The effect of interactive reminders on medication adherence: A randomized trial.

Expanding on evidence that interventions to improve health are more effective when informed by behavioral science, we explore whether reminders designed to harness behavioral science principles can improve medication adherence. We conducted a randomized controlled trial with 46,581 U.S. participants with commercial or Medicare Advantage insurance from Humana. Participants were randomly assigned to one of four experimental conditions. Participants in the usual care condition only received standard mailings that the insurer usually sends. In addition to the standard mailings, participants in the other three conditions also received (1) mailings that reminded them to take a target medication (basic reminder condition), (2) reminders that prompted them to predict their medication adherence in the next 30days (prediction condition), or (3) reminders that prompted them to commit to a self-determined level of adherence for the next 30days (commitment condition). We sent these mailings once a month for three months from November, 2014 through January, 2015, and tracked prescription refills. We find that, during the mailing period, reminders increased adherence by 0.95 percentage points (p<0.05), and this effect was driven by the prediction and commitment conditions; during the three-month post-mailing period, reminders increased adherence by 0.98 percentage points (p<0.05), and this effect was driven by the basic reminder and commitment conditions. The reminders increased medication adherence by 0.7 pills per dollar spent over our 181day study period. Trial registry name: Effect of Reminders on Adherence. Registration identification number: NCT02411006 URL for the registry: https://clinicaltrials.gov/ct2/show/NCT02411006.

Synchronized prescription refills and medication adherence: a retrospective claims analysis.

OBJECTIVES: Medication adherence is often suboptimal, especially among patients on multiple chronic medications. We examined the association between synchronized medication refill schedules-which typically reduce organizational effort and logistical demands-and adherence. STUDY DESIGN: Retrospective study among patients enrolled in Medicare Advantage prescription drug plans. METHODS: We used 2012 pharmacy, medical, and enrollment data linked with consumer meta-data for Medicare patients filling 2 or more maintenance prescriptions for antihypertensives, lipid-lowering agents, antidiabetic agents, antidepressants, and/or antiosteoporotic agents. Medication adherence for the year was measured using the proportion of days covered (PDC) at the drug class level. Patients were deemed adherent if drug class PDC was ≥0.80. Outcomes were compared between 1:1 propensity score-matched patients on synchronized versus nonsynchronized refill schedules for maintenance medications. RESULTS: The synchronized refill group showed better adherence than the control group, although the magnitude of effects varied by drug class and specific outcome measure. Mean PDC scores ranged from 0.02 higher for antihypertensives to 0.07 higher for antidepressants in the synchronized refill group relative to the control group (P <.01). Further, compared with the control group, a larger proportion of synchronized refill group members were deemed adherent, ranging from 6 percentage points higher for antihypertensives to 15 percentage points higher for lipid-lowering agents (P <.01). Differences between the synchronized and control groups were larger among exclusive users of retail versus mail order pharmacies for maintenance medications. CONCLUSIONS: Synchronized medication refill schedules were associated with better medication adherence, particularly for patients filling maintenance medications exclusively at retail pharmacies.

A Synchronized Prescription Refill Program Improved Medication Adherence.

Synchronizing medication refills-renewing all medications at the same time from the same pharmacy-is an increasingly popular strategy to improve adherence to medication regimens, but there has been little research regarding its effectiveness. In light of increasing policy interest, we evaluated the impact of a pilot refill synchronization program implemented by a large national insurer. A random sample of Medicare Advantage patients receiving mail-order refills for common maintenance medications (antihypertensive, lipid-lowering, or antidiabetic agents) were invited to join the program and followed for twelve months. On average, the absolute increase in the proportion of patients deemed adherent during follow-up was 3-10 percentage points for the intervention group, compared to 1-5 percentage points for the control group. Patients with poorer baseline adherence showed larger increases in the absolute proportion deemed adherent in intervention (23-26 percentage points) compared to a control group (13-15 percentage points). Synchronizing refills might be a promising intervention to improve adherence to maintenance medications, especially among Medicare patients with low baseline adherence.