Have We Given Up on Patient Compliance?

//Have We Given Up on Patient Compliance?

I was recently re-reading a white paper I’d done nearly 15 years ago on the opportunity represented by improving patient compliance (adherence) to therapies. Much has changed in Canada for our industry since that time; sales of patented and generic drugs have increased by 50%, we’ve weathered significant economic decline and slow recovery, we’ve seen more consolidation of multi-national drug companies, we’ve experienced unprecedented pressure on drug pricing, biologic growth is outstripping that of total drug sales, and the world of digital health has exploded. The list of dramatic changes could go on and on. Sadly, the issue of compliance has seen no meaningful improvement.

The statistics on adherence to therapies are no less dramatic, or depressing, than they were back then. Those ubiquitous ‘studies’ have recently shown that 50% of Canadians do not take their medications as prescribed. That startling number hasn’t shown any improvement in many years. The effects are broad reaching. Non-compliance is the cause of 10% of all hospital admissions, with 25% being admissions of the elderly. They are also responsible for 23% of all nursing home admissions.1

There’s no question that the issue of compliance is multi-faceted. Its impact is greatest for chronic therapies and the reasons for failure to comply include2:

  • Psychological problems, particularly depression
  • Cognitive impairment
  • Asymptomatic diseases
  • Side effects
  • Lack of belief in benefits
  • Lack of understanding of the condition
  • Cost of medications
  • Complexity of treatment

Whatever the cause, the impact is clear. A PMAC report3, dating way back to 1995, suggested the annual cost of non-compliance in Canada was then between $7 and $9 billion in direct and indirect costs. Of that, a significant portion would be lost drug sales as a result of unfilled initial and refill prescriptions.

So has our appetite for those lost revenues diminished over the years? In large part, as it was when I first discussed this topic, a meaningful difference can be made in patient compliance with education and a better understanding on the patient’s part. While I acknowledge that I’ve oversimplified the solution, neither is it so daunting as to be abandoned as an opportunity, as it appears to have been.

It strikes me that one of the pivotal stakeholders that have minimally delved into programs or initiatives to stem this tide are the very folks that are paying for the medications in the first place – private insurance companies and provincial formularies. They, more than most stakeholders, hold sway over patients for whom they have accepted this cost burden. They also know, in large part through drug claim submissions, those patients who are non-adherent to their therapy. Could they not create patient forums for disease information and compel participation in adherence initiatives?

The cynic in me wonders if the compliance drop-off and subsequent drop-off in claims is an essential element of their business or revenue model. After all, if all patients took their meds as directed, the value of drug claims would exponentially rise. They would get no credit for the resulting positive health outcomes or reduced hospital costs from reduced stays. Will we ever see such an altruistic effort?

Well, for now, we’ll continue to work with our clients, with the tools we have at our disposal, to create a more ‘patient-centric’ approach, but that internal cynic feels like it will take a brave and unselfish approach to really make a difference.


1Canadian Association of Hospital Pharmacists
2Osterberg L, Blaschke T. Adherence to medication. The New England Journal of Medicine 2005;353(5):487-97
3Coambs RB. Review of the scientific literature on the prevalence, consequences, and health costs of noncompliance & inappropriate use of prescription medication in Canada. Ottawa: Pharmaceutical Manufacturers Association of Canada; 1995.