Understanding Patient Non-Adherence and How to Prevent it from Affecting Your Rx Plan Costs

There are many different reasons why patients don't take their medications as prescribed. And unfortunately, prescription non-adherence affects the overall cost of health care. While it may be tempting for employers to cut costs by raising deductibles, out of pocket maximums and copays, there are other solutions to help curb the cost. We want to help employers save money while allowing them to remain empathetic toward employees and the need to continue providing prescription drug benefits with affordable copays. So, let's first take a look at the reasons behind patient non-adherence, then we'll address ways to control it:

Reasons for non-adherence:

Cost of Medications
The cost of many medications, especially for chronic illnesses that require specialty drug treatment, can be quite expensive. If these prescriptions aren't fully covered by the patient's prescription benefit plan, this could cause some financial duress for the patient and make them feel as though they must choose between adhering to the treatment schedule or being able to afford other important expenses in their life. According to the CDC, “Some adults offset the cost of prescription drugs by reducing the dosage and frequency of the recommended pharmacotherapy.” To try to save money and make their prescriptions last longer, patients may take their medication less frequently than recommended.

Rx Not a Preferred or Generic Drug
Another problem that often arises is that physicians are not paying attention to the patient's approved formulary list when prescribing medications. Or, are not considering generic alternatives. When this information is provided and taken into consideration, the physician and patient can more easily work together to determine a medication that will best meet the combination of that patient’s physical, financial, and lifestyle needs, thereby increasing the likelihood of patient medication adherence.

No Employee Benefits
If a patient does not have prescription benefits, there is a greater chance that the medication prescribed will not be adhered to. The reason circles back again to the cost of the medication. While those with prescription drug benefits may still have to pay some out of pocket expense for their medications, those without any coverage must pay in full. For some of the medications prescribed, this could mean a patient is required to pay $1000+ for a single dose of their treatment. Chances are pretty likely that they won't be able to afford their medication, therefore won't fulfill the prescription.

Things we can do to help:

Employer Claims Analysis
As a prescription solutions expert, we strive to deliver state-of-the-art auditing technology to provide feedback on PBM performance, including contract compliance and opportunity analysis for cost management. With aggressive group purchasing contract pricing in place with multiple PBMs, Synergy ensures the best possible outcomes through high-cost drug management and contract audits. We are uniquely positioned to manage the entire spectrum of PBM services – from selection to annual audits – to ensure employers receive benefit options and services typically reserved for exclusive entities.

Finding Lower Cost Generic Alternatives
With prescription drug costs rising, generic alternatives to brand-name medications may help increase patient savings. Generic drugs are safe, effective, FDA-approved and less expensive. Not all drugs have generics on the market but there may be a therapeutic equivalent available. But if patients are made aware of their right to ask for a generic alternative when it's available, this can help them take control of their out of pocket expense.

Patient Assistant Programs
Patient Medication Assistance Programs offered by pharmaceutical companies, nonprofit groups, or state governments, can help financially needy patients purchase necessary medications and supplies. Via these programs, prescription medications may be made available at no cost or at a minimal fee for individuals who do not have insurance or are underinsured. Some programs provide assistance for the purchase of high-cost drugs that have no generic equivalents or close therapeutic substitutes, making it easier for those patients to adhere to their treatment plan.

Prescription Discount Cards
There are many discount pharmacy programs out there that could help patients save on prescription drug costs. Synergy Pharmacy Benefit Consultants offers a FREE prescription drug card that anyone can download. This Prescription Savings card can save an average of 30% on the cost of medications. It's accepted at more than 68,000 participating pharmacies nationwide to save on medication for the entire family - even the family pet! All prescription drugs are eligible for savings and the card is available at absolutely no cost.

Allowing Synergy Pharmacy Benefit Consultants to continually review your prescription drug plan and claims provides you the opportunity to save anywhere from 10%-20% in your pharmacy costs. Regular utilization report cards can help to identify parts of a plan that may need improvement, areas that could be cut to preserve spending, and can show you areas in which you can save money by adjusting copays, modifying benefit design, adding proactive clinical and specialty drug management programs and assistance opportunities and considering a closed formulary. Let Synergy Pharmacy Benefit Consultants help you pinpoint the areas that need improvement and help you save money in the process!

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Synergy Pharmacy Benefit Consultants, LLC
2111 Bagnell Dam Blvd #37
Lake Ozark, MO 65049


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