Avella was recently featured in Pharmaceutical Commerce article for its work in medication adherence and technology.
Poor adherence to prescribed medications creates one of today’s most pressing public health issues. When patients fail to take their medications as prescribed — either stopping before the course of treatment is complete, abandoning long-term therapies prescribed for chronic conditions, or taking the medications incorrectly — it creates far-reaching clinical and financial consequences for all stakeholders:
- Patients are unable to control painful or debilitating symptoms or disease progression, and may face premature death
- Payers (and society) shoulder the cost burden of avoidable emergency room visits, hospitalizations, and medical and therapeutic interventions, as well as the financial toll of worker absenteeism
- Brand teams lose potential revenue (impacting both profitability and ongoing R&D efforts), and market share.
Today, despite concerted effort already underway to improve patient adherence to therapy, roughly 50% of all prescribed medications don’t actually get taken by patients, according to the U.S. Centers for Disease Control (CDC).  In the U.S. alone, this leads to $100 billion or more of avoidable healthcare spending, and accounts for 33–69% of all hospital admissions, according to the agency. 
Studies show that poor adherence impacts nearly every disease state — even progressive, chronic potentially debilitating and deadly conditions that have the highest stakes. These include diabetes, cancer, cardiovascular conditions, immune-system disorders, infections (HIV sidebar?) and post-organ-transplant treatment.
Frustration among stakeholders is palpable. “Even in a category like hepatitis C, where patients can be cured, we still see significant adherence issues,” says Amanda Rhodes, director of client strategy and solutions, McKesson Specialty Health.
Similarly, “within the realm of organ transplantation, you’d think we’d see perfect adherence but adherence in this area can be a real challenge, adds Heather Black, PhD, Director of Health Quality Research for Merck’s Center for Observational and Real-world Evidence (CORE). “However, some of the regimens can require the patient to take many pills/day, at specific time intervals, and that’s incredibly difficult to maintain over time.”
Patients with asymptomatic conditions and those that don’t experience pain or suffering often do not appreciate how sick they really are. “With a broken leg, it’s obvious, but for patients with diabetes or cardiovascular disease or high cholesterol, they often say ‘Well, today I feel pretty good,’ and that undermines their need for vigorous adherence to therapy and healthy lifestyle choices,” says Michael N. Dubroff, DO, FACOP, president of consultancy LeadershipRx LLC, who was, until his recent retirement, senior director of managed care support for Genentech.
Wanted: Fresh ideas
All parties with skin in the game — drug developers, payers, physicians, pharmacists, pharmacy benefits managers (PBMs) and the many third-party service providers operating throughout the pharma supply chain — are digging deep, working to try something, anything, that might be able to move the needle in adherence. Static text or email reminders for patients to take or refill their medications — once a breakthrough concept — are simply not enough.
“Traditionally, everyone’s been focused on education, but over the past 25 years, we’ve all seen that we can’t simply educate our way out of this — there are so many other factors at play,“ says Black of Merck. “Don’t chronically ill patients realize they could die from this? Of course they do, but for so many reasons large and small, many still don’t faithfully take their medications.”
“Historically, the approach was to treat all patients in the same manner, for the same disease,” adds Susan Stinson, BSN, FACHE, SVP of Operations, Clinical Services Lash Group, an AmerisourceBergen company. “Over the years, we’ve learned that a patient-centric approach is critical. We have rethought and retooled our approach and are now dedicated to first understanding each individual patient’s needs and unique barriers to care, and then tailoring our services to best support them along their journey. We are all making progress but there is still so much work to be done.”