A New Perspective on Nonadherence

Apr 26, 2012
Express Scripts is applying behavioral science to the challenge of medication nonadherence. Read more about our solutions.
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  • Accountable Care Organization (ACO)

Most of us have forgotten to pick up a prescription, called a refill in late, or missed a second dose of a regular medication. Although these seem like small lapses, this is actually part of a serious and growing medical challenge classified as medication nonadherence.

What Is Medication Adherence?

"Medication adherence" – sometimes also referred to as "medication compliance" – means taking your medication exactly as your doctor prescribes it: at the right time, at the right dosage and for as long as your doctor recommends.

What Are the Consequences of Nonadherence?

  • Patients who fail to take medications as prescribed have higher healthcare costs and suffer from unnecessary complications like heart attacks or strokes.
  • Failure to take medications as prescribed adds a huge cost burden to the healthcare system: approximately $317 billion annually.

How Prevalent Is the Problem?

  • For many conditions, more than half of Americans fail to take their medications as prescribed.

Why It’s Happening

Unfortunately, there isn’t one explanation for why people don't follow their doctors' orders when it comes to medications:

  • Behavioral influences – simple forgetfulness and procrastination – account for 69% of nonadherence.
  • Clinical questions and concerns account for 15%.
  • Financial reasons account for 16%.

Our research has shown that in most cases, the cost or the side effects of a drug have nothing to do with whether or not a patient takes a medication. More than 2/3 of the instances of nonadherence are caused by simple procrastination and forgetfulness.  

The Intent-Behavior Gap

Our research also indicates that while people intend to take medications as prescribed, and believe taking prescriptions as prescribed is important, they overestimate their own adherence. The main driver of nonadherence can best be described by the intent-behavior gap—the difference between what people want to do and what they actually do.

So let’s reframe the problem of nonadherence

Because there’s no simple cause, there’s also no simple solution.

We took a step back and thought about the issue of nonadherence as if it were a medical condition (it is, after all, more costly than any single disease). Screening for other medical conditions (think mammograms for breast cancer or colonoscopies for colorectal cancer) has been shown to be effective. So, we thought, “why not screen for nonadherence?”

First, we identified the two factors that successful screening hinges upon:

  • Early identification of at-risk individuals
  • Use of interventions that are more effective earlier in the disease course

Second, we developed a new program with two important capabilities:


  • The ability to identify patients who are at risk for nonadherence
  • The ability to deliver effective interventions for those at risk

We’ve called this new program – to be released later in 2012 – ScreenRx.

ScreenRx is a step forward in helping patients stay on the right track when taking their prescribed medications. Not only can we identify who is likely to skip a dose or forget to refill their prescription, but we can also tailor interventions that specifically help the patient where they need it most.

We work every day to gain insight from the data we have for a very important purpose: improving the health and well-being of patients. We’re incredibly proud and excited about ScreenRx. Stay tuned for more.

Author Bio

Lab Staff
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