How Express Scripts Is Improving Medication Adherence


The results of the company's recent research highlight nonadherence and bring to mind novel ways to address a national problem.

Recent research from Express Scripts, titled "Knowing But Not Doing: The State of Rx Adherence in America Report," has some interesting results that are worth diving into.

Results from the study of 800 adults taking any medication for a chronic condition found that nearly 1 in 3 say that "they are not concerned about forgetting to take their medications, despite the fact that almost one-half believe it is the most important thing they can do to protect their health." That is an interesting conundrum. So, what do we do?

This is interesting, particularly considering several large studies evaluating adherence where results show that many patients think that they are adherent, while the technology used seems indicates otherwise.

In the Express Scripts survey, 54% of patients said that they do a better job than others in taking their medications.

"This survey shows that while patients with chronic diseases know that medication is critical to their treatment and health, they don't always act on that knowledge ... Given the huge cost of nonadherence to an individual patient's health, as well as to the country as a whole, it's essential for patients and clinicians to work together to find solutions to help overcome barriers to adherence," said Per Sneezana Mahon, PharmD, and vice president of Express Scripts Clinical Solutions.

The survey was designed to investigate the possible means of pumping up adherence rates, with incentives playing a pivotal role. The survey found that two-thirds of patients would act to improve adherence with rewards, with a higher segment of positive responses noted in those between 18 and 34. That is no surprise, as that is a generation used to being rewarded for positive actions. In the case of electronic reminders, the swath of data also indicated that younger people would be more receptive to the use of applications and devices to help remember to take their medications.

This all builds on the fact that Express Scripts has partnered with several digital health companies focused on medication adherence in the past few years, including Mango Health and Propeller Health.

The Mango Health app is a gamification and rewards platform for patients to track adherence. The app has some great medical information vetted from the likes of Wolters-Kluwer, the reminder features make sense, and users can see how they compare adherence wise to others using the same medications. But the real treat is the adherence rewards. Basically, the more adherent a patient is, the more and better rewards they get. These range from gift cards to company rewards. Although that is not the level of say, Wellth, which gives patients money, it is an incentive, nonetheless.

Propeller Health is a smart sensor that goes on a patient's inhaler to detect and track actuations. It is a means to see if patients are taking their chronic inhaler treatments and if they start to use breakthrough therapy more often. This allows Express Scripts to have its team of pharmacists intervene with patients to see what is going on and hopefully prevent a severe medical event from occurring based on this oversight provided by remote data collection.

Express Scripts has also teamed up with Lifescan and Livongo to provide interventions on chronic diseases, such as diabetes.

All this could open up opportunities for pharmacists. Data collection from multiple new spheres empowers the profession to take a more active stance in not only tracking adherence rates but also predicting nonadherence and then helping promote adherence to hopefully address issues that arise from long-standing chronic conditions without appropriate treatment. This will likely trickle down to the pharmacy profession over time as the technology becomes more acceptable and cheaper. The issue facing its applicability will be the knowledge and use of these platforms by older patients and the training of pharmacists to be engaged in this new pathway of care.


Express Scripts." Knowing but not doing: the state of Rx adherence in America report" finds big difference in what Americans know and do when it comes to their chronic medications. Express Scripts. Published April 25, 2018. Accessed May 9, 2018.

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