Alyssa Billmeyer, PharmD, assistant director of specialty pharmacy, Emory University Hospital Midtown, kicked off day two of the 2023 Specialty Pharmacy Next meeting. Dr Billmeyer discussed medication adherence, reviewed methodologies used to measure adherence, highlighted strategies to circumvent nonadherence, and discussed future opportunities to help improve medication adherence.

According to Dr Billmeyer, the right dose, frequency, time, and way, all lead to better medication adherence outcomes.

She explained that 30-50% of patients do not take medication as planned and many hospitalizations are linked to nonadherence. Further, $100 billion in health care services annually are connected to nonadherence, and she note that “specialty medications add a unique challenge to medication adherence and persistence.”

There are five main factors that are linked with specialty medication nonadherence, according to Dr Billmeyer. They include:

• Access
• Cost
• Complexity
• Clinical effects
• Forgetfulness

And based on nonadherence, the following are items that are impacted:

• Disease progression
• increased costs
• Reduced quality of life
• Increased complications
• Poor outcomes
• Disease management challenges

Dr Billmeyer explained the importance of assessing nonadherence among patients. She said that pharmacy claim records for metrics like medication possession ratio and proportion of days covered should be monitored. Additionally, patients can either self-report, or electronic monitors and pill counting practices can be used.  

Of the five main factors that lead to nonadherence, Dr Billmeyer said there are various solutions for each factor:

• Access: Home delivery; patient navigation; defined benefits investigation, prior authorization; and denials process
• Cost: Financial navigators; copay programs; foundations; free drug enrollment; social workers
• Complexity and Clinical side effects: Patient and caregiver education; goals of therapy; monitoring; real-time interventions
• Forgetfulness: Proactive outreach for initial prescriptions and refills

 Aside from these potential solutions, Dr Billmeyer also highlighted the benefits of technology. Through use of technology, patients can take advantage of refill reminders like text messages and app reminders. Additionally, they can use medication tracking devices or even tracking calendars.

Dr Billmeyer ended the session highlighting future opportunities. She said speciality pharmacies can use adherence risk assessment tools or predictive AI tools. It is also important to advocate for affordable medication pricing and medication access, she said. Finally, a multidisciplinary approach as well as leveraging learners and pharmacist extenders is crucial for improved adherence.