Focusing on Psychosocial Factors

PC: What are the main challenges when it comes to medication adherence?

Marsh: When you look at the specialty medications that are out there, the complexity of the treatment plan that these patients have to go through, economic barriers, and the psychosocial factors are the three big ones that I always look at in terms of challenges. The first one is the complexity of the treatment plan. I always say this is so much different from medications that you walk into your retail pharmacy of a prescription for an antibiotic, you walk out 15 minutes later. With these medications, you have to, at times, have self-injection training, so set that patient up with a nurse, either in the office or through a patient support program hub like Cardinal Health Sonexus. There're first-dose observations that need to happen for some of these medications. There’re all sorts of testing that has to be done before the patient can start therapy, so really ensuring that those patients are educated on their treatment plan and their patient journey to come [is important] because it's not as simple as walking into a pharmacy and walking out 15 minutes later.

It’s incredibly important to educate the patient and then provide them tools, whether that's technology or people, like the personnel that we have at the hub, who can work with that patient to explain the journey that they're about to go down, and ensure that they are well equipped to stay adherent to their medication once they start that therapy. Just because they've been approved for the first fill doesn't mean they aren't going to hit roadblocks in the future. Prior authorizations, re-verifications, re-enrollment—that has to happen, so ensuring that that patient is well equipped to be able to respond to those challenges that they're going to be facing [is important]. And regarding economic barriers, we all know the cost of medications can be a significant barrier for patients staying adherent to their medication. One in five patients skip or delay taking their medications because of cost.

It's imperative that the patient is educated on what financial assistance is available. When patients are enrolled into a patient support hub like at Sonexus, we make sure to educate the patient on what financial assistance is available. Psychosocial factors—such as mental health issues, lack of social support, and health literacy—play a major role in medication adherence. I would say being diagnosed with a specialty disease could be a life-changing event for these patients, and it can take a toll on them. It can take a toll on us, on everyone who’s been in this position, and so ensuring that they have the tools to be successful, the support, whether that's their care team at home, or a nurse or a social worker at the patient support program hub, it's critical that we also focus on those psychosocial factors so we can ensure that those patients stay adherent to medication.