Medications left on the shelf are a major, largely unacknowledged problem in U.S. health care
Boston, Mass. (October 23, 2014) - The U.S. health care system must address the problem of patients not picking up newly-prescribed medicines if national goals for improved health and reduced costs of medical care will be realized, according to a NEHI white paper issued today.
The paper, “Ready for Pick Up: Reducing Primary Medication Non-Adherence — A New Prescription for Health Care Improvement,” outlines the problem of prescriptions for newly-initiated therapy that are not picked up for the first time and, thus, never taken, leading to the possibility of worse health and increased stress on the health care system.
The rate of primary non-adherence (PMN), that is, the percentage of first-time prescriptions abandoned by patients (and thus not picked up at pharmacies), can range as high as 30 percent among some classes of medication, according to recent research.
“In recent years our health care system has begun to take action to improve patient medication adherence, and yet primary medication non-adherence — the failure to commence newly-initiated therapy – remains a major but largely unacknowledged problem,” said Tom Hubbard, NEHI vice president of policy research, who authored the paper. “The good news is that potential strategies for reducing primary medication non-adherence are emerging as electronic prescribing (e-prescribing) becomes common. This paper is a call to accelerate action that will reduce the failure to pick-up newly initiated medication therapy.”
A May 2014 working group convened by the National Association of Chain Drug Stores (NACDS) Foundation, the Pharmacy Quality Alliance (PQA), and NEHI framed the issues outlined in the paper. The paper addresses key issues in the adoption and utilization of a new pharmacy quality metric on primary medication non-adherence endorsed by the Pharmacy Quality Alliance in November 2013. Prior to the advent of e-prescribing, tracking PMN rates was not feasible.
“The PQA PMN measure introduces a consensus-based, scientifically tested, nationally endorsed metric to the market,” noted Laura Cranston, PQA Executive Director. “This metric brings much-needed consistency in defining PMN, which will help us to identify, test, and compare results for PMN interventions across healthcare settings.”
Current adherence policy focuses on patients who have received their therapies at least once — because these patients trigger payment claims processing that allows medication adherence to be tracked.
“Obviously this leaves out patients who never get their newly-prescribed therapy at all,” Hubbard said. “Community pharmacies that receive e-prescriptions can now track primary medication non-adherence by comparing the e-prescriptions they receive to the records of the prescriptions that are actually picked up. This paper outlines the issues pharmacies face in using this data to create effective interventions with patients that will increase the first-fill of new prescriptions.”
NEHI makes eight recommendations that stakeholders, from physicians and pharmacists to insurers and health plans, could do to understand and attack the problem, including pharmacist interventions with non-adherent patients.
High on the list: more dialogue among health care payers, the physician community and the pharmacy industry to establish common ground for action.
“Collaboration is key in the face of the challenges that result from patients not taking their medications as prescribed. And to that end, pharmacy works in close partnership with hospitals, physicians, nurses and other healthcare providers in helping patients understand the importance of taking their medications as prescribed,” said Kathleen Jaeger, NACDS Foundation President. “We are pleased that NEHI has raised awareness of primary medication non-adherence — a critical public health gap.”
Said Hubbard: “As the late Surgeon General C. Everett Koop said, ‘Drugs don’t work in patients who don’t take them.’ He might have continued, ‘Drugs never work in patients who don’t take them for the very first time.’ ”
About NEHINEHI (Network for Excellence in Health Innovation) is a national health policy institute focused on enabling innovation to improve health care quality and lower health care costs. In partnership with members from all across the health care system, NEHI conducts evidence-based research and stimulates policy change to improve the quality and the value of health care. Together with this unparalleled network of committed health care leaders, NEHI brings an objective, collaborative and fresh voice to health policy. For more information, visit www.nehi.net. Follow us on Twitter at @NEHI_News and like us on Facebook at NEHINews.About the NACDS FoundationThe National Association of Chain Drug Stores (NACDS) Foundation is a 501(c)(3) non-profit charitable organization that pursues evidence-based research, and related medication management and educational initiatives, that benefit patients, improve outcomes and advance public health. For more information, please visit www.NACDSFoundation.org.About the Pharmacy Quality Alliance (PQA)Established in 2006, PQA represents pharmacy providers, pharmacy benefit managers, health plans, academia, consumer advocates, community pharmacies, health technology vendors, pharmaceutical research and manufacturing companies, and other stakeholders interested in improving the quality of the medication-use system. For more information about the Pharmacy Quality Alliance, please visit www.PQAalliance.org.