Medication Adherence: A $300 Billion Problem

Solutions Needed to Improve Health and Lower Costs

What is Medication Adherence?

Medication adherence occurs when a patient takes their medications according to the prescribed dosage, time, frequency, and direction.  A breakdown in any one of these elements has the potential to result in unanticipated side effects and complications. Studies show that:

  • Half of all patients do not take their medications as prescribed;[1]
  • More than 1 in 5 new prescriptions go unfilled;[2]
  • Adherence is lowest among patients with chronic illnesses.[3]

What Are the Effects of Poor Medication Adherence?

Poor medication adherence, or non-adherence, limits effective management and control of chronic illnesses. Non-adherence increases the likelihood of preventable disease progression, increased hospitalizations, avoidable doctor and emergency room visits, and other problems arising from poor health, which can significantly increase costs.

  • At least 125,000 Americans die annually due to poor medication adherence.[4]
  • As adherence declines, emergency room visits increase by 17% and hospital stays rise 10% among patients with diabetes, asthma, or gastric acid disorder.[5]
  • Poor medication adherence results in 33% to 69% of medication-related hospital admissions in the United States, at a cost of roughly $100 billion per year.[6]
  • NEHI estimates that total potential savings from adherence and related disease management could be $290 billion annually — 13% of health spending.[7]

What Can Be Done?

A growing body of evidence suggests that medication adherence programs have the potential to reduce health spending and, in the process, generate significant savings for taxpayers.  Policies to promote medication adherence have the potential to improve health and significantly reduce health spending.

The Council for Affordable Health Coverage (CAHC) has launched Prescriptions for a Healthy America: Partnership for Advancing Medication Adherence (the Partnership) in collaboration with several patient, pharmacy, provider, pharmaceutical, and employer organizations to identify specific legislative and regulatory solutions that can be brought to the attention of Congress and the Administration.  

Key Campaign Deliverables

The Partnership will develop policy recommendations and engage in a robust advocacy campaign to advance medication adherence strategies and interventions that lower costs and improve health.  Working with Congress and the Administration, we will aggressively pursue legislative and regulatory solutions to the challenges of medication adherence.  In addition, the Partnership will:

  • Hold monthly membership meetings to discuss policy issues, strategy and advocacy;
  • Conduct briefings with industry, policy and government experts and leaders;
  • Conduct advocacy in support of Partnership-backed solutions; and
  • Foster public interest in adherence through a proactive and aggressive media campaign.

[1] Osterberg L, Blaschke T. “Adherence to Medication.” New Engl.J. Med., Aug 4, 2005; 353(5): 487-97.

[2] Fischer MA, Choudhry NK, et al. “Trouble Getting Started: Predictors of Primary Medication Nonadherence.” Am. J. of Med., 2011 November; 124(11): 1081.e9 – 1081.e22; See also, Fischer MA, Stedman MR, Lii J, et al. “Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions.” J. Gen. Intern. Med., 2010 April; 25(4): 284–290.

[3] Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. “Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost.” Med Care. Jun 2005 ;43(6):521-30.

[4] McCarthy R, “The price you pay for the drug not taken.” Bus Health. 1998;16:27-28,30,32-33.

[5] Goldman D, “Pharmacy Benefits and the Use of Drugs by the Chronically Ill.”, J. of the Amer. Med. Ass’n, 19 May 2004.

[6] Osterberg L, Blaschke T, “Adherence to Medication,” New Engl. J. Med., 2005;353(5):487-497.

[7] NEHI Research Brief, “Thinking Outside the Pillbox: A System-wide approach to Improving Patient Medication Adherence for Chronic Disease.” NEHI, 2009.