Medication adherence is one of the most crucial factors in managing health outcomes, especially for those with chronic conditions. Yet, studies show that nearly 50% of medications aren’t taken as directed, leading to increased hospitalizations, higher healthcare costs, and, ultimately, poorer health.
For health plans and healthcare providers, improving adherence is a top priority, but achieving it can be complex. With insights into medication therapy management (MTM) services, remote pharmacists, and patient-centered approaches, providers and healthcare organizations can build stronger adherence programs that drive positive outcomes for patients and healthcare systems alike.
The impact of non-adherence on health outcomes and costs
Medication non-adherence poses serious health risks, particularly for individuals managing chronic conditions. Consistently taking prescribed medications is crucial for managing symptoms, preventing complications, and improving long-term outcomes. However, for patients with chronic diseases like diabetes or heart disease, missing doses or stopping medications altogether can lead to preventable health crises and deterioration.
Chronic disease management
For chronic conditions such as diabetes, hypertension, and heart disease, medication adherence plays a crucial role in controlling symptoms and preventing progression. Non-adherence can result in higher blood sugar levels, blood pressure spikes, and increased cholesterol, which may lead to complications like kidney disease, neuropathy, and heart attacks.
For example, non-adherence to medication for cardiac conditions increases the risk of death from 50-80%. For diabetic patients, non-adherence to medication resulted in poor glycemic control as well as a 27% higher all-cause mortality rate. In short, non-adherence, especially for patients with chronic diseases, can be catastrophic, even deadly.
Increased risk of hospitalization and complications
As one can imagine, when patients don’t take their medications as prescribed, it can create worsening symptoms and serious complications. This heightened risk of acute events often results in avoidable hospitalizations and emergency department visits, which can be costly.
More specifically, for many patients non-adherence can be compounding. Each missed dose can exacerbate a patient’s risk of serious complications, leading to a vicious cycle of unmanaged symptoms, escalating care needs, and deteriorating quality of life.
For instance, heart failure patients who skip their medications may experience sudden cardiac events, while asthma patients may face severe attacks due to a lack of preventative treatments. And when it comes to Medicare patients, 20% are readmitted within 30 days of hospital release and of that 20%, 50% of the cases result from medication non-adherence.
Financial implications of medication non-adherence
As noted above, the complications of medication non-adherence go beyond the health impact. Unfortunately, it also places a significant financial burden on healthcare systems, providers, and patients themselves. With billions of dollars lost annually due to preventable health complications, improving adherence can reduce costs and improve financial outcomes across the board.
Estimated costs of non-adherence on healthcare systems
Medication non-adherence costs the U.S. healthcare system alone an estimated $100 to $300 billion each year, making it one of the most pressing issues in healthcare. This financial toll arises primarily from hospitalizations, emergency room visits, and additional treatments needed to manage complications from untreated conditions. When patients with chronic diseases like diabetes, hypertension, or asthma do not adhere to prescribed medications, they are at a greater risk of acute events such as heart attacks, strokes, or severe asthma attacks—all of which often require urgent and costly intervention.
In fact, medication non-adherence is a primary driver of approximately 33% to 69% of all medication-related hospital admissions, further highlighting its burden on healthcare resources. These preventable events strain emergency services and increase the need for costly inpatient care, intensive therapies, and rehabilitation. Further, one Swiss study revealed that medication adherence in COPD patients meant they were 51% less likely to incur issues post-hospitalization.
And, when it comes to chronic diseases, ongoing complications stemming from non-adherence often lead to prolonged care needs, further inflating healthcare costs and diverting resources from other critical needs.
Cost savings potential for healthcare providers, insurers, and patients
In contrast, when patients adhere to their medications, they can avoid costly health complications, and both healthcare providers and insurers benefit from reduced emergency and inpatient care needs.
Studies suggest that even a modest improvement in adherence could yield significant healthcare cost savings, as much as $5 billion annually. For providers and health plans, this means investing in medication therapy management (MTM) services to support adherence, which can lead to reduced long-term healthcare expenditures and improved patient outcomes. For patients, adherence helps reduce the need for additional treatments and emergency interventions, making care more affordable and accessible.
