Paying physicians for medication adherence

by George Van Antwerp

Should you pay physicians for medication adherence?

I’d love to hear some physician perspectives on this.  It’s a question that comes up every once in a while.

Let’s start with a few facts:

  • Adherence is estimated to be a $290B problem
  • Poor adherence limits the effectiveness of the healthcare system
  • Interventions do impact adherence
  • There are lots of reasons for non-adherence
  • Medication adherence leads to lower healthcare costs

The question of course is what to do about that.  Most of the programs focus on consumer or patient interventions.

  • Refill reminders
  • Gaps-in-care
  • Off-therapy reminders
  • Auto-refill programs
  • POS consultations by the pharmacist

But, interestingly, I’ve seen a few other studies recently that show that prescription programs targeting physicians can influence behavior.  I’ve also heard a few companies talk about paying physicians to keep patients adherent.

There are a few arguments that happen here:

  • Should the physician play a role in adherence?
  • Does the physician know if a patient is adherent?  Should they get this data?  From whom?
  • If the physician asks the patient, will they tell them to truth or will it simply be a case of “white coat” adherence?
  • Should this be a performance metric in a pay-for-performance environment?
  • Will PCMHs and ACOs structures change this and make adherence a critical issue for discussion between the patient and physician?

In general, I think most people believe that physicians don’t see prescription adherence as a big issue that they can or should influence.   Is that true?  Would “incentives” change that?

George Van Antwerp is the general manager of the pharmacy practice at Silverlink Communications who blogs at
Enabling Healthy Decisions.

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