Understanding Rx Nonadherence: Why how we think about it matters to how we solve for it.

Medication nonadherence is a complex challenge that can damage individual patient outcomes, population health, and healthcare costs. Healthcare marketers hold the key to unlocking the solution by creating a cohesive patient experience that connects messaging across various points of care (POC) and provides a patient-centered system of reminders, alerts, and support. Ideally, these POC touchpoints work together like connective tissue that surrounds and supports patient health journeys to create an optimal system of care. Traditionally, the responsibility for addressing nonadherence has been placed on the patient or the physician. However, this approach overlooks the fragmented nature of patient journeys, infrequent care, and the reliance on patient self-reporting. Healthcare marketers can develop a comprehensive approach to medication adherence by tracking patients across various points of care and reaching into their daily lives. This system should focus on increasing patient understanding, removing adherence barriers, creating easier methods for taking medication, integrating and educating distributed care teams, and seamlessly moving across in-person and digital touchpoints. To create meaningful change, marketers must first understand the barriers to adherence and the landscape surrounding nonadherence. 

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What exactly is Rx Nonadherence?

According to the American Medical Association, medication adherence is defined as taking medication “as prescribed” 80% of the time (AMA 2023). It is not just about whether patients pick up and take medication, but that they follow prescribed usage instructions 80% of the time for the medication to be effective. Not taking it correctly can render the prescription ineffective and change patient outcomes with big immediate and downstream effects to the patient and broader drug perception. There are two types of nonadherence: intentional and unintentional nonadherence, each requiring a different intervention strategy. 

  • Intentional nonadherence can happen for a host of reasons we can explore later, such as medication beliefs or previously mentioned cost concerns that cause patients to abandon prescriptions or skip or alter medication doses. 

  • Unintentional nonadherence can happen due to factors like forgetfulness, cognitive issues, or physical difficulties in handling medication.

Both types of nonadherence can be caused by or rooted in shame or depression, which can inhibit honest adherence reporting to healthcare providers. 

Rx Adherence Facts Infographic

Barriers to Medication Nonadherence

For point of care marketers, understanding these barriers is key to targeting and tailoring resources for patients and practitioners at specific care points. Drilling down into specific barriers and where they exist can identify the problems and solutions POC marketing can address. The top-cited barriers to adherence marketers can impact (see figure below), largely fall under two umbrella categories when abstracting strategically from the World Health Organization’s dimensions of adherence. (Source meta analysis: Divine et al 2018

  • Healthcare system centered barriers include therapy-related and healthcare system dimensions where it was on the non-patient side to provide effective information and communication about conditions and medications or to offer additional patient support. 

  • Patient centered barriers encompassing patient-related and socioeconomic dimensions, may also result from inadequate information, but are influenced by a person’s individual and sociocultural context, such as accessibility issues, psychological state, level of education, medication beliefs, or a history of noninclusive patient experiences.

Caring mom. Smiling loving dark-haired young mother holding medications and talking with her kids about medication adherence

Removing Rx Barriers at the Root

Adherence intervention strategies should focus on where the barrier is rooted, with the vast majority (76%) being patient-centered and addressable by reaching the patient directly. While complementary HCP-focused approaches are valuable, there is a strategic difference between the primary responsibilities of healthcare providers and the independent resources that can compliment or augment healthcare efforts.

Facts about Rx Nonadherence
Looking at cited barriers, we can see that many benefit from addressing the patient and caregivers directly with information, resources, or support to help them understand, access, and take medications successfully. In fact, some barriers, such as beliefs about medications or cultural beliefs that may diminish trust in healthcare providers, may depend on direct patient engagement and awareness campaigns that leverage points of care and community locations outside traditional clinical settings.
Infographic featuring list of Barriers for Patient Rx Adherence
The bulk of the above medication adherence barriers can be addressed by POC engagement that delivers highly relevant information on medications, patient support, and resources at the right point in the patient journey. (See tables below.) Patient-related behaviors and socioeconomic barriers can be addressed by patient-facing communications, while healthcare system and therapy-related barriers, often resulting from health-literacy or communication issues and poor visibility into patient data, present opportunities for point of care tools and HCP-assistance.

