Almost half of all plan sponsors (48 percent) are concerned that non-adherence to medications negatively impacts the cost of their drug plan, according to the 2019 Sanofi Canada Healthcare Survey. This increases to 65 percent among employers with 250 or more employees. While more tools are becoming available to help people take their chronic medications, the road to adherence can be very long for some individuals. What can an employer do?
Awareness is an important first step, noted Sandie Ventin, associate vice-president of Accompass, a division of Gallagher, upon review of the Sanofi Healthcare Survey data. “Insurers have been doing a great job of measuring adherence rates by disease categories. We are seeing more lightbulb moments with clients, when they realize that for every $100 that goes through their plan, about half could be going down the drain due to poor adherence to certain drugs.”
The greater awareness among larger employers is to be expected, given that they tend to have more staffing and resources dedicated to managing their health benefit plans, added Martin Chung, assistant vice-president, strategic health management, Equitable Life of Canada. “If all employers could appropriately be educated about their current and future risk due to non-adherence, I think that overall level of concern of 48 percent would increase substantially.”
Possible supports for non-adherence range from simple text reminders to take medications and refill prescriptions, to individualized coaching sessions from an expert trained in behaviour change. In July 2019, iA Financial Group announced the launch of a pilot project in the fall to support medication adherence. Participating plan members will use an app that will issue reminders, manage prescription renewals and provide information about treatment plans.
Personalized packaging systems are another tactile tool for plan members whose main barrier to adherence is forgetfulness. Among her clients, several have recently partnered with a central-fill pharmacy that offers such a service, said Ventin. Multiple medications are sorted based on when they need to be taken, and the packaging can be carried in a purse or pocket (no vials, pill boxes or bulky blister packs). “I’m very impressed by it. They bring in convenience and save time, which can certainly help with adherence.”
While reminders and improved packaging could help some people, Chung—who is also a practising pharmacist—warned against putting too much stock into tools that appear to improve adherence based on claims data. “This is not about automatically filling prescriptions. This is about constantly checking that the drug is working for the patient.”
He explained that “those who most need to be more adherent are often the hardest ones to get more adherent.” In other words, reminders and convenience will not be enough. There may be behavioural issues relating to the condition being treated or stemming from deep-seated personal opinions about the use of drugs. Non-adherence may also be due to the simple fact that the drug is not working. “Adherence must be predicated by a reasonable assurance that the person is on the right drug at the right dose for the right reason,” said Chung.
In these cases, adherence can be achieved only through individualized coaching and feedback from a healthcare provider. Ideally that would occur during regular visits with the prescribing physician and dispensing pharmacist. At this point, suppliers and benefits providers are still trying to develop an effective business model for coaching, where adherence is likely part of the bigger picture of chronic disease management. For more on adherence, including research that indicates the savings and productivity gains of improved adherence, click here.