Opportunities to improve medication adherence

Strategies for your senior patients

One essential component of improving your senior patients’ health and well-being is ensuring they take their medications as prescribed. You already know the upside of medication adherence. Conversely, poor adherence results in up to 69 percent of medication-related hospital admissions in the U.S. and at least 125,000 deaths annually.¹

But it’s not always as simple as whether patients take their medications, because adherence isn’t a black and white issue. Plenty of grey areas exist, including patients who split pills or who might not even fill a newly prescribed medication. In fact, the results of one study showed that up to 31 percent of new prescriptions for diabetes, hypertension and hyperlipidemia go unfilled.²

Top reasons for nonadherence

Patients don’t take their medications as prescribed about half the time. Reasons include:

Fear. Worry and concern about potential side effects can affect adherence.
Cost. A prescription’s high price might lead to rationing or not filling it at all. Prescription abandonment rates are less than 5 percent when there is no out-of-pocket cost; it rises to 45 percent when the cost is over $125 and 60 percent when the cost is more than $500.²
Lack of symptoms. An asymptomatic patient might not understand the need for medication.
Mistrust. A patient might believe the provider is prescribing a drug to receive an incentive from the manufacturer.
Mood disorders. People with depression tend to be less adherent.

What you can do

Here are some tips to help improve medication adherence rates among your patients.³

Tips	Outcomes
Use easy-to-understand language to ask if the patient realizes the benefits of the medication and whether they have any concerns.	Creates trust and a blame-free environment to talk about medication issues at each patient visit.
Educate patients on new medications. Encourage them to useapps, digital health tools, and electronic pill boxes to help them stay on track.	Teaches patients about side effects and the importance of not skipping doses.
Prescribe a 90-day or 100-day supply (depending on your market).	Reduces the chance of missing days between refills.
Consider home delivery. Express Scripts^® Pharmacy, our home delivery pharmacy.	Makes it convenient to receive prescriptions.
Prescribe generic when possible.	Improves medication compliance by making the cost more affordable.
Prescribe sufficient refills.	Helps patients avoid missed days while waiting for refill authorizations.
Avoid variable dose regimens.	Prevents patients from taking less than the minimum daily dose.
Develop a patient pain plan. Have an open conversation to discuss the benefits, risks, and alternatives before prescribing opioids.	Helps patients buy in to and adhere to the treatment plan when it’s tailored to their lifestyle and unique health care needs.
Be sensitive to the timing of the last refill of the year. Use tools like medication-assisted therapy or look at pharmacy claims feeds.	Helps patients avoid refill authorization delays during the holidays.
Follow up. Continue the conversation to assess medication adherence, address concerns, and reinforce the importance of compliance.	Improves adherence. Patients are 20 times more likely to refill late medications and three times more likely to end the year adherent.⁴

Provider resources

Our pharmacy quality improvement team offers clinical programs to support your treatment plans, including:

Medication therapy management. This program improves medication therapy outcomes by identifying gaps in care, reducing barriers to accessing needed medications, and addressing adherence. It’s offered at no cost to your eligible patients.
Case management pharmacy referrals. Our pharmacy case management teams conduct comprehensive medication reviews for high-risk patients, including those recently discharged from inpatient care or with potential medication-related issues.
Drug utilization reviews. Our Part D prescription drug formulary provides a comprehensive list of medication therapies that consider product safety and utilizes logical algorithms to proactively identify and alert a dispensing pharmacist of potential risks.

The Cigna Healthcare Medicare Advantage Part D Partnership Guide contains information on these and other resources for providers. Visit the Cigna Healthcare Medicare Advantage provider website at MedicareProviders.Cigna.com > Pharmacy Resources > Part D Stars Quality Overview > Part D Partnership Guide.

Combatting the opioid epidemic and preventing fraud, waste and abuse

For certain patients struggling with opioid use disorder, Cigna Healthcare supports the following:

Medication-assisted treatment, which can include a combination of therapy and medications.
Proactively reaching out to high-risk patients and collaborating with providers to ensure continuity of care.
Engaging with patients to complete behavioral health treatment for pain management to ensure safe and appropriate therapy.
Leveraging interventions as part of the Express Scripts Advanced Opioid Management program.

The Express Scripts pharmacy routes all opioid prescriptions to a dedicated group of trained pharmacists who review them against the Centers for Disease Control and Prevention Clinical Practice Guidelines and Drug Enforcement Administration guidelines. This ensures appropriate dosing and supply for patients.

You can find opioid-related and other pharmacy resources by visiting MedicareProviders.Cigna.com> Pharmacy Resources > Cigna Opioid Safety Resources and Tools.

2024 Updates
Effective January 1, 2024, the Cigna Healthcare Part D Plans (PDP) and Medicare Advantage Prescription Drug (MAPD) formularies have been updated. Here are some highlights: – All patients with TotalCare Dual Eligible Special Needs Plans (D-SNP) or Cigna Healthcare Primary health maintenance organization (HMO) plans that receive Extra Help now have $0 copayments for all covered Part D medications. – Weight loss drugs (GLP-1) now require prior authorization for all PDP and MAPD plans (except those enrolled in the Diabetic Special Needs Plan, Achieve Plan). – Most patients have received written notification of any changes that may limit access to maintenance medications. Questions? Review the Cigna Healthcare Medicare Advantage drug list formularies at MedicareProviders.Cigna.com > Pharmacy Resources.

2024 Updates

Effective January 1, 2024, the Cigna Healthcare Part D Plans (PDP) and Medicare Advantage Prescription Drug (MAPD) formularies have been updated.

Here are some highlights:
– All patients with TotalCare Dual Eligible Special Needs Plans (D-SNP) or Cigna Healthcare Primary health maintenance organization (HMO) plans that receive Extra Help now have $0 copayments for all covered Part D medications.
– Weight loss drugs (GLP-1) now require prior authorization for all PDP and MAPD plans (except those enrolled in the Diabetic Special Needs Plan, Achieve Plan).
– Most patients have received written notification of any changes that may limit access to maintenance medications.

Questions?
Review the Cigna Healthcare Medicare Advantage drug list formularies at MedicareProviders.Cigna.com > Pharmacy Resources.

“8 reasons patients don’t take their medications.” American Medical Association. 22 February 2023. Retrieved from https://www.AMA-ASSN.org/delivering-care/patient-support-advocacy/8-reasons-patients-dont-take-their-medications.
“Contributor: Medication Adherence is Not a Zero-Sum Game.” American Journal of Managed Care. 5 April 2022. Retrieved from https://www.AJMC.com/view/contributor-medication-adherence-is-not-a-zero-sum-game.
“Fostering Medication Taking Tips and Tricks.” Diabetes Educator. 2020. Retrieved from https://www.DiabetesEducator.org/docs/default-source/living-with-diabetes/tip-sheets/medication-taking/fostering_med_adherence.pdf?sfvrsn=4.
“Reach for the Stars: Medicare Advantage Part D Partnership Guide.” Cigna Health Medicare Advantage. Retrieved from MedicareProviders.Cigna.com/static/medicareproviders-cigna-com/docs/part-d-stars-partnership-guide.PDF.

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