Health care has fooled us into believing a number of myths that—taken at face value—sound logical and true. Here’s one of the most pervasive and dangerous myths: Pharmacy’s value comes from convenience and access. And here’s another one: 90-day fills, and automatic refills on prescriptions improve medication adherence and patient health.
It’s not surprising that people might champion the efficacy of these tactics. It feels easier to get 90 days of medication with a single pharmacy visit as a consumer instead of the typical 30 days. It’s more convenient to have refills available without having to think about it or call anyone.
The tactics work like a charm … for pharmacies and for pharmacy benefit managers, which benefit financially and operationally. For patients, the opposite is true.
Instead of improving access and adherence to medications and boosting patient health, 90-day fills and automatic refill programs can hinder patients’ ability to receive the actual care required to improve their health. Let’s explore how this happens:
Convenience alone does not create care.
Both 90-day fills, and auto-refill programs were built with the purpose of removing barriers that impede patient health, especially for patients with chronic conditions or multiple conditions that increase care complexity. However, studies show that even with these automated approaches, between 20 and 30 percent of prescriptions are never filled, and nearly 50 percent of medications for chronic disease are not taken as prescribed. In fact, not taking medications as prescribed results in 125,000 deaths in the U.S. each year and between $100 billion to $290 billion in avoidable costs.
Diving into the issue further, we see a multitude of reasons why this occurs. Patients might be afraid of potential side effects or other adverse events. According to the Journal of the American Medical Association, adverse reactions to some of the most commonly prescribed medications result in more than 700,000 landing in the emergency room.
Other patients skip medications due to out-of-pocket expenses. The Kaiser Family Foundation reported that 29 percent of Americans did not purchase at least one medically necessary prescription because of the cost. This includes about one in five who said that they didn’t fill a prescription or took an over-the-counter drug instead and about one in ten who said they have cut pills in half or skipped a dose.
What we see in all this is that the most used tools for driving medication adherence simply don’t address the multitude of endemic issues that prevent patients from following their medication plans—lack of trust and communication, fear of adverse reactions, and concern over costs.
In many ways, 90-day fills and automatic refills amplify these issues by creating even more distance and less engagement between patients and expert care providers. Medications sent directly to a patient’s doors every three months might increase convenience … but more often than not, this practice also reduces the opportunities for patients to engage their clinical teams, raise concerns, ask questions and seek help. In three months (or even longer, if automatic refills are just kicking in), patients might accumulate a lot of unused or misused medications, and they’ll surely accumulate even more questions about their health. Without a scheduled or proactive intervention during this time, it’s no wonder that outcomes continue to miss the mark. That’s not the fault of the patients – it’s the fault of the health care system.
Partnering to improve medication management
So what’s the alternative? Primary care physicians (PCPs) can start the transformational improvement process by continuing to do what so many of them do better than any other specialty: Build strong relationships with patients. Research shows that a positive doctor-patient relationship can help improve adherence rates—with consistent, accessible communication serving as a core component for building patient trust and opening the channel for two-way conversations about the patient’s medication plan.
However, devoting more time, energy, and resources toward patient relationships can be draining for an already-overburdened physician population. That’s why many PCPs are moving to an integrated, team-based approach to care delivery. PCPs lean on pharmacists, nurses, care coordinators, social workers, and others to expand the opportunities for interacting with patients. Pharmacists work in tandem with PCPs to deliver the convenience that patients want and the personalized care and attention that helps them take their medications as prescribed and address questions and concerns along the way.
From a patient’s perspective, it can be the best of all worlds: a relationship with your PCP where you feel known and heard; proactive support from pharmacists and other specialized experts that provide help and peace of mind at every spot along the care journey; and all of this connected back to your PCP to ensure progress on your care plan.
This approach elevates the role of the pharmacist and the pharmacy team from human dispensing machines and delivery mechanisms … to empathetic, clinically expert partners in care. By rejecting 90-day fills and automatic refills, pharmacists can instead use scheduled, 30-day touchpoints to listen to patients and understand how their medication plans are working. These aren’t “tollbooth experiences” to get refills. Instead, they are intentional opportunities to identify and remove barriers related to costs, insurance requirements, clinical circumstances, or changes in life situations. More than that, they serve as opportunities to engage patients in their own health and provide regular observational moments to inform patients’ physicians about care plan progress.
This isn’t a “what if” scenario; this type of physician-pharmacist partnership happens today … just not as broadly or as regularly as it should. And suppose that sounds like a complete paradigm shift from the standard 90-day fills and automatic refills. In that case, it is because the pharmacy tactics we’ve used in the past to improve medication adherence have simply fallen short. Automation and technologies can enable adherence, but true change happens when physicians and pharmacists work together in collaborative teams to achieve common goals: Better managed chronic conditions, fewer complications, and improved experience for patients and physicians.
Tony Willoughby is a health care executive.
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