Adherence to a medication regimen is generally defined as the extent to which patients take medications as prescribed by their health care providers. As C. Everett Koop, M.D. once said, “drugs don't work in patients who don't take them.”

The costs of patients not finishing their medications or treatment are substantial. Poor adherence to medications increases overall health care costs because patients get sicker faster and require more serious care. A survey released by the National Community Pharmacists Association found that an astounding three-quarter of adults do not always take their prescription medicine as directed. In more than half the cases, the patients made these decisions without talking to a health care professional. Experts estimate that this patient non-adherence costs the United States nearly $100 billion per year in extra medical costs, including hospital visits, doctor visits, lab tests, and nursing home admissions. Pharmacists reinforce the importance of patients completing their prescriptions.

Ensuring that medications are used correctly is another critical function for pharmacists. The costs associated with the improper use of medications in the United States exceeded the cost of drugs themselves: $177 billion was spent in the year 2000 to treat problems caused by legal drugs. Many of these costs can be prevented through the involvement of pharmacists. Pharmacists’ expertise can also help to eliminate medication duplication and reduce drug interactions.

Chronic disease such as diabetes and cardiovascular disease present an enormous burden on our health care system. Proper adherence is critical in controlling the financial costs of chronic diseases for patients and the impact they have on their health.

Health care resources consumed by chronic disease:

• 91% of prescriptions filled
• 81% of all hospital admissions
• 76% of physician visits

Costs associated with chronic disease:

• Health care currently consumes 26% of all federal spending and continues to grow annually.
• In 2005, more than 75% of the country’s $2 trillion health care budget went toward the treatment of chronic disease.
• Over 96¢ of each Medicare dollar.
• Over 83¢ of each Medicaid dollar.

Adherence to appropriate treatment can greatly reduce these costs and risks.

Pharmacists Improve Treatment of Diabetes and Reduce Overall Health Care Costs
In a recent study called the Asheville Project, pharmacists supported adherence by providing ongoing education, training, assessment, monitoring, follow-up, and referral as needed for patients with diabetes.

After 7 to 9 months:

• Overall health care costs decreased 16%.
• 37% of patients decreased their A1c* concentration at least 1%.
• Percentage of patients with A1c less than 7% increased from 42% to 57%.

* A1c is the measure of blood glucose used to evaluate diabetes management. Normal A1c is 4% to 6%. The goal for patients with diabetes is generally less than 7%.

After up to 5 years:

• Total mean direct medical costs decreased by $1,200 to $1,872 per patient each year.
• Costs for prescription medications used increased, but were offset by savings from fewer hospitalizations, emergency department visits, and physician visits.

Pharmacists Improve Management of Cardiovascular Disease
Heart disease is the leading killer of Americans. High blood pressure and cholesterol increase the risk for heart disease. Pharmacist adherence interventions more than double the number of patients who achieve their treatment goals for blood pressure and cholesterol.

In an extension of the Asheville Project:

Blood pressure study: Pharmacist intervention compared with a control group.

• 81% of patients in pharmacist intervention group achieved blood pressure goal versus
• 30% of control group that didn’t have contact with a pharmacist.

Cholesterol study 1: Pharmacist intervention group compared with people who didn’t have pharmacist contact.

• 69% of patients in pharmacist intervention group achieved cholesterol goal after 6 months, versus
• 33% at who didn’t have pharmacist contact

Cholesterol study 2: Pharmacy-based demonstration project compared with national data.

• 62.5% of patients reached their treatment goal with pharmacist support compared with national averages of 8% to 34% for patients without specific pharmacist intervention

When pharmacists are a part of a patient’s life they can provide critical information that improves medication use. This intervention profoundly impacts patient health and saves everyone money.

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