When individuals fail to take their medications as prescribed, plan sponsors can end up paying even more for avoidable expenses.
As the pandemic exacerbates barriers to adherence, promoting the value of taking medications as prescribed is more critical than ever to improve member health and cost savings.
Even before the COVID-19 pandemic rattled the country, medication non-adherence—when patients fail to take their prescriptions as prescribed by a doctor or pharmacist—has been an ongoing issue causing serious health consequences and unnecessary medical costs. In fact, non-adherence to medication leads to a financial burden of $100 billion to $290 billion on the U.S. health care system annually, which causes significant ramifications for plan sponsors who consequently experience higher medical costs and lost earnings and productivity.
Recommended For You
As the pandemic continues to create lasting effects on our economy and health care system, the major barriers to medication adherence, such as high costs and misunderstanding of health conditions, have worsened. Financial hardships impacting the affordability of prescriptions and fear of in-person visits to the doctor are preventing those needing medications from getting a diagnosis or filling their prescriptions. These challenges present an essential opportunity for benefits professionals to re-evaluate how they support employees through their pharmacy benefits and help identify barriers and solutions to adherence.
Here are three ways plan sponsors can promote the value of adherence and work directly with their employees to improve health outcomes, generate significant savings and boost productivity.
1. Offer personalized support and education
Patients often fail to adhere to their medications because they don't understand the importance of taking their prescriptions as directed. Employees might not have a clear picture of the anticipated side-effects or how their prescriptions benefit their health. As patients are told to limit nonessential doctor visits during the current health crisis, their access to physicians and pharmacists who can provide consultations is also limited. When individuals fail to take their medications as prescribed, plan sponsors can end up paying even more for avoidable expenses.
Benefits professionals can provide opportunities for plan members to discuss their health with a professional. For example, helping members overcome suboptimal health literacy by working with employees one-on-one to offer personalized support or coordinating virtual employee education sessions can provide clarity and knowledge about their medications. By taking an active role and supplying the resources for employees to better understand how taking medications improve their health, you can promote the value of adherence and educate members to avoid non-adherence and misuse. When members adhere to their medications, they are less likely to experience complications that may lead to emergency room visits or hospitalizations, which reduces unnecessary costs for plan sponsors.
2. Identify at-risk employees
Individuals are typically most at-risk for non-adherence when starting a new therapy. One method for addressing this initial risk is to engage a pharmacy benefit manager (PBM) partner who offers programs and materials dedicated to promoting member adherence. PBMs can provide tools that incorporate innovative technologies or personalized reports that identify members who are at risk of future non-adherence and provide customized strategies so employers can take action quickly. For example, Sempre Health offers an SMS-based engagement tool to lower copays when members fill their prescriptions consistently and on time, reminds members when it's time for a refill and can even submit refill requests on the member's behalf.
In addition, benefit managers involved in selecting a new PBM partner should consider a PBM that offers the lowest-net-cost formulary, as well as opportunities for their employees to save money. Ensuring a high-performance formulary that consistently delivers the lowest-net cost translates to low out-of-pocket copays for prescriptions and a benefits plan design that won't shift costs to members, especially those most at risk of non-adherence.
Opportunities for employees to save money may include, but are not limited to, generic prescription savings, tablet-splitting and copay assistance programs. PBM partners with a diverse offering of programs and commitment to reducing overall costs will help you increase adherence, deliver financial value and improve your employees' experience.
3. Address accessibility
In addition to high costs and low health literacy, several factors relating to accessibility affect medication adherence. Language, income and beliefs are three social factors that contribute to medication non-adherence. Often, just by demonstrating empathy and understanding for members facing these barriers, PBMs and benefits professionals can guide members towards the path of improving their health with medication adherence.
Bridging the language gap with access to interpreters, braille or large print documents, foreign language translations, and tele-relay or transcription services can improve member understanding of the importance of medication and why or how they need to take it. Due to economic concerns, patients who once could afford their copays might now be compelled to prioritize other essential items over their health needs. Others have lost access to transportation and simply can't get to a pharmacy.
By exploring a plan member's needs, beliefs and values about what they are experiencing, PBMs and benefit managers can better understand how the person's background shapes their adherence to medications and, therefore, offer personalized support critical to preventing unnecessary health conditions and costs.
Employees who need chronic drug therapy can cost plan sponsors more in prescriptions and unnecessary hospitalizations resulting from non-adherence. By enhancing engagement in this process and working with a PBM partner that helps you manage growing prescription costs and offers useful tools and resources, you can identify the most effective strategies to increase adherence so members can take control of their health and generate savings.
Ultimately, each individual's health journey is unique. Managing the variety of barriers to adherence will improve their quality of life and increase workplace productivity, giving employees the confidence and resources needed to effectively manage their health. As a result, you create savings opportunities to reduce pharmacy benefit plan costs while still delivering improved health outcomes.
Brent Eberle is the senior vice president and chief pharmacy officer at Navitus Health Solutions. At Navitus, Brent oversees the Health Strategies Division, which is responsible for clinical and population health initiatives; drug utilization review programs, formulary and drug rebate management; and outcomes management initiatives. Brent is also General Manager of Lumicera Health Services, a wholly owned Navitus subsidiary and full service national specialty pharmacy accredited by both URAC and ACHC.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
