Research has shown that patients who do not take their medication according to schedule cost the healthcare system between $100 and $300 billion each year.
In an attempt to improve the quality of care and also to keep costs down, CMS has created a star rating system. The purpose of the star rating is to measure the performance of Medicare plans. The ratings also measure how well patients adhere to their medication refill schedule. Improving medication adherence helps improve patient outcomes and well as controlling costs.
To achieve the highest rating, which is five stars, health plans need to have patients get their prescriptions filled nearly 80 percent of the time for hypertension medications, statins for treatment of hyperlipidemia, and oral diabetic medications for the treatment of diabetes. The percentage is calculated according to how often a prescription is refilled. So, for example, someone with a 30-day prescription for a daily medication who gets his medication refilled 12 times during the year (once each month) would have a 100 percent adherence rate.
Five-star health plan pharmacies use different strategies to increase the level of patient adherence in getting their medications filled and refilled. These include:
One big reason that patients don’t adhere to their medication schedules is that they forget to get medications refilled on time. To counter this problem, pharmacies have started synchronization programs, where patients get prescriptions filled for some or all of their medications at the same time. Patients on these programs are three to six times more likely to adhere to their schedules.
Pharmacies have begun to package medication by dose, rather than having a bottle filled with pills. It is much easier this way to determine if patients have been taking their medication.
Pharmacists are taking more time to talk with patients about their medications, explaining when and why patients need to take them. This is much more effective than simply telling people that they have to take their medicine.
Another reasons for non-adherence is that patients forget to order refills. This can be countered by electronic reminders, such as text messages and email. There are also dose reminders for patients who forget to take each dose.