Executive Summary - A Spoonful of Sugar: Helping People Take Their Medicine

Judy is 51 with Type II diabetes and high cholesterol. Either one of those diseases can land her in the hospital unless she takes her medications. But in between work, taking care of her kids, and her other demands, she has trouble figuring out the best daily schedule. Moreover, she sometimes forgets to pick up one of her prescriptions, which run out at different times of the month.

Judy’s pharmacist tells her about a new program aimed at helping her manage her chronic conditions. If Judy forgets to pick up her prescription, an automatic alert is sent from the pharmacy to the prescriber. The pharmacist calls Judy, reminds her that her prescription is ready to be picked up, and asks why she hasn’t come to pick up her drug yet. Judy explains that she has not had time because she’s had to pick up three other medications at different times this month. The pharmacist notes this in her file and synchronizes her refill schedule so that she only has to pick up her refills once each month. Judy explains that she has been having trouble tracking when to take her pills. To help her remember, Judy’s pharmacist gives her a pill bottle with sensors that trigger a text message to Judy when she doesn’t open her pill bottle on time. By helping patients manage their medications more easily and avoid more expensive care in a hospital, Congress can make patients healthier, happier and save as much as $5.3 billion over 10 years

This idea brief is one of a series of Third Way proposals that cuts waste in health care by removing obstacles to quality patient care. This approach directly improves the patient experience—when patients stay healthy, or get better quicker, they need less care. Our proposals come from innovative ideas pioneered by health care professionals and organizations, and show how to scale successful pilots from red and blue states. Together, they make cutting waste a policy agenda instead of a mere slogan.

What Is Stopping Patients From Getting Quality Care?

Nonadherence—when patients do not take their medications as prescribed—accelerates the decline in health of millions of Americans and can easily result in illness, patient hospitalization, or hospital readmissions. Abysmally low medication adherence rates lead to more than 125,000 deaths and $290 billion in wasted spending in the United States every year.

People are not taking their prescribed medications for four key reasons.

1. Some patients never initiate therapy or pick up their prescription (called primary nonadherence) because they are afraid of possible side effects.
2. Other patients do not take medications as prescribed (called secondary nonadherence) because they suffer from actual side effects.
3. Some patients are deterred by out-of-pocket costs, and, as a result, may stop taking their medications.
4. Some patients with multiple prescriptions may have to pick them up at different times or at different pharmacies. This can prove to be an overwhelming obstacle for some patients who opt to not fill or refill their prescriptions and has been shown to decrease adherence.

Where Are Innovations Happening?

Doctors, pharmacists, and health plans are working across the country to improve medication adherence with drug therapy management systems that target individual obstacles to adherence while being held accountable for improving patient outcomes and saving money. Successful examples include:

• In Indiana, CVS Health’s Pharmacy Advisor program promotes discussions between patients with diabetes and pharmacists. The program improved adherence rates and initiated recommendations for medication that had been missing from the patient’s treatment. The program yielded a return on investment of approximately $3 for every $1 spent.
• In New York, the Capital District Physicians’ Health Plan Enhanced Primary Care Initiative, a medical home model, integrates pharmacists into care teams, providing physicians with recommendations based on comprehensive medication reviews of patient records. Pharmacists also meet with patients to support patient education and address concerns. The overall hospital admission rate for Part D members enrolled in the program was 19% lower compared to nonparticipants, and the readmission rate was 27% lower.
• In Minnesota, HealthPartners Medical Group’s medication therapy management programs assists patients with issues like medication adherence. One trial of 450 adults found more medication therapy management program participants reduced their blood pressure to recommended levels, and another study found the overall cost of care with 19% lower among participants.

How Can We Bring Solutions To Scale?

Policymakers should improve and advance drug therapy support services through the following six steps:

1. Require Medicare to establish high-priority criteria for adherence improvement efforts.
2. Establish a method to let providers indicate who is taking responsibility for checking up on patients and helping them with adherence.
3. Improve Medicare’s medication therapy management program with better criteria and more flexibility for targeting services.
4. Provide a performance-based payment to providers delivering drug therapy support services that follows the patient no matter where she receives the services.
5. Expand the role of pharmacists through payment policy and increased patient access to drug therapy support services.
6. Continue to improve and expand the use of adherence quality measures to encourage more effective drug therapy support programs

Potential Savings

Because the field of medication adherence is still developing, the potential for cost savings is uncertain. To illustrate the potential, however, if only 5% of the national costs of poor medication adherence were recovered, the federal savings would be $87 billion over 10 years. One study found that when comprehensive medication review is utilized, federal savings ranged between $400 to $525 in lower overall hospitalization costs per beneficiary with diabetes and congestive heart failure.

Based on our estimates, federal savings from this proposal total $5.3 billion over ten years. States will save an additional $500 million. Private sector plans—including employer-based, Affordable Care Act marketplace plans, and other individually-sold health plans—will save $1.5 billion over ten years.