient, we understand the fear of side effects mentioned in commercials or called out in online posts. Patients need to weigh the pros and cons of taking medications that could have serious side effects. The key for brand teams is to communicate with patients so they understand what side effects to expect, how long they might last, and how to deal with them successfully to stay on drug.

Fortunately, you can reach patients with these supportive messages in several tech-based ways:

• In the doctor’s office: New technology can send side-effect-focused messages to patients while they are in the HCP office via print, text, or patient portal. The appropriate message—based on the National Drug Code (NDC) and/or other triggering criteria—is generated when a prescriber creates an electronic prescription (eRx) during a medical encounter. This technology has been proven to educate patients and mitigate Rx abandonment.
• A patient’s mobile devices: Brands can use SMS messaging to reach opted-in patients, proactively addressing key side-effect issues. Multimedia Messaging Service (MMS) enables even richer engagement, including images, videos, and audio.
• At the pharmacy counter: Patients can also be reached while they are picking up their prescriptions at the pharmacy, encouraging them to fill and refill while staying educated about their therapies. An Rx triggers a personalized message for the patient, delivered by the pharmacist.

2. Lack of Transparency with Out-of-Pocket Costs

High OOP costs may lead patients to not fill initial prescriptions, not refill, or ration in order to extend their supply. Of course, the first response here is to provide solid copay assistance. But new prescriber- and pharmacist-targeted prompts can augment and extend the value of copay support by:

• Delivering real-time messages in the eRx module of the electronic healthcare record (EHR) to support prescribing behavior with real clinical information, including patient copay savings messages that can be passed on to patients.
• Leveraging in-EHR capabilities that allow a brand’s copay offer (including the patient’s net OOP cost, where available) to be shown to doctors as part of real-time benefit check results, immediately before they send the prescription electronically to the pharmacy. Our internal research shows that over 66% of providers want to understand these savings options within the EHR workflow, and 82% will act on that information immediately for a patient.
• Prompting pharmacists automatically and in workflow when a prescription is eligible for copay assistance. If the pharmacist foresees a significant risk of cost-based abandonment, they simply apply the copay support and then explain the manufacturer-provided savings to the patient.

3. Poor Communication Leads to Misunderstandings

Medication nonadherence can also occur when a patient does not understand the need for the medicine or the time it takes to see results. Similar to what we saw with the “fear of side effects” issue, patient misunderstandings can often be alleviated by better communication and education. And here, personalized, patient-focused messaging offers solid solutions:

• Service providers can now deliver personalized patient communications in the pharmacy to encourage healthy behaviors and improve medication adherence. An Rx triggers a personalized message for the patient, based on the Rx or drug history. The patient receives their prescription and personalized information directly from the pharmacist.
• New technology also enables prescription-related messaging directly from the pharmacy to patients via text. This can create a stronger relationship between pharmacists and patients that results in reduced misunderstanding.

What are the Top Factors that Drive Adherence and Compliance?

Non-adherence can account for up to 50% of treatment failures, around 125,000 deaths, and up to 25% of hospitalizations each year in the U.S.

Between the time a therapy is prescribed and when they actually begin treatment, patients have the daunting task of integrating medication schedules, managing side effects, and affording their therapy. All and all, support is crucial. However, despite increased investment by pharma companies in patient support services and overwhelming evidence that patients value these services—80% of patients find them valuable or extremely valuable—very few are aware of them.

So how can pharma companies, healthcare providers, and pharmacies increase patient adherence and compliance?

Hub Services Improve Patient Outcomes

Effective hub services programs combine three core functional skill sets to help patients get on prescriptions as quickly as possible:

1. A team of people who genuinely want to help patients.
2. Processes that simplify rather than complicate the process for providers and patients.
3. Technology that adds speed, accuracy, and enhanced functionality to the processes and is invisible to patients and providers.

The high touch aspect of a hub program is critical, as the human connection is imperative in establishing and maintaining positive relationships between the brand, the patient, and the provider. From the moment a patient, caregiver, or provider calls a case manager, their experience will be measured by whether they had a pleasant and informative experience.

In addition to the human element, electronic services (e-services) are one of the most important foundations for successful hub programs. Providing electronic benefit verifications and electronic prior authorizations through integrations with healthcare providers and insurance providers is the new frontier. Knowledgeable hub team members interacting with a prescriber can maximize the completeness of electronic prior authorizations by requesting supporting comments or attaching clinical documentation.