Causes of medication non-adherence
Given the very real, and costly consequences of medication non-adherence, understanding the root causes of this behavior is essential for healthcare providers and systems aiming to improve patient outcomes. Medication adherence is a complex issue influenced by a mix of patient, healthcare system, and medication-related factors. Identifying and addressing these causes can help health plans and providers offer more personalized and effective interventions.
Patient-related factors
A range of patient-related factors can impact medication adherence, including knowledge gaps, cultural beliefs, and mental health issues.
Knowledge Gap and Health Literacy
Many patients struggle with understanding the importance of their prescribed medications or how they work, which can lead to skipped doses or discontinuation. In fact, according to the U.S. Department of Health and Human Services, nearly 88% of Americans across all education levels have less-than-proficient healthcare literacy. What does this mean? For some, it may be the simple lack of awareness that missing medication can lead to worsening symptoms or complications, while for others, it may result in not even filling required prescriptions.
Cultural Beliefs
Cultural beliefs can significantly influence medication adherence, as patients’ attitudes toward health, treatment, and medication often stem from deeply rooted cultural perspectives. In some cultures, there may be a preference for traditional remedies over pharmaceuticals, leading patients to avoid prescribed medications or use them inconsistently. Additionally, certain cultural beliefs may view chronic illness as something to be endured rather than actively managed with medication, impacting patients’ willingness to adhere to treatment plans.
Finally, language barriers and differing expectations around patient-provider communication can also create misunderstandings about the purpose or benefits of a medication, further hindering adherence.
Other Healthcare Concerns
Mental health issues such as depression, anxiety, or cognitive impairment also play a critical role in medication adherence. These conditions can, unfortunately, reduce a patient’s motivation and ability to manage complex medication schedules. Patients dealing with depression, for example, may struggle to consistently take their medications or attend follow-up appointments, potentially exacerbating their health conditions.
Healthcare system-related factors
Unfortunately, the healthcare system itself can contribute to non-adherence. Inadequate follow-up and poor communication between providers and patients can leave patients feeling unsupported and unable to manage their medications effectively.
Poor communication and gaps in follow-up care can be particularly problematic for patients with chronic diseases, as they may face challenges that require ongoing guidance. When patients feel they don’t fully understand their treatment plans or that their concerns are not being heard, it can create medication adherence issues. For example, if a patient experiences side effects and cannot easily communicate with their provider, they may stop taking the medication altogether without seeking alternatives or adjustments.
Medication-related factors
Medication-related factors, such as the complexity of the regimen, side effects, and the cost of the prescription itself, may play a substantial role in non-adherence. Complex medication regimens, where patients must take multiple medications at varying times each day, can be overwhelming, especially for older adults or those managing several chronic conditions. The more complicated the regimen, the more likely it is that a patient may miss doses or abandon the medication altogether.
Unfortunately, side effects are another significant barrier; when patients experience unpleasant symptoms, they may hesitate to continue their treatment, especially if they lack information on how to manage these effects.
Lastly, financial constraints can make adherence difficult or even impossible for some patients, particularly if medications are costly or not covered by insurance. This financial burden often forces patients to make difficult choices, such as rationing their medication or skipping doses to save money, ultimately impacting their health.
Addressing these causes of medication non-adherence requires a multi-faceted approach that combines patient education, system improvements, and financial assistance. Remote pharmacists and outsourced pharmacy services can play a crucial role by providing patients with accessible support, answering questions, managing side effects, and offering follow-up to encourage adherence.
How MTM improves medication adherence
MTM plays a transformative role in promoting medication adherence, particularly for patients managing complex treatment regimens, such as those with chronic conditions.
To start, MTM is a patient-centered approach to optimizing medication use and improving therapeutic outcomes through various personalized services. Key components of MTM include comprehensive medication reviews and the creation of individualized adherence plans tailored to each patient’s unique health needs.
During a comprehensive medication review, a pharmacist conducts a detailed assessment of all medications a patient is taking, identifying potential interactions, side effects, or duplications that may impede adherence. MTM helps address these issues proactively while also allowing patients to understand the purpose of each medication and feel more confident in their treatment plan.
