Best Practices for Medication Adherence During COVID-19

As we have highlighted, patients do not take their medicine as prescribed about 50% of the time and approximately 25% of new prescriptions are never filled. Such shortcomings in medication adherence can decrease the effectiveness of a treatment. This increases the likelihood that a condition will worsen, even to the point of death.

But these figures fail to consider the numerous challenges patients are now facing during the COVID-19 pandemic, which are making medication adherence significantly more difficult for some patients. Consider the following:

• Social distancing and stay-at-home orders can discourage patients from leaving their home to pick up medications.
• Serious complications of COVID-19 are most likely to develop in elderly people and those who are immunocompromised, perhaps due to chronic conditions. These vulnerable populations may be even more hesitant to leave their homes to go to the pharmacy. But it is particularly important that such higher-risk patients maintain adherence to reduce their vulnerability to COVID-19.
• Public mail carriers will typically leave packages in a mailbox or at a front door without notifying recipients of the delivery. Higher-risk populations may choose not to venture out even to check for delivered medications without assurance that the delivery has arrived.
• During the pandemic, millions of people have lost their jobs and been furloughed. The financial strain is forcing many people to reevaluate their expenses. Some patients may choose not to fill and refill prescriptions or try to ration and extend the life of a prescription to save money.
• COVID-19 is exacting a significant toll on Americans' mental health to the point that the Centers for Disease Control and Prevention (CDC) has a dedicated webpage to stress and coping during the pandemic. When people are struggling mentally, they may also struggle with medication adherence, as a American Kidney Fund survey found: "Forty-two percent of patient respondents said depression, fear, or anxiety had kept them from participating in their daily activities at least once in the previous month."

5 Medication Adherence Recommendations

The challenges listed above are just a few of the ways maintaining medication adherence has become more difficult during the pandemic. Organizations and prescribers are under even greater pressure to help ensure patients adhere to their medication regimen. Many hospitals are overwhelmed with treating COVID-19 patients. If a medication nonadherence event requires a patient to receive emergency care at a hospital, this may prove more difficult and could increase the likelihood of them contracting COVID-19.

Here are five best practices to help you improve your patients' medication adherence during COVID-19.

1. Understand medication adherence challenges

The list of medication adherence challenges above is not exhaustive. Other challenges include potential delivery delays, drug shortages, and disruption in routines that can reduce patient access to medications, such as decreasing availability of ridesharing and caregiver assistance.

Take the time to learn about these various challenges and understand how they may affect or are already affecting the patients in your community. This will help you ask appropriate questions about adherence challenges (discussed next) and provide the guidance and resources necessary to keep patients adherent with their regimen.

2. Ask targeted questions

When speaking with patients about medication adherence, work to identify potential obstacles. This remains true during the pandemic, but now you should ask pointed questions about medication adherence specifically concerning COVID-19. These may include variations on the following:

• Have you made any changes to your medication regimen during the pandemic?
• Have you made any changes to how you fill your prescriptions? Are you encountering any challenges?
• Is social distancing or stay-at-home orders making it more difficult to get your medications?
• Has your income (or family's income) been affected by the pandemic? Are you finding it more difficult to afford your medications? Are you worried about your future financial situation?
• Are you taking any new medications, vitamins, supplements, etc., to try to keep yourself safe from COVID-19? Note: This question can help identify if patients are using unproven therapies that could potentially jeopardize wellness and cause harmful drug-drug interactions.

3. Stay current with medication-related developments and trends

To give the timeliest advice, try to stay current with any developments and trends during COVID-19 that can affect medication adherence. Examples include the following:

• Some big chain stores, like CVS and Walgreens, are now offering free home delivery of prescription drugs. Many independent pharmacies also deliver medications.
• As GoodRx notes, "Given the national state of emergency due to COVID-19, many health insurance plans now allow you to pick up your prescriptions earlier than usual. … If you're out of refills, most states will allow pharmacists to dispense emergency refills of up to a 90-day supply for non-controlled medications."
• Research is showing that some patient groups are doing a better job maintaining adherence during the pandemic. An analysis conducted by healthcare technology company AllazoHealth found that, "For both high-risk and low-risk populations, fewer patients filled their prescriptions late post-COVID-19. However, the gap between high- and low-risk patients has increased from 14% to 20%." This indicates a need to provide greater support to your high-risk patients.
• GoodRx is reporting that there are more than 20 drugs used to treat or possibly treat COVID-19 experiencing shortages.
• Telehealth regulations have been loosened in ways that can help you safely communicate with patients about their medication needs and adherence. Telehealth can even be used for prescribing purposes, including prescribing for opioids and other controlled substances. As we previously wrote, two examples of organizations using telehealth for medication-related purposes are Elizabeth Layton Center and Community Medical Services, the former for medication management and the latter to help opioid addicts adhere to their medication regimen.

As with understanding COVID-19 challenges, keeping yourself apprised of current matters will help you provide the best medication adherence support possible.

4. Leverage telepharmacy

With telehealth rules loosened and patients clamoring for remote assistance, now is a great time to explore how to use telepharmacy to your advantage. As we wrote last year, "… telepharmacy solutions make it possible for clinical pharmacists to follow up with patients more frequently and more efficiently than would be possible in a traditional healthcare workflow." At a time when healthcare workflow is far from traditional, the value of telepharmacy has become even more apparent.

Cureatr is ahead of the game concerning telepharmacy. We supply organizations and health systems with board-certified clinical pharmacists who assess patients, identify drug therapy problems,, develop medication care plans, and handle follow-up and monitoring via the Meds360° medication platform. This platform is available for free for a limited number of organizations until the COVID-19 pandemic subsides.* 

5. Continue following general medication adherence best practices

While the COVID-19 pandemic has significantly impacted medication adherence, routine best practices remain important. Combine the guidance in this blog with the tips and tools shared in previous Cureatr medication adherence blogs found here, here, and here.