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The American Journal of Managed Care August 2016
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Association Among Change in Medical Costs, Level of Comorbidity, and Change in Adherence Behavior
Steven M. Kymes, PhD; Richard L. Pierce, PhD; Charmaine Girdish, MPH; Olga S. Matlin, PhD; Troyen Brennan, MD, JD, MPH; and William H. Shrank, MD, MSHS

Association Among Change in Medical Costs, Level of Comorbidity, and Change in Adherence Behavior

Steven M. Kymes, PhD; Richard L. Pierce, PhD; Charmaine Girdish, MPH; Olga S. Matlin, PhD; Troyen Brennan, MD, JD, MPH; and William H. Shrank, MD, MSHS
The authors found that comorbidity burden and the direction of behavioral change influence the relationship between adherence and medical spend. This could affect the cost-benefit considerations of medication adherence programs.
Fourth, in our analyses, we have focused exclusively on the financial impact of medication adherence on payers, ignoring the detrimental impact that medication nonadherence might have on the quality of life of the patient or their family. However, we conducted these analyses from the payer’s perspective—as it is the payer who makes coverage decisions in the United States—and there is considerable heterogeneity in the way that quality-of-life information is used by payers, as well as a multiplicity of quality-of-life measures used, even for the 3 conditions considered here. Thus, it is not clear how to properly measure quality of life related to medication adherence in a manner meaningful to a payer, or how meaningful the results might be for them. Therefore, we have taken the more conservative approach of considering only the financial impact, which might be considered the lower bound of potential impact of a change in adherence behavior. Finally, we have addressed the consequence of changes in adherence behavior and the importance of persistency, but we have not spoken to the long-term impact of the 40% of the cohort members who remained nonadherent. Finding methods to move these patients to healthy behaviors remains an essential and intractable public health challenge.


Medication adherence is a critical health problem worldwide. Resolving it requires careful targeting of effective programs, and one element of that targeting criteria must be the value of adherence to the patient and payer. What we have demonstrated will vary with the direction of adherence behavior change and the comorbid conditions; thus, thoughtful policy makers, investigators, and clinicians should take these factors into consideration when implementing their adherence programs.

Author Affiliations: Division of Enterprise Research and Analytic Development, CVS Health (SMK, RLP, CG, OSM, TB, WHS), Woonsocket, RI.

Source of Funding: None.

Author Disclosures: All authors are employees of CVS Health, a pharmacy company and PBM with an interest in better adherence in general. All work was performed as part of their employment with CVS Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of CVS Health. Plan member privacy is important to us. Our employees are trained regarding the appropriate way to handle members’ private health information. These analyses were conducted using data de-identified in accordance with HIPAA regulations and CVS Health business associate agreements. The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (SMK, CG); acquisition of data (RLP); analysis and interpretation of data (SMK, CG, RLP); drafting of the manuscript (SMK); critical revision of the manuscript for important intellectual content (SMK, CG, OSM, WHS, TB); statistical analysis (SMK, CG, RLP); administrative, technical, or logistic support (SMK, OSM, CG); and supervision (SMK, CG, OSM).

Address Correspondence to: Charmaine Girdish, MPH, CVS Health, 9501 E Shea Blvd, Scottsdale, AZ 85260. E-mail:

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