PATIENT CENTERED ADHERENCE SOLUTIONS

HEALTHCARE SYSTEM CENTERED SOLUTIONS

TARGET AUDIENCE: Patients and social systems (caregivers, family, community, etc) are the target audiences and the source of adherence barriers.

CHALLENGES MARKETERS CAN ADDRESS:

  • Lack of understanding or information about conditions and medication
  • Patient beliefs or concerns about medication or treatment unaddressed
  • Noninclusive of patient identity or unrelatable
  • Culturally or personally untrusted sources or approaches
  • Low health literacy
  • Mental and emotional states not considered
  • Unable to afford or access prescribed treatments or medications
  • Inadequate patient support
  • Inconvenient or difficult treatments or medication routines

TARGET AUDIENCE: Healthcare systems and HCPs are target audiences, and source and location of adherence barriers.

CHALLENGES MARKETERS CAN ADDRESS:

  • Inadequate communication around conditions and medication
  • Ineffective communication strategies
  • Not attentive or attuned to patient beliefs
  • Lack of understanding of patient / overall health journey
  • Multiple care providers / fragmented information
  • Reliance on patient reporting / self-advocacy

Affordability Both Drives and is Driven by Adherence

Once diagnosed, the same patients who eagerly searched for solutions to medical conditions often don’t pick up or fail to take medications as directed. “Some 50% of Americans don’t take their medications as directed by their doctor, for any of a host of reasons. This non-adherence leads to preventable hospitalizations and preventable deaths, and costs 16% or $500 billion of the entire U.S. healthcare spend every year.” (PSQH 2022)

Cost concerns play a dominant role in nonadherence and abandonment across demographics and access levels. According to IQVIA (2020), when a medication is seen as expensive (over $500), unfilled prescriptions jump from 5% to 60%. Cost concerns drive patients to prioritize other expenses, change or skip dosages, or develop negative beliefs about medications, leading them to seek alternatives. Such behavior not only affects patient outcomes and public health but also has a significant impact on healthcare, prescribers, and pharmaceutical companies  (IQVIA 2020).

Nonadherence has far-reaching consequences beyond what patients realize. Undertreated or untreated conditions can lead to increased lifetime healthcare costs, secondary problems, and extended diagnostic work (AMA 2023).

Ironically, affordability concerns that drive nonadherence may ultimately contribute to higher drug prices. As Drug Discovery Today (2023) states, “High medication adherence is not only important to achieve the expected treatment effects but can also effectively reduce medical costs.”

Point of Care Tactics Can Address Cost Concerns

Specific POC strategies and tactics can address patient cost concerns, removing the largest barrier to care. For example, healthcare marketers can: 

  • Work within the Electronic Health Record (EHR) to identify drug options and couponing opportunities (PSQH 2022)
  • Empower patients with information on affordable medication and pharmacy options 
  • Offer materials on the dangers of medication misuse at the time of prescription or in-bag at pickup. 
  • Create support lines dedicated to helping with financial and insurance related concerns, questions, and navigation

Find the right point of care marketing solution with the Point of Care Marketing Product Finder tool. Tailor solutions specifically to your healthcare marketing needs based on the following selection criteria: point of care setting, target audience, specialty / specialty location, media tactic, and product lines. 

Physician Rx Blindness and Adherence

Doctors are not frontline in battling nonadherence, yet treatment evaluation and decisions rely heavily on patient adherence. There are many reasons patients may not report problems interfering with intentional or unintentional adherence.

  • Patients may mistakenly believe their providers are aware of nonadherence. 

  • Patients may be reluctant to talk to doctors about how or whether they are taking medications. 

