Medication non-adherence is a huge, costly and growing problem for plan sponsors.

Studies have consistently shown that 20 to 30% of medication prescriptions are never filled, and that approximately 50% of medications for chronic disease are not taken as prescribed.

Non-compliance can have serious health consequences, ranging from poorly managed symptoms to decreased quality of life and even death.

This health care issue might not get the attention that others do but its impacts for medication users – and payers – are significant.

Non-adherence not only affects health outcomes, it negatively impacts health plan benefits and the healthcare system at large.

Costs of medication non-adherence

One study found that non-adherence accounts for 5% of Canadian hospital admissions, 5% of physician visits and costs our healthcare system $4 billion annually. That’s not to mention the millions of dollars plan sponsors lose annually in in benefits costs, lost earnings, avoidable medical costs, and lost productivity.

Little wonder that medication non-adherence is called health care’s “elephant in the room” or Canada’s “other drug problem.” Another term to describe medication non-adherence could be “the silent killer” because of the number of people it affects (it’s the cause of 125,000 preventable deaths each year in the United States) with almost zero awareness.

Sanofi Survey findings on medication management

The 2020 Sanofi Canada Healthcare Survey sheds light on what is an increasing concern for plan sponsors. Here are some of the survey’s key findings on medication management:

• 55% of Canadian plan members take at least one medication on a regular basis; this increases to 70% among those with a chronic condition and/or chronic pain and 87% among those in poor health
• 43% of plan members who take at least one medication admitted they sometimes don’t take their medication, increasing to 61% among those aged 18 to 34
• The biggest reason cited for non-adherence was forgetfulness (41%), followed by the perception that they don’t need the medication because they feel fine (24%) or they ran out (20%)
• 52% of plan members who don’t always take their medication indicated this happens at least a quarter of the time
• 54% of plan sponsors are concerned that the overall cost of their drug plan is negatively impacted by plan members who aren’t taking their medications properly
• Employers with 500 or more employees are more concerned (59%) by this issue, as are employers in Quebec (60%)

As the pharmacy benefits manager for nearly 3 million Canadians, medication adherence is a top-of-mind issue for our organization.

Importance of medication adherence

We recognize that taking medicine as prescribed is important for controlling chronic conditions, treating temporary conditions, and overall long-term health and wellbeing.

According to the World Health Organization, medication adherence can have a more direct impact on health outcomes than the specific treatment itself.

We also know that the reasons for non-adherence are as varied as plan members themselves.

Our adherence-focused solutions

That’s why our adherence support programs and tools are tailored to their unique profiles. Our adherence-focused solutions include:

• Our Patient First Network, which fully leverages and integrates patient support programs for specialty drugs
• Our Managed Chronic Disease benefit - the first in Canada – which provides easy access to support including adherence education. Consider that:
  • Chronic disease is the biggest driver of benefit plan spend
  • 23% of plan members with a chronic condition and/or chronic pain and 48% of plan members in poor health take three or more medications
  • The more medications a patient requires, the less likely they are to follow their prescribed medication regimens

• Our Preferred Provider Network, which offers access to support services such as medication reviews from their pharmacist, linking cost savings and education
• Our comprehensive Days’ Supply Program, which controls costs for prescribed medications that patients may discontinue because of side effects
• Data on individual adherence can also be used to directly inform coverage decisions. A shared accountability model can make drug coverage available for the right patient, at the right time so patients are reimbursed for dosing properly. For example, for Repatha claims we use claims data to track whether a patient is adherent to their base statins before authorizing this additional coverage.
• The medication management feature of our mobile app, Medavie Mobile, which takes a proactive, personalized approach to drug compliance.
  • Prescriptions are loaded automatically into the app, allowing members to set daily reminders to take their medications, based on their individual preferences, along with renewal and refill reminders.
  • It’s an effective and easy-to-use tool that also helps plan members understand the importance of taking drugs as prescribed.

Role of plan sponsors

Plan sponsors can make an important difference in addressing this issue by educating and encouraging members to members stay on-track of their medications. Communications with members can help them:

• Adopt healthy drug adherence habits, such as creating a checklist or diary and incorporating medication into their daily routines
• Set up a schedule for the frequency and time of the day they take their medications
• Learn important details about their medications by reviewing their prescriptions with their pharmacist
• Follow expert medication management advice, including top tips listed in this blog from our Living Well Hub

Contact your Medavie Blue Cross representative to learn more about the medication management solutions we have outlined in this blog.