Medication Adherence A Hard Pill to Swallow An

Medication Adherence: A Hard Pill to Swallow An action oriented analysis on the current state of medical adherence

Medication Adherence Defined As defined by The Centers for Disease Control and Prevention: Medication adherence is the Patients conformance with the provider’s recommendation with respect to timing, dosage, and frequency of medication taking during the prescribed length of time. Non adherence can be broken up into three categories Non Fulfillment Non Persistence Non Conforming

Consequences of non adherence Non adherence leads to higher hospital readmission rates. The lack of proper control over chronic conditions such as hypertension and cardiovascular disease. The overall cost of non adherence estimated around $290 billion in avoidable medical spending. $100 billion in hospitalizations Insurance, hospitals, and patients all lose out in some way due to non adherence. On an individual basis, a study found that medication adherent diabetes patients, had annual healthcare costs of $8, 886, whereas the non adherent patient had an annual cost of $16, 498.

The extent of non adherence in the United States 20 30% of prescriptions are never filled. Medication is not properly consumed as prescribed 50% of the time. Adherence much lower in chronic diseases. Lower over time. Statin drugs (used to lower cholesterol) adherence estimated at 80% for first three months, 56% after 6 months Only 25% maintain adherence level of 80% or greater after 5 years. Affects communities disproportionately Lower adherence rates in black Medicare recipients compared to white Medicare recipients

Causes of Medication Non Adherence Relational and organizational factors Condition Related Factors The importance of adherence perceived by the patient based off of their personal and cultural view of their illness Characteristics of therapies Patient provider relationships, follow up, patient education Complexity of treatment plan as well as side effects associated Patient related factors Self efficacy, socioeconomic status, health literacy of patient

Current Efforts Care coordination/ case management Improvement of reminder technology Phone applications and prescription bottle alarms Simplifying drug regimens Drugs that need to be taken once a day that historically needed to be taken twice a day Patient education

Proposed Legislation (720 ILCS 570/316) Sec. 316. Prescription monitoring program. (a) The Department must provide for a prescription monitoring program for Schedule II, IV, and V controlled substances that includes the following components and requirements: (1) The dispenser must transmit to the central repository, in a form and manner specified by the Department, the following information: (A) The recipient's name. (B) The recipient's address. (C) The national drug code number of the controlled substance dispensed. (D) The date the controlled substance is dispensed. (E) The quantity of the controlled substance dispensed. (F) The dispenser's United States Drug Enforcement Administration registration number. (G) The prescriber's United States Drug Enforcement Administration registration number. (H) The dates the controlled substance prescription is filled to be sub. (I) The patient self reported measure of medication adherence. When acquiring this measure, the patient must be informed of the confidentiality of his answer, and that his answer will be exempt from penalty from his healthcare provider and/or insurer. (J) The payment type used to purchase the controlled substance (i. e. Medicaid, cash, third party insurance). (K) The patient location code (i. e. home, nursing home, outpatient, etc. ) for the controlled substances other than those filled at a retail pharmacy. (L) Any additional information that may be required by the department by administrative rule, including but not limited to information required for compliance with the criteria for electronic reporting of the American Society for Automation and Pharmacy or its successor.

Sample Questionnaire Did you take your prescription according to the provided directions? *Your answer will only be viewed by the pharmacist and prescribing physician and will remain confidential from other entities such as insurance [ ]Yes [ ] Somewhat [ ] No

Why the prescription monitoring program? National Alliance for Model State Drug Laws (NAMSDL) identifies the prescription monitoring program with the following goals: 1. Support access to legitimate medical use of controlled substances, 2. Identify and deter or prevent drug abuse and diversion, 3. Facilitate and encourage the identification, intervention with and treatment of persons addicted to prescription drugs, 4. Inform public health initiatives through outlining of use and abuse trends, and 5. Educate individuals about PDMPs and the use, abuse and diversion of and addiction to prescription drugs.

Policy Paramours Ø Senator John G. Mulroe (D) Ø 10 th District Ø Chair of Public Health Committee Ø J. D. from Loyola and certified public accountant Ø Representative Mary E Flowers (D) Ø 31 st District Ø Health Care Availability Access Committee (Chairperson) Ø Health and Healthcare Disparities Committee Sponsor of House Bill 108 • • Illinois Universal Health Care Act Has introduced it in the House every year since 2007 • Bill focuses on centralized records system, choice of providers, and reducing health care costs. • • • Primary Sponsor of a lot of bills Focus on prevention/ screening legislation Eg. Senate Bill 1410 Tightens exceptions on vaccinations Passed in Senate, now in House Also sponsored by Robyn Gabel in the House Ø Representative Robyn Gabel (D) Ø 18 th District Ø (Former)Medicaid Subcommittee Ø MSPH from UIC Ø Master of Jurisprudence (MJ) in Health Law Sponsor of House Bill 2915 • • Sponsored by Gabel, Bellock and Reitch Creates the Caregiver Advise, Record, and Enable Act

