Paying People to Take Their Meds

An experimental program in Philadelphia is giving financial incentives to patients who follow their prescriptions for warfarin, a generic anti-blood clotting medication. Patients who don’t properly fill and follow their prescriptions cost the US $100 billion in additional health care costs every year, reports the New York Times. To reduce this waste, the Aetna-sponsored program in Philly creates a lottery-like pool in which patients can win up to $100 a day for taking their prescribed meds.

Two leading causes of prescription non-compliance are cost of medicine and forgetting to take it. In addition, says IMC2, a “brand engagement” company, patients also complain about side-effects and insufficient information. Prescriptions may help certain diseases, but lead to potentially deadly side effects: for example, studies have shown warfarin (prescribed for heart conditions) can significantly raise the risk of death from stroke or internal bleeding. And even without the side-effects, some patients
simply believe they don’t really need the medication. NYT reader Booth Selig, says: “As a 74-year-old, I have fought doctors for years when it comes to various prescribed medicines—multiple heart meds and wafarin being two examples… It is difficult and time consuming to manage, requires weekly doctor visits until regulated, and has caused countless hospitalizations and deaths… Many people no longer trust the FDA or their doctors advice and with good reason.”

If the industry push isn’t enough to increase adherence, encouragement from doctors profiting from their own incentive programs may do the trick. Another Aetna-financed program incorporates bonuses to doctors who prescribe prevention meds, such as beta-blockers to prevent heart attacks.

Despite these programs, there isn’t much proof that incentivizing adherence even works. A US study by Kaiser Permanente showed that after two different incentive programs concluded, the percentage of prescription adherence actually decreased. As the health care industry debates the effectiveness of incentives and the consequences of expanding the Philadelphia program, pharma may come out the winner. Pharmacy marketing consultant Intercontinental Marketing Services (IMS) says: “[t]here is certainly a significant pot of gold at the end of this rainbow. Should we be trying to improve adherence? Yes. Is it complicated and hard to do? Absolutely—but well worth it.”