Personalized adherence plans further support patients by offering specific strategies for managing medications, which may include setting reminders, simplifying dosing schedules, or identifying financial assistance options. Together, these services provide a solid foundation for long-term adherence, helping patients maintain consistent medication use and achieve their health goals.
Benefits of MTM for different patient populations
MTM services are especially beneficial for populations with unique medication management challenges, such as the elderly, those with chronic illnesses, and patients recently discharged from the hospital.
Because elderly patients often take multiple medications to manage a range of conditions, it increases the risk of medication errors and non-adherence. Through MTM, pharmacists can simplify their medication regimens and provide ongoing support to help them stay on track, significantly reducing the likelihood of adverse events or hospital readmissions. This is part of the reason CMS adjusted its eligibility requirements, which will inevitably result in a spike in demand for MTM services.
For patients with chronic conditions like diabetes, heart disease, or asthma, MTM offers ongoing monitoring and adjustment of medications to ensure optimal therapeutic outcomes. This is particularly valuable in cases where patients need to adjust their treatment based on changing health needs, as MTM ensures they have access to timely, personalized support. Additionally, post-discharge patients benefit from MTM’s emphasis on medication reconciliation and education, as many are prescribed new medications that can be confusing or overwhelming.
Finally, during transitions of care, MTM services can help bridge the transition from hospital to home by ensuring patients fully understand their discharge instructions, medication changes, and adherence requirements, reducing the likelihood of readmission due to medication-related issues.
Technology and tools for medication adherence
Technology plays a pivotal role in improving medication adherence by making it easier for patients to manage their regimens consistently. Various digital solutions have emerged to support adherence, including medication reminders, adherence apps, and remote monitoring tools. Medication reminder systems, such as smartphone notifications or pill dispensers with alarms, help patients remember to take their medications at the correct times. For those managing multiple prescriptions, adherence apps offer comprehensive tools that go beyond reminders, allowing patients to track doses, monitor progress, and even connect with healthcare providers.
Some apps are designed to notify caregivers or family members if a dose is missed, adding an extra layer of support for patients struggling with adherence. Additionally, remote monitoring devices allow healthcare providers to receive real-time updates on patients’ adherence. For instance, smart pill bottles can detect when a bottle is opened and communicate this information to the provider, enabling early intervention if doses are missed. Together, these digital solutions empower patients to stay on track, reduce the chances of missed doses, and improve overall adherence.
Role of remote pharmacists and outsourced pharmacy services in medication adherence
Telepharmacy, which connects patients to remote pharmacists via digital platforms, plays an essential role in supporting adherence by making pharmacist expertise more accessible to patients in need, especially those in underserved communities.
Remote pharmacists can provide counseling and education sessions tailored to individual patients’ needs. They can help patients understand their medication regimens and address any concerns about side effects, interactions, or usage instructions. This is especially valuable for patients with complex treatment plans, as it allows them to have personalized guidance without the need to travel to a pharmacy.
Telepharmacy and remote pharmacists can also help bridge communication gaps that can arise when patients have questions after hours or are unable to visit a physical pharmacy location. By offering support through video calls, messaging, or phone consultations, remote pharmacists make it easier for patients to manage their medications effectively and feel confident in their treatment.
Benefits of access to remote pharmacist support
One of the most significant advantages of telepharmacy for medication adherence is the availability of 24/7 remote pharmacist support. Around-the-clock access ensures that patients can get immediate assistance, whether they have questions about a new prescription, are experiencing unexpected side effects, or need advice on managing missed doses.
This accessibility can be especially critical for patients in rural areas or those with mobility issues who may find it challenging to visit a pharmacy in person. Having access to 24/7 support from remote pharmacists also offers peace of mind, as patients know they have a resource available whenever they need help with their medications. Studies have shown that patients who feel supported and informed about their treatment are more likely to adhere to their medication regimen, underscoring the value of telepharmacy as a tool to improve adherence outcomes.
In summary, digital tools and telepharmacy services work in tandem to make medication adherence more achievable and sustainable. By leveraging reminders, monitoring technologies, and accessible pharmacist support, healthcare providers and pharmacy services can better assist patients in managing their medications effectively. These advancements not only help prevent medication-related complications but also improve the quality of life for patients, ensuring they receive the full therapeutic benefits of their prescribed treatments.
