Addressing Barriers to Medication Adherence: Sam Peasah, PhD, MBA, RPh

At the 2025 Academy of Managed Care Pharmacy (AMCP) annual meeting, Sam Peasah, PhD, MBA, RPh, director for the Center of High-Value Health Care at the University of Pittsburgh Medical Center (UPMC), presented findings from a study that found medical costs significantly decreased for patients moving from 80% to 90% to above 90% adherence, resulting in a lower total cost of care.

In this interview with The American Journal of Managed Care® (AJMC®), he shares some of the challenges to medication adherence, as well as policies that can help address this burden.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What do you believe are barriers preventing patients from reaching the 80% adherence threshold, and what policy or system-level changes could help improve adherence?

Adherence is not a new topic; it's been around for a long time. A lot of people have done studies to study why some people don't become adherent. Things like forgetfulness. There are people who are so busy they forget to take their medications today, and maybe tomorrow they remember and they take it. Forgetfulness is one of them.

Cost is also a huge reason why. I mean, we've seen people who will skip a medication and take it the next day so that they can save money. They buy [for] 30 days and then they use it over 60 days just to save some money; people have done that, and that obviously affects adherence. Also, [there are] side effects, they just don't like taking this medication. Every time they take it, either they feel like throwing up or they just don't like it. There are some people, especially those who are taking medications for chronic conditions, at times they don't really appreciate the impact of not taking their medications. We've seen that a lot, because there are times that you speak to them and let them know the importance of being adherent, and all of a sudden, the adherence improves.

For example, blood pressure is something that at times you don't have any symptoms. You're walking around, you think everything is fine, all of a sudden, boom, something huge happens to you. For those people, once you explain the impact of not taking their medications, what will happen to their organs, for example, all of a sudden they feel like they have to take the medications now.

I will say forgetfulness, side effects, cost of the medications, and the need for the medication; those are some of the reasons why some people don't take their medications.

In terms of policy things, a lot of things have been implemented over the years. Like I mentioned earlier, this is an area that people have studied a lot, right. They have things to help people remember, like cell phone text reminders to patients [saying],”Hey, it's time to take your medications,” and then they do it.

People have also implemented things like reduced copay, or even in government when it comes to policy at the national level, we have programs like the 340B, where the goal is to make it cheaper for certain group of patients who are struggling, especially when it comes to these brand name programs, even for Medicare. If you remember when we had the donut program, where, if you fall into the donut, then the cost of the medications, you have to bear all of it. It was affecting adherence. Most of the seniors, when they get there, they don't take it. Now we have a new program in mind, which is what they call the $2000 cap. After that, you don't have to pay anything. And those are things that policy wise, have been put in place to even improve adherence.