Coinciding with the Atlantic Health Care Forum I attended a couple of weeks ago was the release of the 2010 Annual Drug Trend Report (a market and behavioral analysis) from Express Scripts, a pharmacy benefits management company and mail-order pharmacy which handles both traditional and specialty drugs. 

The primary gist of the presentation and release of the Report was a focus on making it easier for patients to change their prescription-filling behavior to improve compliance and adherence, and to lower costs to the healthcare system over all.  According to research which Express Scripts commissioned, patients are aware of effective methods to lower drug costs but that they do not actively pursue those methods when it comes to their personal prescription-filling behaviors. 

An example would be that consumers/patients know that generic medications are cheaper than brand medications.  But patients do not ask their doctor to prescribe generic medications at the time of their appointment.  For me, it is my insurance company who automatically switches my medications to the generic form at the pharmacy unless I insist on the brand.  As a result, I am responsible for paying the difference in cost between the brand and the generic which is an effective method of influencing my behavior.

Another scenario arising from Express Scripts’ research involves mail-order pharmacies (of which Express Scripts is one).  They propose that patients have knowledge that it is less costly to order their medications through mail-order, but that they continue to fill prescriptions at the local retail pharmacy.  Express Scripts proposes that the disparity is rooted in a difference between intent and action among patient behavior.  I somewhat disagree.

One argument for using mail-order is that you will typically receive a 3-month supply of medication as opposed to a monthly supply at the local pharmacy.  A benefit of having a 3-month supply on hand is an increase in adherence.  If you do not refill your prescriptions on time and run out, you cannot remain adherent.  The hole in Express Scripts’ logic is that many of us are able get that 3-month supply at the local pharmacy without being required to use mail-order.  I really appreciated it when my insurance company made that change a couple of years ago.

The importance of continuing to take your medications as prescribed is the message we hear over and over.  An increase in adherence and compliance will supposedly decrease overall healthcare costs by preventing illness and further chronic disease.  Studies have been published which support this theory.  For medications such as those which control blood pressure, diabetes, or cholesterol, it makes sense.  For medications used in multiple sclerosis, I have doubts.

Adherence and compliance sound like perfectly good things when it comes to taking care of your heath.  So why do those two words make me cringe just ever so much?