Mobile Tools Put Support in the Patients’ Hands

New mobile tools offer patients a simple and seamless way to access support services and connect them to alerts, reminders, and support communities, ultimately helping to boost adherence. These tools—including live chat with nurses and case managers, access to copay support, and the ability to match patients with others experiencing similar challenges—leverage the patient’s phone to integrate the therapy journey into their daily routines and help empower them to take a more active role in their own care.

Mobile support has been shown to lower medication drop-off rates while helping increase enrollment in patient support services and leading to higher rates of patient satisfaction. For example, results show 2% to 6% less initial drop-off and 30% less drop-off after three months when brands invest in mobileCare Manager, a platform that offers a variety of mobile tools and strategies, for their patients.

The Evolution of Pharmacies in the Medication Journey

Three key elements are impacting the evolution of pharmacies and the role they play in how patients move through their prescription journey.

1. The Digital Pharmacy 

While they perform many of the same functions as traditional pharmacies, digital pharmacies change the prescription process by:

• Enabling patients to access care virtually
• Order medication online and have it delivered
• Use mobile apps to manage their medications
• Request refills
• Schedule and track deliveries

Telehealth is a key differentiator for digital pharmacies, and so far, it appears to be most useful for simple, straightforward prescriptions, particularly in areas such as sexual health, hair growth, and smoking cessation.

2. Non-Commercial Pharmacies Speed Up Access to Medication 

Today, nearly all doctors are e-prescribing medication, but when they want to order a specialty medication, they often must go to a website, download a form, fill it out, and fax it to a patient support hub. The non-commercial pharmacy (NCP), however, can accept e-prescriptions, so the provider simply needs to prescribe the medication to the NCP. Pharma manufacturers can set up patient support programs using the NCP as the intake channel for enrollment into hub services.

For example, rather than exiting the patient’s EHR and manually filling out a patient enrollment form, the provider selects NCP to receive the prescription for the drug, just like (s)he would any retail or specialty pharmacy at the point of prescribing. Patient data doesn’t need to be input because it is already in the EHR, and the relevant information is automatically transferred to the prescription. In-workflow EHR prescribing can give patients access to the medication days or even weeks faster.

3. Pharmacies’ Increased Role in Compliance

Major retail pharmacies are taking a more active role in patient compliance, offering services that help patients manage their medications. For patients with complex medication regimens in particular, packaging that labels dosing according to what medication the patient needs to take and at what time of day can simplify the medication journey and help patients easily identify late or missed doses.

Can In-Workflow Tools Change Medication Nonadherence?

A top goal of physicians is to encourage adherence, and they are fully aware that drug costs remain a big reason why patients don’t take their medication as prescribed. When providers discuss the amount the patient will pay for a prescribed medication while the patient is still in their office via Real Time Patient Savings embedded in workflow, it reduces the likelihood that the patient will leave the pharmacy empty-handed and frustrated. The potential impact on the provider-patient conversation driven by the inclusion of patient-specific drug prices in the EHR is game-changing.

In a ConnectiveRx study of 144 prescribers of oral anti-diabetic medications, 72% report that they would have a discussion about the price the patient will pay for a selected medication, as well as possible alternative therapies, once they view actual out-of-pocket costs. It is creating a new kind of conversation between prescriber and patient.

How Does Data Analysis Enhance Medication Adherence?

Pharma manufacturers are focused on acquiring new patients while keeping patients from leaving therapy once they start. As the overall patient view shifts to a more holistic approach that examines overall challenges, conditions, and medications, we’re increasingly able to move the needle to improve adherence. Cost is one relatively easy component to address, and copay programs are designed to take the bite out of cost and go a long way to building patient loyalty. Leveraging—and measuring—other patient support programs as well as prescriber education can help keep patients on their medication and focused on overall health.

Sometimes the addition of a simple messaging program with the right message can drive results, such as increased adherence or migration to a 90-day supply so patients don’t have to visit the pharmacy as often. By comparing the results of different message types sent to patients, brands are empowered to develop the most effective content.

Overcoming Medication Nonadherence with ConnectiveRx

Patients face many challenges when it comes to medication nonadherence, including concerns about costs, side effects, and even the daily struggle of being unwell. ConnectiveRx offers innovative solutions like ScriptGuide, CarePoints, and mobileCare Manager to address these hurdles. If you're ready to explore how our solutions can support your brand and empower patients on their healthcare journeys, connect with our experts today!