A recent New York Times article discusses the impact economic woes continue to have on individuals increasingly cutting back on prescriptions that they need.

According to IMS , the number of prescriptions dispensed in the first eight months of 2008 was lower than last year, the first downturn in over a decade.

The ramifications could be disastrous to a health system already facing monumental challenges in trying to stem rising costs and keep people healthy. Think about it this way:, if too many chronic condition patients stop taking medicines like cholesterol-lowering statins or anti-hypertensives for too long the result could be catastrophic leading to expensive emergency conditions, such as a strokes or heart- attacks. Catastrophic situations only serve to increase a rapidly escalating healthcare cost base.

Of course, there is a school of thought that America is over-medicated to begin with and that perhaps the prescription cuts are beneficial. In some cases, I might agree with this philosophy, but it seems like a foregone conclusion that individuals with serious conditions such as diabetes, high cholesterol, hypertension, and obesity either stretching out their medicines or not taking them altogether, will result in a truly bad and expensive outcome for that person.

There also was an interesting fact in this article regarding the spend on pharmaceutical products in total in the U.S. Pharmaceuticals only constitutes about 10% of the total healthcare spend in the country. From a financial perspective, I would say that medicines still appear be a more cost-effective way of mitigating higher medical costs, such as hospitals and physicians fees. So the challenge for our healthcare system is finding methods to reinforce that message and help consumers to make the right decisions about using their medicines as a method of preventing more serious acute health issues.

A study released by Blue Cross and Blue Shield of North Carolina indicates that companies offering comprehensive wellness programs can realize an approximate cost savings of 25% in medical and absenteeism in about 3.6 years after implementation.

I find this study interesting because it speaks to some of my earlier posts that discuss the whole-brained approach that Maritz employs in the health and productivity solutions we deliver to clients. The bottom line is that human beings are complex individuals and that asking individuals to adopt and consistently act on new health behaviors is a very personal journey that requires time and continuous reinforcement.

Blue Cross and Blue Shield of North Carolina further discusses the mindset change employers are embracing – less cost shifting to drive behavior and more health services and wellness offerings to drive healthier outcomes.

The key to seeing this type of cost savings resides in a highly integrated approach to supporting the participant. Obviously, the wellness offering needs to include a wide variety of offerings and campaigns that keep it fresh and top of mind with participants. As I mentioned in a previous post, communication around five questions that participants want to know is critical:

1) What do you want me to do?
2) Why do you want me to do it?
3) How do you want me to do it?
4) What’s in it for me?
5) How am I doing?

Organizations tend to either neglect or take a prescriptive approach to questions four and five. The result: poor participation and engagement rates. Organizations that want to see 25% cost savings need to consider incentives and communications to be equally important investments in their comprehensive wellness programs.

A challenge that pharmaceutical companies continue to have in adherence programs that they bring to the market is driving initial participation and ongoing engagement in their programs without “inducing” the patient. Traditionally, adherence programs have been run through a combination of interventions that include the use of alternative coupons and vouchers, samples, patient starter kits, and loyalty programs. These programs have not been extremely successful as adherence continues to be a challenge. Part of the reason, I believe is that not enough patients are motivated by a co-pay deduction or a seven-day free trial of a drug to actually take action. In addition, adherence programs are front-loaded with communication when a patient initially opts-in, but then the communication all but disappears (I know this because I am enrolled in several adherence programs).

Similar to today’s wellness programs, pharma companies have to begin understanding the catalysts that will truly motivate patients to participate and engage in adhering to their medication. They need to find methods that tap into the intrinsic motivators that engage patients.

Companies should consider a more integrated adherence program that incorporates more of a loyalty premise that enable patients by offering a choice of rewards for staying adherent – ideas such as offering patients points for persistency. While there may be some discussion around getting close to the line of an inducement, the idea is that providing patients with points that they can then redeem for health related rewards offers what we call at Maritz “purposeful choice.” It essentially allows the patient to choose from rewards that are personally meaningful and may further engage them in maintaining adherence to their medication regime. Rewards could include items such as debit cards to be used on prescription refills or may include merchandise that helps them better manage their life around the disease they have.

Or better yet, why don’t health plans, who are actively initiating wellness programs, consider working with pharma or adopting these programs under their larger wellness strategy?

The discussion on wellness has reached a crescendo pitch. From bulletin boards, to hospital outreach, to employer and health plan sponsored programs, wellness initiatives represent a strategy for recalibrating how consumers think, act and decide about their healthcare activities. For some, it is a term that conjures up images of slow deep breaths, brilliant skin and tight abs. For others, it is just another thing to be added to the already long list of things to get done. So what exactly is wellness?

Physician Halbert L. Dunn first coined the phrase in 1961 in the publishing of a small book entitled “High Level Wellness.” Dr. Dunn saw wellness as a life-style approach to achieving an optimal state of physical and mental well-being. The philosophy he embraced was based on principles of personal responsibility and environmental awareness.

Beyond what I believe are the no-brainer activities around wellness: maintain a healthy weight, don’t smoke, exercise regularly, reduce stress and eat right, there are other behaviors that are not so obvious. Some of these are: taking vitamin supplements, regular check-ups, get plenty of sleep, mental health, and while it may sound strange, taking your medication as prescribed.

But wait a minute! Doesn’t it mean if I am on medication I am not well? If I was well, I wouldn’t be on medication. Makes sense, right? Not necessarily.

Medications are prescribed for a multitude of chronic medical conditions. The most prevalent are hypertension, high cholesterol and diabetes. Patients are told that they should take their medication as directed and for as long as medically necessary. Who could possibly want a stroke, heart attack or blindness? No one comes to mind, yet millions of people are acting in ways that could trigger one of these devastating medical events because they self-medicate or in situations where they have an asymptomatic disease, they may stop taking medication all together.

There have been many industry studies completed that have gained insight on why patients discontinue their medication for chronic medical conditions. Financial hardship, no prescription plan, negative side-effects, laziness, patients reported feeling better and even denial that it is needed. Without the medications, these patients are no longer healthy. Decreased medication adherence increases hospitalizations and total costs of care. They have not achieved an optimal state of physical or mental health as called for by Dr. Dunn.

Not taking medication correctly or self-medicating actually impacts the full benefits that patients derive when taking their medication correctly and it can’t be underscored the importance that medicines play in helping to control and maintain health. In order to understand how they relate to an individual’s personal responsibility in their overall wellness, one must look at the definitions. Compliance and adherence is defined as the extent to which a patient’s behavior coincides with medical advice. This behavior includes modifying habits, taking medications, attending clinics or health fairs, changing eating habits and nutrition. Persistence is the continuation over time of the medication therapy. In other words, is the patient taking the medication for as long as medically necessary?

From these definitions, one can see the role personal responsibility has in medication therapy and its overall contribution to a person’s state of wellness. Regardless of whether the medication is needed due to poor habits or is hereditary in nature, taking it as prescribed, and for as long as necessary, will play a large role in whether a patient is on the path to wellness.