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Almost 90% of employers consider employee medication compliance to be a prime health management objective, according to a study by the National Pharmaceutical Council (NPC).1 The majority of study respondents reported that they are analyzing or have plans to analyze prescription data to determine medication compliance for select health conditions.
Almost 90% of employers consider employee medication compliance to be a prime health management objective, according to a study by the National Pharmaceutical Council (NPC).1 The majority of study respondents reported that they are analyzing or have plans to analyze prescription data to determine medication compliance for select health conditions (Figure 1).
About 95% of all employers also reported being involved in numerous activities to improve patient medication compliance, including general health education and targeted learning programs on specific medical conditions (Figure 2). Specific programs discuss cholesterol, blood pressure, cardiovascular disease, congestive heart failure, chronic obstructive pulmonary disease, asthma, depression, back pain, obesity, and smoking.
The greatest focus is on diabetes initiatives. Diabetes prevalence is expected to increase, and this will impact employer-initiated disease modification programs. In the United States, approximately 11.3% of all adults have the disease, and more than 15% may be living with this condition by the end of 2015.2 Advances in diabetes management are being made all the time, and the various stakeholders will have to keep in mind that cost and benefits for the patient and the payer must be paramount.
The NPC study also showed that employers take the primary responsibility for implementing and managing medication compliance initiatives as well as for promoting healthiness and cost reduction for a variety of conditions. Health plans were shown to be active in programs including targeted education, medication compliance as part of the disease management process, and the identification of noncompliant patients.
Disease management vendors are more active in the same areas as the various health plans; however, they are extremely energetic in providing incentives to encourage and reward medication compliance. While pharmacy benefit managers are strongest in the implementation of numerous medication reminder programs, they play weaker roles in other types of initiatives. Minimal information is available in the NPC report regarding the activities of practicing pharmacists in medication compliance.
Although there are numerous initiatives to improve medication compliance, employers perceive that only a small percentage of these programs are effective. The interventions that were perceived to be most effective were vendor-targeted intervention, value-based benefit design, and employer incentives.
Successfully implementing patient medication compliance will require all participants in the health reform process to integrate their activities. Evidence on the effects of compliance initiatives are needed, such as models to show the impact of the programs; case studies that include patient outcomes; and studies that investigate the results of inadequate compliance on quality of life, direct and indirect costs, and employee productivity. Other health management issues include targets for drug compliance in patients with major health concerns, best practice tactics for intervention, and guidance for benefit design.
Most patients do have an interest in their health yet have numerous reasons for noncompliance. Patients may lack overt symptoms, may be cognitively impaired, or may have multiple diseases. Others may take multiple medications daily or only use “as-needed” medications.
The relevant stakeholder has to successfully impart the effect of noncompliance to each patient. Realizing the consequences of noncompliance might place a patient in a position to take his or her medications as prescribed.
Improving medication compliance of just one patient can elevate the health status of almost all employees. Effective compliance holds down health care costs and contributes to a healthier environment. For employers, it provides increased productivity and decreased absenteeism. For medical practitioners, it elevates the quality of care provided to their patients. When medication compliance is improved, the managed care industry improves its medical loss ratios.
1. National Pharmaceutical Council. Employer medication compliance initiatives research findings and analysis. November 2009. http://npcnow.org/Files/NPC%20Compliance%20Survey%20Slides%2011-09%20Final.pdf. Accessed January 13, 2010.
2. Witters D. US diabetes rate climbs above 11%; could hit 15% by 2015. Gallup. October 27, 2009. http://www.gallup.com/poll/123887/u.s.-diabetes-rate-climbs-above-11-could-hit-15-2015.aspx. Accessed January 13, 2010.