Q&A: Pharmacists Guide Patients Through Clinical, Social Determinants of Nonadherence

With pharmacists’ authoritative expertise on both medications as well as social determinants of health for patients in their community, they are well-positioned as providers best capable of correcting nonadherent patients.

“Oftentimes, patients aren't fully aware of what the medications can do, what the potential side effects are,” Andrew Maiorini, PharmD, FAHM, vice president of clinical programs at PerformRx, told Drug Topics. “They're not certain of what the benefits to taking the medication could be. Then, there's also cost issues as well as access to care. All of these things contribute to members not taking their prescriptions exactly as they were prescribed to be taken.”

In part 1 of our interview with Maiorini, he helped us understand the issues of medication nonadherence in the US, the factors contributing to such high rates of nonadherence, and the crucial role, as Maiorini puts it, that pharmacists play in facilitating adherent prescription drug regimens.

Maiorini discusses medication adherence in the US and the ways pharmacists are occupying the front lines for patients across the country. | image credit: Grustock / stock.adobe.com

READ MORE: Pharmacist Counseling Improved Medication Adherence for Chronic Diseases

Drug Topics: Fifty percent of patients do not take their medications as prescribed. In your experience as a pharmacist, what does medication adherence look like among your patients and why do you think it’s so prevalent?

Andrew Maiorini: It varies based on the patient population, and there's a lot of factors that contribute to that. There are some studies that show as high as 30% of patients don't even fill their first prescription. It definitely looks very different. There's a lot of nuance to that, but there's a lot of reasons why that happens.

Oftentimes, patients aren't fully aware of what the medications can do, what the potential side effects are. They're not certain of what the benefits to taking the medication could be. Then, there's also cost issues as well as access to care. All of these things contribute to members not taking their prescriptions exactly as they were prescribed to be taken.

Drug Topics: What challenges do pharmacists encounter that truly impede successful medication adherence across the country?

Andrew Maiorini: Pharmacists, obviously, play a crucial role. They're right at the front lines of when members are getting prescriptions filled. Some things can impede pharmacists a little bit. It really depends on what types of insurance the patients have, how much they have to pay out of pocket, because sometimes costs can be an issue. Oftentimes, there are other determinants that play a role as well—for example, transportation issues. Some patients might have a hard time getting out of the house. They may not have a pharmacy that's within a walkable distance for them, and then they have transportation problems.

All of these things go in to play a role in causing the member from missing fills or missing prescriptions. Pharmacists can play a crucial role. A lot of times, sending out notifications, calling members up for refill reminders, but a lot of times, the issue will be, if you don't get the patient in the front door, there's not a lot someone can do to get the medications in their hands. We try to do certain things like increasing use of things like mail order so that it eliminates some of those issues that a patient may have getting to the pharmacy. But yes, it's a very varied, nuanced problem. I think as therapeutic regimens get a little more complex, as they get more expensive even, we're going to still see these same struggles occurring as we move forward.

READ MORE: Pathology of Nonadherence Does Not Accurately Represent Structural Barriers to Care

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