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Drivers of Rheumatoid Arthritis Prescription Abandonment

Patient prescription abandonment and medication non-adherence is a major market concern, with estimates of up to one-third of written prescriptions not being filled and projected costs of $290 billion each year from non-adherence1. While more traditional research focuses on prescription fill rates, the Abandonment Insight Monitor dives more deeply into which factors drive patient decisions to not fill new prescriptions (primary abandonment), take medications as directed, and stop filling current prescriptions (secondary abandonment). In a recent survey of 302 rheumatoid arthritis patients, 46% indicated that they had decided to not fill a prescription at some point in their treatment history. Moreover, the information these patients encountered along their treatment journeys played a critical role in these fill decisions.

Fifteen percent of surveyed patients indicated that they had failed to fill a new prescription, most frequently reporting that they were not ready to start the treatment at the time or had done research that convinced them to not make the initial fill. This suggests that patients are leaving their provider’s office without enough information to feel confident in filling their new prescription. In fact, patients who would not communicate to their doctor that they had hesitations about taking a prescribed medication were more than twice as likely to have abandoned a new prescription in the past. Moreover, patients who research new prescriptions were more than three times as likely to have failed to fill a new prescription. These patients may be encountering difficult-to-interpret lists of potential side effects, information about class-action lawsuits, biased articles, and misinformation. Effective provider and patient messaging strategies should address patient concerns and direct patients to appropriate resources should they have further questions. Ensuring that patients leave the provider’s office feeling fully informed and prepared to begin treatment could be a key way to decrease primary abandonment.

Thirty eight percent of surveyed patients had decided to stop filling a prescription after treatment initiation, most frequently citing a lack of sufficient improvement or unbearable side effects. Over three-fifths of these abandonments occurred within the first year of treatment, with almost one-fifth occurring in the first three months. In the first six months of treatment, side effects were the primary driver of secondary abandonment; past six months, a lack of perceived efficacy was the primary driver. Although clearing the initial fill hurdle, these patients may not have been sufficiently prepared for potential treatment obstacles. When asked how long patients believed they need to be taking a rheumatoid arthritis medication to see effects, less than one-fourth correctly identified a duration of longer than six weeks. Interventions to help patients form reasonable expectations of treatment results and informed side-effect management plans could be an effective strategy in minimizing secondary abandonment.

How do the drivers of primary and secondary abandonment vary by diagnosis? Stay tuned to learn about prescription abandonment in diabetes, multiple sclerosis, hepatitis C, asthma and COPD!

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“Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease.” New England Healthcare Institute, August 2009.


 

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