The Role of Medication Delivery in Non-Adherence

For patients managing chronic conditions, medication adherence plays a crucial role in successful treatment. However, adherence rates are alarmingly low, with only about 50% of patients consistently following prescribed regimens. This lack of adherence contributes to the estimated $500 billion in avoidable healthcare costs and 125,000 preventable deaths annually in the United States. 

To set the stage, two chronic conditions, diabetes and obesity are growing health concerns in the United States, and globally. There are around 537 million people living with diabetes worldwide, with only 15% of patients in good control. Worse, over 988 million people live with obesity, a threefold increase since 1975. 

It’s not just adults either. As of 2022,  160 million children aged 5–19 years were living with obesity, putting them at risk of developing early onset type 2 diabetes and is a predictor of adult obesity.

Multiple contributing factors

Non-adherence is a multifaceted issue, influenced by factors such as cost, access, side effects, and human behavior, including forgetfulness and inertia. In fact, most medication non-adherence in chronic disease treatment stems from these behavioral factors. 

Many patients forget to follow their treatment regimen due to its complexity — especially when it involves multiple daily doses, which can overwhelm patients and lead to missed doses, inconsistent use, and ultimately, ineffective treatment outcomes. Medication concerns or feeling that healthy outcomes are not attainable are also contributors to non-adherence, despite the medication’s importance. Furthermore, the high cost of medications may also lead patients to forego their prescriptions altogether due to financial stress.  

For GLP-1 receptor agonists specifically, adherence challenges are a major concern, as these medications require long-term use to achieve meaningful health benefits in chronic conditions like diabetes and obesity. In diabetes, non-adherence is a key reason for low, real-world effectiveness. Similarly, in obesity treatment, studies show that only 32% of patients remained on a GLP-1 medication for weight loss after one year, and only 15% continued treatment after two years. Discontinuation often leads to rapid weight regain and worsened health outcomes, as patients revert to previous eating habits and metabolic states. Additionally, adherence gaps create complications in achieving sustained efficacy, leading to increased healthcare costs and reduced long-term benefits for both patients and payers. 

When it comes to the way medications are delivered or administered, traditional delivery methods such as daily pills or weekly injections require active patient participation, which can lead to inconsistencies in adherence as well. Many patients prefer oral medications over injections for various reasons, including fear of needles or complexity of administering the medication. However, preference alone does not resolve the issue of adherence, because effective absorption can vary with oral pills, and patients must remember to take their pills at specific times. 

Promising innovations

Recent advancements aim to address adherence barriers, by creating more convenient and patient-friendly delivery methods that reduce the burden of frequent administration. Options such as injectables, oral formulations and patches each present unique advantages and challenges. While oral treatments are generally preferred by patients, they still require consistent daily use. Injectables offer extended efficacy but may be a burden due to administration discomfort and the potential for missed doses. 

One promising innovation is the development of long-term implantable drug delivery systems. These devices eliminate the need for frequent patient action, ensuring continuous medication delivery over extended periods of time. Like contraceptive implants, these implants can be physician-administered in an outpatient setting, with a potential replacement timeline of every six months or even annually. These tiny implants sit just under the skin and are designed to be simple, discreet, and low maintenance.

By reducing patient reliance on self-administration, implants could enhance adherence rates, improve treatment persistence, and increase accessibility, especially for medications like GLP-1s that are experiencing shortages. This method offers healthcare payers a more cost-effective solution and benefits patients, making their lives more convenient and helping them forget they have a condition that even needs treatment.

The future holds promise with drug delivery innovations such as long-acting injectables and drug implants, which may overcome the administration challenges of current methods and offer more convenient and effective options for patients. The healthcare industry must continue to focus on improving adherence and making long-term treatment more sustainable, with the ultimate goal of benefiting patients in every way possible.

Photo: Peter Dazeley, Getty Images

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