Key Components of Effective Adherence Programs


Drug adherence is a huge problem that community pharmacies are well-positioned to help solve. But what exactly should we do?

Why Drug Adherence Matters

  • As every pharmacist knows, lack of adherence to prescribed drugs is a common and costly problem. In a July Smart Retailing Rx article (Why the Fervor Over Drug Adherence? Why Should You Care?) a few facts were highlighted:
  • Nearly two-thirds of Americans who take medications don’t take them properly[i]
  • Lack of proper adherence costs the U.S. healthcare system almost $300 billion each year[ii]

In a recent report,[iii] the NCPA reports the top non-compliant behaviors, including:

  • Missed a dose (57%)
  • Forgot if took (30%)
  • Did not refill (28%)
  • Took lower dose (22%)
  • Did not fill new Rx (20%)

Click here for the full report.

Increasingly, multiple stakeholders want to improve adherence.

  • Payers want to improve drug adherence to reduce overall medical costs.
  • Medicare Advantage plans want to improve adherence to improve their quality-based star ratings and receive bonus payments.
  • PBMs want to improve adherence because their customers are now considering this a key aspect of a PBM’s performance.
  • Pharmaceutical manufacturers want to improve compliance to increase revenue.

For community pharmacies, improving adherence means filling more prescriptions, generating more traffic and revenue, and continuing to evolve as a valuable community health resource.

Components of Adherence

At a conceptual level, the idea of improving adherence makes perfect sense. An abundance of research has shown that when patients adhere to their prescribed medications, they have better outcomes and cost less to care for. For a community pharmacy, a very practical question is what steps can be taken to improve adherence, while simultaneously benefitting the business?

“There is not one solution that fixes adherence. It is multi-faceted.” That is the conclusion of McKesson’s Tony Willoughby, a pharmacist who now works with McKesson’s independent pharmacy customers on their operations and marketing. In studying the medical literature to understand the essential components of successful adherence efforts, Willoughby has identified four common elements:

  1. Relationships. Adherence is about listening to and understanding patients’ situations and often influencing individuals to change their behaviors. This requires establishing trusted relationships.
  2. Education. Effective adherence programs involve initial and continuous patient education.
    • Studies show that this is best achieved with face-to-face education, but it can also include phone-based education, and use of various educational tools and resources.
    • Education should take place at the initiation of prescription therapy so patients understand exactly what they are taking and why they are taking it.
    • Education should also be ongoing because non-adherence often takes place when individuals lose motivation to treat their condition.
    • Many of our biggest opportunities to improve adherence are in patients with chronic conditions such as high cholesterol or high blood pressure. These conditions often do not provide symptomatic reminders or motivators to continue therapy.
  3. Reminder packaging. People often forget if they have taken their daily medications. Effective adherence programs incorporate reminder packaging and tools such as medication trays, pouches and alert systems to remind individuals to take their daily meds as prescribed.
  4. Refill reminders. On average, patients get their 30-day prescriptions refilled every 35–45 days. This is because patients may not properly take their medications each day or may not remember to refill a prescription before running out. So, a key element of effective adherence programs is some type of refill reminder, which may be a phone call, an email or a text.

Steps for Community Pharmacies

Community pharmacies can create adherence programs that incorporate each of these components.

A study by the National Community Pharmacists Association[iv] found that a patient’s connectedness with a pharmacist who “knows you pretty well” is the single strongest predictor of adherence. In fact, 89% of individuals feel that their neighborhood pharmacy knows them well, compared to 67% for chain pharmacy and 36% for mail order. This means that community pharmacies are in a great position to positively influence adherence.

Steps that community pharmacies can take that have proven to be effective are behavioral coaching, disease state education, comprehensive medication reviews (CMR), and medication therapy management (MTM).

A recent study found that Medicare beneficiaries receiving MTM were more likely to be adherent, and the results were greatest among those who also received a CMR, where each drug was reviewed to make sure adverse reactions were avoided.[v]

Pharmacists can support their patients through behavioral coaching. Programs like the Pharmacy Intervention Program offered through McKesson’s Sponsored Clinical Services Network provide pharmacies with a unique opportunity to support patient adherence through brief-yet-personalized behavioral coaching sessions. As a result of these conversations, pharmacies can deepen patient loyalty while also continuing to grow and evolve their pharmacy business.

Reminder Packaging
Pharmacies can offer medication pouches and can provide prescriptions in cold-seal blister packaging, which makes it easier for individuals to keep track of their daily medications.

Refill Reminders
Community pharmacies can use simple, effective, low-cost and automated technologies to provide phone, text or email reminders to customers to refill their prescriptions, depending on the preferred type of communication they establish.

Bringing It All Together

A foundational strategy recommended by Willoughby that incorporates all of these components is medication synchronization. This involves coordinating a patient’s prescriptions so they all come due at the same time. When medications are synchronized, there is frequent communication with patients about refills and there are opportunities for ongoing education. When medication synchronization is employed, it is also much easier to incorporate compliance packaging and refill reminders.

Lastly, once a pharmacy has implemented a medication adherence program, it is important to market this program to customers as well as local prescribers who can choose to refer patients to a specific pharmacy for personalized care. (Click here to learn more about McKesson’s Physician Outreach Program.)

What You Can Do Right Now

There are several practical steps that community pharmacies can take right now to help improve adherence and relationships with customers.

  • Identify your target patient population. The best place to start is with those patients who are taking five or more prescriptions.[vi]
  • Create expertise by educating staff, particularly on diabetes, hypercholesterolemia and hypertension so they are able to educate customers.
  • Implement Motivational Interviewing and behavioral counseling techniques.
  • Talk to and educate every patient about adherence.
  • Leverage reminder technology to keep patients informed
  • Implement an appointment-based model for medication synchronization.
  • Begin utilizing compliance packaging.
  • Drive awareness among providers of your pharmacy’s capabilities and focus on adherence.

The facts are clear: adherence is a major problem and is receiving a great deal of attention, and community pharmacies can be part of the solution. In fact, adherence solutions fit well with what community pharmacies are already doing. With some planning and focus, community pharmacies can help address a critical national health issue, build their business, and further position pharmacy as a vital community health resource.

Check out other Smart Retailing Rx blog posts on the subject to give you more ideas:

You are the sole owner of your pharmacy and in sole control of all aspects of its operations. The information provided here is for reference only and does not constitute legal advice. We make no representations with regard to the content’s comprehensiveness. You are solely responsible for investigating and complying with all applicable laws that govern the operation of your business.
[i] Greenberg Quinlan Rosner Research Public Opinion Strategies, Lack of Medication Adherence Harms Americans’ Health: Results from a U.S. National Survey of Adults, May 2, 2013
[ii] New England Healthcare Institute, “Thinking Outside the Pillbox: A System-Wide Approach to Improving Patient Medication Adherence for Chronic Disease,” August 12, 2009
[iii] Medication Adherence in America: A National Report 2013; National Community Pharmacists Association; slides from online briefing, June 25, 2013
[iv] Medication Adherence in America: A National Report 2013; National Community Pharmacists Association; slides from online briefing, June 25, 2013
[v] The Role of Medication Adherence in the U.S. Healthcare System, Avalere, June 2013