Medication Adherence Levels Vary from State to State


A new report from CVS Caremark finds variability in medication adherence levels by state as well as insurance type, with higher adherence in Medicare beneficiaries than those covered by private insurance.

A new report from CVS Caremark finds variability in medication adherence levels by state as well as insurance type, with higher adherence in Medicare beneficiaries than those covered by private insurance.

A number of recent studies have confirmed that increased medication adherence reduces health care costs and improves patient outcomes, citing pharmacists as key figures in increasing adherence. A report released by CVS Caremark on June 27, 2013, strengthens these findings even further, estimating the possible cost-savings achievable in each state through improved adherence.

The “2013 State of the States: Adherence Report” takes a state-by-state look at adherence rates and health care costs for patients with diabetes, hypertension, dyslipidemia, and depression based on data from the 2012 CVS Caremark pharmacy benefit management book of business. This year’s report, the second annual release of its kind, also explores differences in adherence among patients covered by 3 different forms of insurance: individual health plans, employer-sponsored plans, and Medicare Part D prescription drug plans.

To evaluate adherence rates and costs for each state, researchers used a pharmacy care economic model that measures 4 different areas pertaining to adherence. The medication possession ratio measured how many days during the year patients had medication available compared with the total number of days they could have had it on hand. If patients were in possession of their medication at least 80% of the time, they were determined to have an optimal medication possession ratio. The report also calculated the portion of prescriptions that included an 84- to 90-day medication supply and the generic drug dispensing rate for each state. Data on the portion of patients who refilled their prescriptions for the first time after the initial fill was collected as well.

The cost of care for each condition was then calculated per patient to determine the maximum amount of money that could be saved. The potential annual savings if all patients were to reach optimal medication possession rates and were to be switched to generic medications ranged from $19 million to $2.1 billion per state.

Across all insurance types, the report stated, patients with depression were least likely to be adherent, as no state achieved an average optimal medication possession ratio for these patients. Patients with hypertension were the most adherent, and all states reached an optimal medication possession ratio for hypertension patients covered by employer-sponsored plans and Medicare Part D plans. Among the different insurance types, Medicare beneficiaries had the highest rates of overall adherence.

The report also found distinct regional differences in adherence levels. The lowest adherence rates for ndividual health plan members with diabetes and depression were found in the Midwest. Only 37% of self-insured diabetes patients in North Dakota, for example, reached an optimal medication possession ratio, while 73% of comparable patients in Vermont did. The lowest adherence rates for patients with any condition covered by employer-sponsored plans and Medicare Part D plans were found in the South. For example, 67.3% of hypertension patients with Medicare Part D coverage in Alabama achieved an optimal medication possession ratio, compared with 83.5% of comparable patients in Massachusetts.

To supplement the report, the CVS Caremark Pharmacy Care Research Institute released a compilation of 28 studies conducted by CVS Caremark and its research partners over the last several years. “Advancing Adherence and the Science of Pharmacy Care: Volume III” includes research done in collaboration with Brigham and Women’s Hospital that attempts to understand the reasons why patients do not take their medication and that tests the best ways to improve adherence.

The researchers of these studies are currently developing and testing 4 strategies for improving adherence. The first strategy is to simplify complex medication regimens, working with pharmacists and patients to allow patients to pick up all their medications on a single day each month rather than requiring them to make multiple trips to the pharmacy. The second is to make dosage information on certain medication labels more legible, which is especially important for elderly patients.

The third is an approach called preventative analytics, which analyzes data to determine which patients are at the highest risk of non-adherence. Pharmacists then contact these patients and their physicians to stop non-adherence before it starts. The researchers are also investigating whether it is most effective to contact these patients by phone or text message or to contact their doctor. The final method for improving adherence is to increase involvement by physicians, who may be unaware of their patients’ adherence habits. Once they are provided with this information, physicians can collaborate with pharmacists to improve adherence and reduce the overall cost of care throughout the country.

To read the complete report, visit

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