Inside Nonadherence: Examining Technology’s Role

It may seem like a logical assumption that once an ill patient is diagnosed and put on a care plan to treat their illness, said patient will naturally follow all treatment steps properly and punctually.  But for reasons often beyond the control of the patient, that is not remotely the case in America today. In fact, the Centers for Disease Control and Prevention have shared that each year roughly one in five of the nearly 4 billion prescriptions written in the US, aren't even filled. 

What is Specialty Medication Nonadherence? 

One of the largest ongoing concerns specific to the specialty therapy sector of health care is exactly this- patient nonadherence to medication and care plans. 

To be clear, medication adherence is defined by the US Food and Drug Administration as, “the extent to which patients take medication as prescribed by their doctors- this involves factors such as getting prescriptions filled, remembering to take medication on time, and understanding the directions." 

When it comes to specialty illness treatment in particular, adherence to medication is not remotely as simple as it may be for other, less complicated care plans. Adhering to specialty care may mean traveling miles to receive treatment at an ambulatory infusion center.  It often means navigating complex authorizations and benefit verifications back-and-forths in order to prevent thousands in personal cost responsibility. Put simply- it means far more than picking up a bottle of pills from a local pharmacy and remembering to take them every day. 

The Impact Of Specialty Medication Nonadherence 

The hard truth is that specialty medication nonadherence is directly linked to increased hospitalization and mortality across numerous disease states. 

Consider the following data from a 2016 CDC report on medication adherence- bearing in mind that since this research, millions of additional Americans are being diagnosed with specialty illnesses every year as the nation faces what seems to be a skyrocketing reliance on specialty care:

• Medication nonadherence was a cause for approximately 30- 50% of treatment failures and 125,000 deaths annually.
• Medication was not continued as prescribed in approximately 50% of cases. 
• Medication rates of compliance typically  dropped off after 6 months. 

Medication nonadherence is a matter of life and death for the nation’s sickest patients. So if leaders in the healthcare, biotechnology and pharmaceutical industry are truly dedicated to the experience and outcomes of our patients, a focus on bolstering patient ability to adhere to care is an indisputable priority. 

What are Causes of Medication Nonadherence? 

One of the most practical ways we can tackle the issue of patient nonadherence is by carefully considering the challenges these patients are facing as we identify what may be causing them to abandon their care regimens. 

• Low Health Literacy- The Center for Health Care Strategies (CHCS) states that nearly 36% of adults in the United States have low health literacy. Health literacy can be defined as a degree to which individuals have the capacity to obtain, process, and understand basic health information, insurance information, and the relevant services needed to make appropriate health decisions.

This report also points out that individuals with low health literacy are disproportionately low-income populations- and that patients with lower health literacy are also said to ultimately experience greater health care costs compared to those with proficient health literacy. 

So in a seemingly vicious cycle, it would seem the poorest patients in the nation wind up paying more for their care, simply because they sometimes struggle to understand the complexity of the conversations they're forced to have regarding their illnesses and the complicated care they need. 

The CHCS goes on to point out that through a combination of impacts- medical errors, increased illness and disability, loss of wages, and compromised public health-  low health literacy is estimated to cost the U.S. economy up to $236 billion every year. 

• Financial Barriers- Especially when examining barriers specific to the specialty illness patient population, cost is an impossible barrier to ignore. 

According to a 2020 report from Advanced Medical Reviews, per capita drug spending on specialty drugs increased by 55 percent from 2013-2016. That’s a staggering trend to consider, considering the average cost of a specialty drug is $4,500 per month. For some patients, the decision to neglect a lifesaving care plan is simply a financial one. It shouldn’t need saying that this should not be the case, and that leaders have an opportunity to step up in providing smarter solutions to assist these struggling specialty patients. 

The Role of Technology in Addressing Specialty Medication Nonadherence 

There lies an opportunity here for technology to be better leveraged in solving for the aforementioned barriers to care adherence. According to the Advanced Care Planning Decisions organization, making use of available technologies such as patient portals, telemedicine solutions, and mobile applications can help the right stakeholders connect more effectively with their patients, facilitating a convenient, accessible pathway to contribute to improved health literacy, and therefore to improved adherence outcomes. 

This technology-enabled clinical support could come in the form of simple, patient-centered measures such as those CareMetx seeks to provide. This could include things like:

• Disease and Product Education
• Therapy Administration Reviews
• Ongoing Clinical Monitoring
• Patient Status Updates
• Adverse Event Recognition, Reporting and Reconciliation

In examining the role technology could play in addressing affordability barriers, we could start by pointing out the current difficulties patients face at intake, when it comes to navigation of things like benefits verifications and prior authorizations needed for their prescribed plans of care. At the offset, specialty patients are often thrown into overwhelming administrative navigations as they seek to determine how much their care will cost, and if they’ll be able to afford it. 

The fact that these patients are battling complex, life-threatening illnesses aside, even an individual not facing the intense stress of specialty illness would likely struggle when asked to confirm: a pharmacy claim review, an outreach call to their insurance carrier to verify the pharmacy benefit, a determination of whether said benefit is retail or mail order, a confirmation of preferred specialty pharmacy, a navigation of copay and deductible amounts for said patients care options, a look into prior authorization or statement of necessity requirement, a medical benefit verification, a determination of out-of-pocket posts, deductibles, buy and bill monitored dosage systems, coordination of injection training or travel requirements- the list need not go on. 

Accessible, practical patient support  needs to be the industry standard across the board of care. Expecting a severely ill patient to navigate the above described is unrealistic at best, and cruel at worst.  Automated, real-time, technology-enabled support for all the administrative complexities associated with specialty care should be the digital standard that healthcare and pharmaceutical industries of today commit to providing to our sickest patients. CareMetx is dedicated to redefining access to specialty pharmaceuticals by way of technology solutions like these- electronic services that automate and expedite- think real-time, automated performance of things like benefits verifications and prior authorizations.

Put simply, the time for expecting patients to navigate complex specialty care on their own has come and gone. It is up to leaders and bold innovators in today’s healthcare and pharmaceutical organizations to come to the table in providing the more practical, empathetic, technology-enabled solutions that today’s specialty patient demographics deserve.