Strategies to improve medication adherence
Improving medication adherence requires a multi-faceted approach that prioritizes effective communication, personalized support, and innovative follow-up strategies. In healthcare settings, strategies that focus on both provider education and patient-centric solutions have been shown to significantly enhance adherence rates.
To start, healthcare organizations must equip providers with communication tools and techniques that foster better patient engagement and understanding. Further, developing adherence programs that make it easier for patients to stick to their regimens, healthcare plans, and organizations can help create an environment that supports consistent medication use and improves patient outcomes.
Provider education and communication strategies
Effective communication is key to promoting medication adherence, and healthcare providers—including pharmacists—play a central role.
Education programs for providers can focus on communication techniques that build trust, encourage open dialogue, and ensure patients feel heard and supported. For instance, using “teach-back” methods, where patients repeat back instructions in their own words, can confirm they understand how and when to take their medications.
Another valuable approach is motivational interviewing, which involves asking open-ended questions to understand a patient’s challenges with medication adherence. This allows care providers to guide patients toward practical solutions without judgment.
Training clinical pharmacists and providers in these techniques helps them create more collaborative relationships with patients, building trust, which increases treatment plan and medication adherence. Clear, empathetic communication also empowers patients to ask questions and voice concerns about side effects or medication costs, making it easier to address adherence barriers before they lead to non-adherence.
Patient-centric approaches
Much like stronger education, patient-centric approaches are essential for promoting adherence. Treatment plans tailored to each patient’s unique needs, preferences, and lifestyle, which consider factors such as a patient’s daily schedule, potential financial constraints, and any physical or cognitive challenges that might impact their ability to manage medications, are more successful.
For example, simplifying medication regimens by aligning dosing times or providing combination medications can help patients manage their schedules more easily, reducing the chances of missed doses. In some cases, particularly with chronic disease patients, providing pill organizers or smart pillboxes with reminders can make adherence easier and more intuitive. Learning to address the specific barriers each patient faces means healthcare providers and health plans can create medication adherence strategies that are realistic and sustainable over the long term.
When paired with a remote clinical pharmacist who is not only well-versed in a patient’s needs, but who shares common demographics only enhances the connection and understanding, further boosting medication adherence.
Leveraging remote pharmacist services for better adherence
Remote pharmacist services offer healthcare settings an invaluable resource for supporting medication adherence through regular follow-up, medication monitoring, and patient education.
More specifically, outsourcing pharmacy services to a team of remote pharmacists enables healthcare providers and health plans to extend adherence support without increasing on-site or in-house demands. For example, remote pharmacists can conduct routine check-ins with patients, reinforcing adherence and addressing potential issues, such as side effects or confusion over medication instructions.
Further, remote pharmacists can conduct comprehensive medication reviews and develop and implement medication adherence programs, including automated refill reminders. These programs keep patients engaged with their treatment plans and encourage timely medication pickups. Consistent follow-ups from remote pharmacists can help identify early signs of non-adherence and help patients stay on track with their regimens.
The convenience and accessibility of remote pharmacist services also help reduce the strain on primary care providers and in-house pharmacists, allowing them to focus on acute care needs while still ensuring patients receive adherence support. For healthcare organizations, including health plans, these services offer a scalable solution for improving adherence outcomes, lowering readmission rates, and reducing the costs associated with medication-related complications. In turn, patients benefit from feeling supported and informed, which ultimately enhances their confidence in managing their health and fosters long-term adherence.
Adopting a combination of provider-focused, patient-centered, and technology-enabled strategies can help healthcare settings significantly improve medication adherence rates. By equipping providers with the tools they need to communicate effectively, personalizing adherence plans, and leveraging the specialized expertise of remote pharmacists, healthcare organizations can create a comprehensive adherence support system that benefits patients and providers alike.
When it comes to patient care and ensuring plan members are actively engaging with their care team, there’s no time to cobble together solutions. Finding the tools, resources, and services to help support long-term care goals, especially when it comes to managing chronic conditions, the Aspen RxHealth team is ready.
Whether you need in-house support, outsourced pharmacy services, or a combination of the two, we have a solution to meet your plan members needs. Reach out today and let’s get started on the path to better outcomes!