Tackling Nonadherence

Compliance packaging can be part of the plan to improve patient adherence with prescribed drug regimens.

NEHI, a national health policy institute seeking to identify strategies to improve health care quality and lower health care costs, has released a national medication adherence agenda. Compliance packaging could play a role in the agenda’s priorities put forth by NEHI for public and private policymakers.

NEHI points out that the U.S. Congressional Budget Office claimed that a 5% increase in the number of prescriptions used by Medicare patients would result in a 1 percent decrease in their medical and hospital spending.

To address nonadherence, NEHI urges the following:

• Promoting sharing of best practices and lessons learned from pilots of new medication management techniques.
• Supporting large-scale implementation of promising, evidence-based “tactics” for improved medication management.
• Continuing development of metrics of medication use to spur adoption of proven medication management strategies.
• Accelerating adoption of electronic prescribing and electronic medical records that support evidence-based interventions for improved adherence.
• Improving Medication Therapy Management services in Medicare Part D.
• Integrating medication adherence research, policy development and advocacy with broader efforts that aim to improve use of medicines, including those focused on patient safety.

“There is no question that packaging is a part of the overall strategy to addressing medication adherence,” Tom Hubbard, NEHI’s Vice President of Policy Research and author of the new agenda, told PMP News. “Medication adherence is a metric in the quality ratings for Medicare drug plans. There are goals that are pressuring drug plans to hit targets for adherence. Payers and providers are thinking more strategically about adherence.”

There is also a shift to accountable care organizations, and many goals are tied to patient populations, such as those taking multiple medications, Hubbard says. “Healthcare plans are trying to figure out the right mix of steps to keep patients adherent and head off overall medication spending. Packaging is part of that response. My personal sense is that there are industry players that are leading the way in packaging. Walmart, for instance, has made a major commitment in its strategy to use packaging.”

However, Hubbard doesn’t foresee any mandates around packaging, at least not from Medicare. “We are more likely to see pressure from Medicare drug plans or commercial drug plans to see better adherence, but no dictating on how to do so,” he says.

“But the pressure to meet goals might provide an incentive to use compliance packaging. There may also be interest in using compliance packaging when it can serve in place of more hands-on intervention or face time.”

Hubbard believes that forces are converging for packaging and other adherence-promoting tools, such as medication therapy management and face-to-face pharmacist interventions. “It probably won’t be an either/or choice but rather a way of weaving tools together for strategies,” he says.

Details of the six new policy recommendations can be found in the report, “Six Priorities for Action to Support Patient Medication Adherence,” now available on the NEHI website, www.nehi.net.

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