Medication Adherence Solutions

Friday, February 1 2013 2:44 PM - by Brett Kappelmann

Suppose you go in for a routine checkup with your primary care provider. They check your blood glucose level and it measures over 300. You have never had high levels before but you figured the day would come due to the high percentage of diabetes running in your family. Your doctor prescribes a medication that he tells you will help control your blood sugar. You take the prescription to the pharmacy, hoping that just maybe it is on the four dollar list, but the pharmacist tells you that not only is it not on the list, this drug is available only in the brand-name version. You wait at the pharmacy for an hour as they duke it out with your insurance company and finally get it covered at eighty dollar copay! The pharmacist then proceeds to counsel about the high percentage of nausea and vomiting for people taking this medication.

"Great," you tell yourself sarcastically. You justify to yourself that you feel just fine even with blood sugars that high, and with all of your responsibilities at home and at work, you can't afford to be dealing with the side effects from starting a new medication. "I'll start it next month," you tell yourself, but by next month, and the month after, there are ten other reasons to justify not taking the medication. And those blood sugars continue to creep up.and up.and up.

I see different versions of this scenario play out every day as a pharmacist. In the scenario above, this customer is at risk of quite literally shaving years off her life-expectancy as well as severely impeding her quality of life once the diabetic complications start setting in due to chronically high blood sugars. Medication non-adherence is at an all-time high today due to many of the factors represented above. Lack of medication reconciliation, lack of medication availability, intention non-adherence, poor medication understanding, and cost of medication are the five basic causes of non-adherence. But how do you overcome these causes? Let's look into a few solutions.

Lack of medication reconciliation. Keep a current list of your medications with you at all times. On that list be sure to include the dose, directions, indication, and prescribing physician. Utilize your pharmacy to help you with the list if necessary. Don't forget your OTC medications. Refer to this list often to make sure you have not forgotten a medication. It also will come quite handy on your trips to the doctor or hospital.

Lack of medication availability and cost of medication. Utilize the expertise of your doctor and pharmacist in case a medication becomes unavailable or perhaps cost prohibitive. Nine times out of ten there is an alternative, and many times that alternative is a less expensive generic. Also, be proactive by calling in refill requests days before you run out of your current supply. Oftentimes the pharmacy will have to call the prescriber for refill authorization or sometimes the prescription will be held up to due to an insurance situation such as a prior authorization. Both instances could affect adherence if you run out before the next refill is ready.

Intentional non-adherence and poor medication understanding. This can only be overcome through education of need, expected side effects, and outcomes associated with medication use as well as identification of reason for intentional non-adherence and overcoming that barrier. In the situation above, what if the pharmacist counseled that the high incidence of nausea and vomiting could be minimized if the medication is taken with food? What if the patient was better educated on the long term effects of non-controlled diabetes?

To conclude, if you have a chronic condition or conditions that causes you to be on multiple medications, partner with a pharmacy that specializes in finding innovative ways to find solutions that allow you to take the right medications at the right time, every time. For example, at Cooper Drug Store, we offer three such programs, each designed to meet the needs of a specific set of patients. No-Wait Refills is our autofill program designed for the patient with perhaps a busy schedule who is only on one to three maintenance medications. We will keep track of the date to refill your meds and then even give you an email or text when ready. SyncRx is designed for the patient on multiple medications who seems like they spend literally every other day at the pharmacy. We will synchronize all of your meds to come due at the same time! Not only that, we keep track of when you will come due for a refill and proactive call you days before you run out to review your medication list in order to prepare your next month of medications. Finally, we have recently released the Med Manager Medication Adherence Program through our closed-door pharmacy, Golden Plains Pharmacy Services, which takes SyncRx to the next level by packaging your oral medications in strip packaging, sorted by administration time and day. We are the first pharmacy in our area to offer this unique and innovative service to the patients who live at home.

Although medication adherence can be a challenge, with a little planning, education, preparation, and assistance from your pharmacy, you can soon be an adherent patient and hold your head up high when you go in for the next checkup with your doctor.