Photo Credit: Jacob Wackerhausen

According to Samuel K. Peasah, PhD, MBA, RPh, “almost half of patients do not take their medications for several reasons, including forgetfulness or cost.”

Programs that decrease point-of-sale medication costs and remind patients to take their meds on time improve adherence while leaving total cost of care unchanged, results of a new retrospective observational study suggest.

“Almost half of patients do not take their medications for several reasons, including because of forgetfulness or cost. This can cause health problems. We studied a program that reminds patients to take their medications and helps reduce the cost for patients. More patients adhered to their medications and used the emergency department less,” lead study author Samuel K Peasah, PhD, MBA, RPh, and his coauthors wrote in the Journal of Managed Care & Specialty Pharmacy. “Although medication costs paid by their health insurance plan increased, the amount paid for all their health care did not increase.”

Dr. Peasah and his colleagues analyzed data from patients taking a platelet inhibitor (ticagrelor) or an anticoagulant (apixaban or rivaroxaban) through the large, regional health plan Sempre Health. Of the 1,292 one-to-one program and control patients, 166 took a platelet inhibitor, and 480 took an anticoagulant. The study team propensity-matched patients by demographics, socioeconomic status, baseline copay, prior pharmacy and medical spending, and morbidity.

Patients in the anticoagulant group averaged 62 years, more than 60% were male, and around 45% had no prior unplanned care events. By contrast, those in the antiplatelet group averaged 57 years, more than 70% were male, and around 21% had no prior unplanned care events.

The researchers compared patients who were contacted by the program between February 2019 and October 2021 and filled at least one prescription through the program with a propensity-matched control group of patients contacted during the same period who filled no prescriptions through the program (but who did so outside the program).

Due to differences in patient characteristics, the study team analyzed patients in the antiplatelet group and those in the anticoagulant group separately.

At 12 months, in the antiplatelet group, the proportions adherent (proportion of days covered at least 80%) for patients in the program vs controls were 63.3% versus 42.8% (P<0.001). Similarly, in the anticoagulant group, the proportion adherent for those in the program vs controls was 77.9% vs 60.2% (P<0.001).

Ticagrelor cost increased by $77 per monthly member (P=0.0102) with no statistically significant difference in other costs. Apixaban and rivaroxaban costs increased by $79 per monthly member (P<0.001), with no statistically significant difference in other costs.

Emergency department use for patients in the program decreased 16% (P=0.032), but the cost reduction was not statistically significant in the antiplatelet subgroup (−$20 per member per month, P=0.1388). However, decreased emergency department use (12%, P=0.0206) and cost (−$15 per member per month, P=0.0343) were statistically significant for participants in the program in the anticoagulant subgroup (Table).

Ongoing Research to Improve Long-Term Outcomes

“As a Health Plan, we continuously look for ways to improve the health of our members and routinely evaluate the effectiveness of various interventions,” Dr. Peasah says. “Higher medication adherence has the potential to improve clinical outcomes and condition management in the long term.”

The authors plan to expand their research. “The impact of improved medication adherence is condition-specific,” he says. “We started with anti-thrombotic agents, and we are currently assessing anti-diabetic medications. Eventually, we want to learn which essential branded medications give patients the greatest clinical impact from improved adherence.”

Dr. Peasah advises clinicians to devise strategies to help patients with problems adhering to their medications. “Knowing that high copays could be a disincentive for adherence, clinicians can help patients take advantage of copay discount programs when they are available, especially for essential branded medications.”