  • Patient conditions, emotional state, or accessibility may limit ability to correctly self-report 

  • Patients go to multiple doctors

  • Patient medications or health routines are confusing 

  • Patients go too infrequently to prescribing doctor 

  • Lack of trust or trusted relationship with prescriber

  • Lack of caregiver or advocate to help with communication

For POC marketers, helping providers understand and address concerns, identify patients with barriers, and equipping them with inclusive communication strategies and tools can help address noncommunication. 

Additionally, helping patients report more accurately or automating medication tracking for easier reporting may triage this noncommunication. Medication trackers, wearable interactive alerts, pharmacy apps, and print or digital medication journals could be integrated into patient-doctor experiences or portals. Many can also help log side effects and symptoms that may impact patient adherence. 

Of course, with any technology, resolving adherence issues means making it simple for patients to use, sustain, and share information. Automating wherever possible helps. 

Woman after chemotherapy taking pills at home

Why the Language around Adherence Matters

It’s important that we get the language right to keep our mindset as marketers focused on creating patient-centered messaging. There is a key distinction between adherence and compliance. (Tasaduq 2023) Adherence shows a willingness to take medication, relying on patient disposition, aptitude, and behavior. Importantly, “Adherence, when defined appropriately, means that the patient has a choice to receive or not to receive needed treatment” (Adherence Versus Compliance 2023). The takeaway is: 

  • With intentionally nonadherent patients, we need to answer why they are not adherent and give them reasons to take medications that address concerns or barrier beliefs head-on. 
  • White unintentionally nonadherent patients, we need to answer how they can be adherent, and make it possible.

This nuanced definition is mission-critical because when we talk about adherence, these are all areas that POC marketers can help with. POC marketers can create information and content that boosts confidence, understanding, and action. We can develop patient-centered messaging that addresses the specific and varied factors influencing adherence, improving medication adherence and, ultimately, patient outcomes.

Pharmacists Can Help Unintentional and Intentional Nonadherence

Pharmacists are well positioned to identify behaviors that spur medication nonadherence. (Read more on Pharmacy’s role in patient intervention in our blog.) As a high-impact point of care, pharmacists can: 

  • Leverage patient relationships to encourage patient sharing 
  • Engage with caregivers and/or have visibility into familial and care status
  • Handle questions about medications and side effects
  • Introduce or work with tools, like punch cards or pharmacy apps, to help patients remember and routinize medication and the correct way to take them
  • Problem solve issues around adverse effects or physical limitations, including offering dietary or over-the-counter aids to help maintain medication routine (upset stomach, dehydration, digestion, bowel functioning, etc) 
  • Help patients with cost savings and navigation. 

Which pharmacy a patient goes to can play a role in adherence, especially around intentional nonadherence related to costs or busy schedules. Not all patients know about pharmacy options and how strongly it can impact cost, or would know how to competitively shop. POC materials and tools can help patients find the best cost-to-access pharmacy option to boost medication taking.

Strategic POC/Healthcare Marketing Tactics and Considerations

Intuitively leveraging point of care marketing makes sense, but the machinations of marketing often mean investment in these critical engagement strategies is lost to disparate initiatives or oversight. Integrating point of care is a strategic master play that, done effectively, lightens patient and HCP burdens, removes adherence barriers, and heightens marketing ROI. One case study (Crossix) showed an ROI of 8.5x the investment in a 100M campaign resulting in POC driving 17% of the NBRx attribution when paired with digital and television. By leveraging point of care marketing and tools, healthcare marketers can transform medication adherence and drive patient satisfaction.Some considerations include:

  • Develop educational materials that increase understanding and support for patients and caregivers

  • Provide medication reminders, alerts, and dosage tools to help patients stay on track

  • Support and integrate care providers to increase transparency, create safe spaces for questions, and equip patients and caregivers with the information they need

  • Embrace healthcare consumer behavior by leveraging digital portals, apps, and trending POC locations to create a seamless messaging experience across touchpoints

  • Tailor POC strategies to specific barriers of care, targeting healthcare system-facing and patient-directed solutions

By understanding and addressing the barriers to medication adherence, POC marketers can create meaningful interventions that improve patient outcomes and drive positive change in the healthcare industry.

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