Apr. 8—The ongoing challenge of medication nonadherence was underscored by recent research that found 31 percent of patients did not even fill their prescriptions.

The retrospective study of 15,961 patients in a primary care network of 131 physicians in Quebec, published April 1 in the Annals of Internal Medicine, found the drugs that patients were least likely to fill included those that were the most expensive as well as skin agents, gastrointestinal drugs, and autonomic drugs. Better adherence was associated with increasing patient age, elimination of prescription copayments for low-income groups, and those prescribed by a physician who most frequently treated the patient.

Patients with no co-pay were 63 percent less likely to leave their prescription unfilled than patients with the highest co-pays, according to the study.

Although the study was unable to obtain the patients' rationales for not filling their prescriptions, the authors concluded that so-called primary nonadherence is common.

Its findings echoed a 2012 meta-analysis also published in the Annals of Internal Medicine that concluded that up to 30 percent of prescriptions go unfilled, although other research has indicated up to half of prescriptions may go unfilled. Those medical adherence failures cost the healthcare system from $100 billion to $289 billion a year, the meta-analysis concluded. 

Possible Causes

The authors of the latest study hypothesized that the problem could be reduced by lower drug costs and copayments, as well as increased follow-up care with prescribing physicians for patients with chronic conditions.

However, one 2011 study found the rates at which people discharged from the hospital after a heart attack were adherent to cardiovascular medications (antihypertensives, beta-blockers, and statins) were relatively low (41 percent, 49 percent, and 55 percent, respectively), even after the insurer waived patients’ out-of-pocket costs.

Hospitals may increase their investment in medication adherence initiatives in the face of growing Medicare readmissions penalties, according to the authors of a 2012 Health Affairs post. Aaron McKethan and colleagues at RxAnte said such penalties may increase hospital investment in post-discharge care management programs that increase the likelihood that patients are on the right medications and that they take the drugs as directed.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.

Publication Date: Tuesday, April 08, 2014