Health insurance CEO Rob Hennin admits he was once a personal example of a problem vexing modern medicine – large numbers of people who don't take their prescription medication or don't take it properly.
"I'd gone in for a repeat prescription a few years ago – and the pharmacist asked me if I was taking them at night. No, I said, in the morning because I remember in the morning.
He said: 'Really? Did you know they are 50 per cent less effective if you don't take them at night?'
"There it was, written on the label: 'Take at night'," says Hennin, CEO of nib insurance which has partnered with online pharmacy Zoom in their revolutionary medications home delivery scheme to help combat such costly and dangerous mistakes. "I hadn't read it; I'd just headed off on my own little routine."
Hennin's experience is one small instance of the worldwide phenomenon costing unknown millions in New Zealand and untold billions globally – medication adherence or, more precisely, non-adherence.
Hennin says pharmaceutical company estimates suggest one in three Kiwis do not fill a prescription provided by their doctor. Even if prescriptions are filled, 40 per cent of medication is either not taken or not taken properly.
There are no firm figures for what that means in New Zealand – but the US has tracked the cost of medication adherence. Their figures suggest 50 per cent of prescription medications are not taken or not taken correctly while 20-30 per cent do not fill prescriptions at all.
One study in 2012 maintained non-adherence caused up to 125,000 deaths a year, 10 per cent of all hospitalisations, and US$100-$289 billion annually in unnecessary costs. Earlier this year, giant pharmacy retailer Walgreens estimated that about 100 million Americans with chronic conditions were non-adherent.
Never mind the cost, the health of millions of people globally worsen because they are not taking medicines designed to, if not cure them, keep them out of hospital where they may face more dire consequences.
So why does this happen? Human frailty, says Hennin. Many, especially those with chronic diseases, are forgetful, don't understand or make assumptions about how to take their medicine: "The reality is convenience is a big thing; we all lead busy lives and often have conflicting priorities."
That's why the pilot nib partnership with Zoom Pharmacy is set to make big dents in New Zealand non-adherence.
Zoom is by their own description a "closed door pharmacy" (online only) and "the Uber of prescription medicine", delivering such medicines to a patient's home or work – removing the need to travel to a pharmacy (one reason for prescriptions not being filled). nib members are receiving free shipping costs for medications as part of the pilot scheme.
Zoom's app provides personalised medication information, daily dose reminders plus repeat and refill alerts when patients begin to run low.
"You can see," says Hennin, "how this works for patients. From a health outcome point of view it really is worth our while making it easy for people to take their medications.
"What we at nib do with health insurance is protect people against the financial risk of illness. Zoom are helping us do that by connecting our members more effectively to the health care system and empowering them – and they are doing it in a way we believe will be the way of the future."
Zoom has been operating for about a year and commercial pharmacist and spokesman Din Redzepagic says similar schemes in Europe and the US are producing "huge shifts" in medication adherence.
"There are some phenomenal outcomes starting to accrue," he says, "and insurance companies have seized on that; populations are being kept healthier and there are fewer claims."
Redzepagic says Zoom uses new technology to take care of medicine dispensing, thus giving their pharmacists more time to liaise with patients, contact that goes well beyond the digital: "We have two robots which look after counting out pills and tablets. The drugs usually come in packs of 1000 but need to be broken down into bottles of 32 or 64, for example – very time-consuming.
"That frees us up to liaise with patients and nurses – that's where a lot of the value is.
They love our app but we also make lots of follow-up calls to people and we can often tell, just through conversation, when someone isn't following the right procedure or outcomes are not going as planned.
"It's been really encouraging – our customers are really enjoying what we do and we get so much good feedback; we're over the moon."
Reasons why people don't fill prescriptions or take medications properly:
• Forgetfulness – some struggle to remember when or if they'd taken their pills
• Convenience – going to a pharmacy is an extra trip if it is not co-located with a doctor's clinic and if they simply need a repeat prescription
• Assumptions – some assume, wrongly, they know how and when to take their medications
• Misunderstanding – some don't take their medications because they don't understand how they are supposed to work