Policy Paramours Ø Senator Mattie Hunter (D) Ø 3 rd District Ø Majority Caucus Whip Ø Public Health Committee Ø Representative David R. Leitch (R) Ø 73 rd District Ø Deputy Republican Leader Ø Health and Health care Disparities Committee Ø State Legislator of the Year in the U. S. by the AMA Ø Representative Patricia R. Bellock (R) Ø 47 th District Ø Health and Healthcare Disparities Committee Ø Formerly in Medicaid Committee (co chair) in 96 th GA Public Act 97 -0689 / SB 2840 Sponsor of House Bill 3285 Sponsor of Senate Bill 1792 • • • Program Integrity for Medicaid and Children’s Health Insurance Program Act Mulroe sponsored this bill in the Senate Protects rights of Medicaid recipients to be able to choose their own physician • Sponsored with Flowers Currently interested in mental health reform Medicaid Diabetes education Attempts to start a pilot program for diabetes self management training in Medicaid recipients.

Governmental Stakeholder Analysis Healthcare and Family Services Health Information Exchange Authority, Illinois Department of Human Services Illinois Department of Public Health Illinois Department of Healthcare and Family Services Illinois Board of Pharmacy Illinois Comprehensive Insurance Plan Prescription Monitoring Program Illinois University of Illinois Hospital System Center for Medicare and Medicaid Services

Private Stakeholder analysis National Consumers League The Pharmacy Quality Alliance, Inc. American College of Physicians Foundation Society for Women’s Health Research American Pharmacists Association American Accreditation Commission for Health Care Society of Health System Pharmacists American Medical Association Intelecare Compliance Solutions, Inc. Illinois Pharmacists association Kaiser Permanente Pfizer National Association of Chain Drug Stores National Community Pharmacists Association National Council for Patient Information and Education National Family Caregivers Association National Health Council National Research Center for Women and Families

Future Directions Small picture Better targeted case management More precise data surrounding medication adherence Follow up opportunities for pharmacists and physicians Big picture Healthcare savings by all parties Infrastructure for prescription compliance for patients of all demographics Better treatment of chronic conditions

Resources Centers for Disease Control and Prevention. (2013, March 13). Medication Adherence. Retrieved April 28, 2015, from http: //www. cdc. gov/primarycare/materials/medication/docs/medication adherence 01 ccd. pdf Chisholm Burns, M. , & Spivey, C. (2012). The 'cost' of medication nonadherence: Consequences we cannot afford to accept. Journal of the American Pharmacists Association, 823. Gerber, B. S. , Cho, Y. I. , Arozullah, A. M. , & Lee, S. Y. D. (2010). Racial Differences in Medication Adherence: A Cross Sectional Study of Medicare Enrollees. The American Journal of Geriatric Pharmacotherapy, 8(2), 136– 145. doi: 10. 1016/j. amjopharm. 2010. 03. 002 Health Affairs. (2001, December 19). Patient Medication Adherence: The Next Act. Retrieved April 28, 2015, from http: //healthaffairs. org/blog/2011/12/19/patient medication adherence the next act Health Care Financing and Organization. (2011). Does Medication Adherence Lower Medicare Spending Among Beneficiaries with Diabetes? Ho, P. , Bryson, C. , & Rumsfeld, J. (n. d. ). Medication Adherence: Its Importance In Cardiovascular Outcomes. Circulation, 3028 3035. Illinois General Assembly. (n. d. ). Illinois General Assembly (720 ILCS 570/316). Retrieved April 28, 2015, from http: //www. ilga. gov/legislation/ilcs/fulltext. asp? Doc. Name=072005700 K 316 Illinois Prescription Monitoring Program. (n. d. ). Retrieved April 28, 2015, from https: //www. ilpmp. org/index. php Marcum ZA, Sevick M, Handler SM. Medication Nonadherence: A Diagnosable and Treatable Medical Condition. JAMA. 2013; 309(20): 2105 2106. doi: 10. 1001/jama. 2013. 4638. National Conference of State Legislatures. (2012, November 1). Medication Adherence: Taking Pills as Ordered. Retrieved April 28, 2015, from http: //www. ncsl. org/research/health/medication adherence taking pills as ordered. aspx National Health Council. (2009, July 17). Letter to Congress. Retrieved April 28, 2015, from http: //www. nationalhealthcouncil. org/sites/default/files/NHC_Files/Pdf_Files/medicationadherence_08 12 09. pdf New England Health Institute. (2009). Thinking Outside the Pillbox A System wide Approach to Improving Patient Medication Adherence for Chronic Disease. New England Health Institute. Prescriptions for a Healthy America. (n. d. ). Prescriptions for a Healthy America Medication Adherence: A $300 Billion Problem. Retrieved April 28, 2015, from http: //adhereforhealth. org/who we are/medication adherence/