NEHI white paper tackles nonadherence problem

BOSTON — The U.S. healthcare system must address the problem of patients not picking up newly-prescribed medicines if national goals for improved health and reduced costs of medical care will be realized, according to a NEHI white paper issued Thursday
The paper, “Ready for Pick Up: Reducing Primary Medication Non-Adherence — A New Prescription for Health Care Improvement,” outlines the problem of prescriptions for newly initiated therapy that are not picked up for the first time and, thus, never taken, leading to the possibility of worse health and increased stress on the healthcare system. 
The rate of primary nonadherence, that is, the percentage of first-time prescriptions abandoned by patients (and thus not picked up at pharmacies), can range as high as 30% among some classes of medication, according to recent research. 
“In recent years, our healthcare system has begun to take action to improve patient medication adherence, and yet primary medication nonadherence — the failure to commence newly initiated therapy — remains a major but largely unacknowledged problem,” said Tom Hubbard, NEHI VP policy research, who authored the paper. “The good news is that potential strategies for reducing primary medication nonadherence are emerging as electronic prescribing becomes common. This paper is a call to accelerate action that will reduce the failure to pick-up newly initiated medication therapy.” 
A May 2014 working group convened by the NACDS Foundation, the Pharmacy Quality Alliance and NEHI framed the issues outlined in the paper. The paper addresses key issues in the adoption and utilization of a new pharmacy quality metric on primary medication nonadherence endorsed by the Pharmacy Quality Alliance in November 2013. Prior to the advent of e-prescribing, tracking PMN rates was not feasible. 
“The PQA PMN measure introduces a consensus-based, scientifically tested, nationally endorsed metric to the market,” said Laura Cranston, PQA executive director. “This metric brings much-needed consistency in defining PMN, which will help us to identify, test and compare results for PMN interventions across healthcare settings.” 
Current adherence policy focuses on patients who have received their therapies at least once — because these patients trigger payment claims processing that allows medication adherence to be tracked. 
“Obviously this leaves out patients who never get their newly-prescribed therapy at all,” Hubbard said. “Community pharmacies that receive e-prescriptions can now track primary medication non-adherence by comparing the e-prescriptions they receive to the records of the prescriptions that are actually picked up. This paper outlines the issues pharmacies face in using this data to create effective interventions with patients that will increase the first-fill of new prescriptions.” 
NEHI makes eight recommendations that stakeholders, from physicians and pharmacists to insurers and health plans, could do to understand and attack the problem, including pharmacist interventions with nonadherent patients. 
High on the list: more dialogue among healthcare payers, the physician community and the pharmacy industry to establish common ground for action. 
“Collaboration is key in the face of the challenges that result from patients not taking their medications as prescribed. And to that end, pharmacy works in close partnership with hospitals, physicians, nurses and other healthcare providers in helping patients understand the importance of taking their medications as prescribed,” said Kathleen Jaeger, NACDS Foundation president. “We are pleased that NEHI has raised awareness of primary medication non-adherence — a critical public health gap.” 
“As the late Surgeon General C. Everett Koop said, ‘Drugs don’t work in patients who don’t take them,’" Hubbard said. "He might have continued, ‘Drugs never work in patients who don’t take them for the very first time.’” 
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