The Medisafe Annual Adherence Index highlights the critical issue of medication nonadherence, which claims an American life every four minutes and results in $637 billion in annual costs. Medisafe, a medication management platform, helps enhance patient adherence through data-driven insights, personalized support, and partnerships with pharmaceutical companies. Despite its effectiveness, adherence rates vary globally, with the U.S. ranking low compared to other countries, underscoring the need for targeted interventions.

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Medisafe Annual
Adherence Index
JULY 2018
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M
edication nonadherence claims
the life of an American every
four minutes and costs the global
pharmaceutical and pharmacy
industries $637 billion annually. As nonadherence
rates reach near epidemic levels — it is estimated
that only 50 percent of patients correctly follow
their regimens — understanding the data behind
patients’ behavior is crucial to a more informed
and proactive approach.
Medisafe, the leading medication management
platform addressing all major causes of nonadherence,
empowers millions of patients and caregivers to
manage their medications and stay informed about
their condition. To support international efforts
to combat nonadherence, Medisafe took a look at
the billions of data points generated by our global
community, and identified behavioral adherence
trends. This unparalleled insight goes beyond claims
data and presents a global picture of adherence at
the individual dose level.
ResearchhasdemonstratedthatMedisafehelpspatients
to remain adherent. A June 2018 study examined
patients taking HIV medications and found:
• 90% of patients with pre-app medication possession
ratio of < 0.90 increased their Medication
Possession Ratio (MPR) on Medisafe
• 79% of patients with pre-app MPR < 0.80 increased
by at least two deciles on-app
• The proportion of patients with MPR ≥ 0.80
increased from 82.3% pre-app to 88.6% on-app,
a 7.7% relative increase.
In addiiton, Medisafe demonstrated a double-
digit impact on adherence in a May 2018 study
of hyptertension patients.

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To help achieve such results, Medisafe offers a HIPAA-
and GDPR-compliant, cloud-based infrastructure that
supports a suite of adherence solutions for consumers
and business clients. The app is intuitive, creating a
“virtual pillbox” that divides patients’ medications
into four daily quadrants, or an hourly timeline, so
they know what they have taken, as well as their
regimen for the rest of the day. When their doses
are due, people receive a digital “nudge” through
their Android, iPhone, or smartwatch.
It’s not just patients who can benefit from this
approach. Healthcare providers also have access
to a portal to bridge the gap between patient visits.
They can ask their patients to connect, allowing
the provider to see health information on his or
her dashboard.
PARTNERSHIPS
Medisafe has a number of pharma partners, includ-
ing two recent announcements: Merck KGaA, of
Darmstadt, Germany, is collaborating with Medisafe
to help its cardiometabolic patients better manage
medication intake and adhere to prescribed treat-
ment regimens. The partnership, announced March
27, 2018 will start in Brazil, Russia, and Mexico,
allowing patients on certain medications to have
access to a customized version of Medisafe.
In June 2018, Medisafe announced a partnership
with Boehringer Ingelheim to support U.S. Pradaxa
patients using Medisafe with educational materials,
videos, relevant health tips and even a Pradaxa
savings card in the app.
HELPING PATIENTS ACHIEVE MORE
Despite these positive strides, Medisafe is hopeful
for more. Its vision is to go beyond having patients
take their medication, and to create measurable
benefits for patients and the healthcare industry.
“Medications are potent weapons in our fight to
prevent and treat illness, but when patients don’t take
them as prescribed it results in excess morbidity and
mortality as well as wasted
medical visits,” said Medisafe
Chief Medical Officer
Daniel Sands, MD, MPH.
“Medisafe is a useful tool
to help patients understand
and take their medications
as prescribed.”
This vision touches therapeutic areas of great import,
such as HIV, diabetes, and cardiovascular diseases.
In these particular areas, patients failing to adhere
to their medication schedules can result in serious,
even fatal health impacts.

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BEHAVIORAL
INSIGHTS
Medisafe is used by patients in 25 languages in 200
countries and territories. We are therefore able
to compare users’ contemporaneously reported
medication adherence patterns. Taking a global
view of all therapeutic areas, the U.S. trails many
countries in terms of adherence rates (77%),
coming in 28th place. That is tied with Turkey
and Australia. Chile was the only country with
lower adherence (76%). Germany (85%) was
number one of the 30 countries with the most
adherent users.
The most common reason for skipping doses,
according to patients, was that they forgot or they
thought they did not need to take them (tied at
30%). Furthermore, they were least compliant
on Fridays and Saturdays. Those taking their
medications in the mornings seem to have a better-

5. SHARE: Medisafe Annual Adherence Index July 2018 5
established routine. “By exploring the timing of
nonadherence and the underlying reasons, we
are able to offer digital interventions that are
best customized to the
needs and concerns of
the individual patient at a
specific time-point, based
on the latest knowledge
in behavioral science,”
said Medisafe’s Director
of Behavioral Insights,
Oren Shapira, PhD.
HELP FROM A FRIEND
Medisafe also relies on social networks to
help patients adhere to their medication
schedules, and positive results already have been
demonstrated. For example, 71% of Medisafe users
improved their reported medication adherence
after adding a Medfriend. A Medfriend can connect
with the patient on the app and support him or
her to encourage adherence. At least one study,
titled “Association between different types of social
support and medication adherence,” found that
having friends or family engage patients “in the

6. SHARE: Medisafe Annual Adherence Index July 2018 6
mundane and practical aspects
of medication purchasing and
administration,” could help boost
adherence. The study appeared the
The American Journal of Managed
Care in December 2012.
Medisafe hears many firsthand
accounts of the importance of the
Medfriend feature. One daughter
noted that she was alerted that her
mother had missed several doses
of her medicine. While abroad,
she was able to alert police and
EMS that her mother needed help.
She was found, unable to stand.
The daughter credits Medfriend
for saving her mother’s life.
Having loved ones help patients is a key step,
particularly when it comes to more frequent
dosing. Looking at diabetes in particular, there
was — perhaps unsurprisingly — a higher rate
of adherence (88%) among those who took their
diabetes meds once a week (e.g., a GLP-1 receptor
agonist). Adherence declined to 71% for those on
rapid-acting meds who dosed three times a day.
It also was found that adherence peaks around
mealtimes, probably because it’s easiest to establish
new habits by pairing them with existing ones.
CARDIO MEDICATIONS
People take cardiovascular medications for a
host of reasons — to control their cholesterol levels,
help with high blood pressure, or
provide aid after a heart attack.
According to Johns Hopkins
Medicine’s Health Library,
roughly 84 million people in
the U.S. suffer from some form
of cardiovascular disease. It is
estimated that about 2,200 people
die each day from cardiovascular
disease — a startling number that
underscores just how important
adherence is[U1]
.
Despite the high number of
deaths due to cardiovascular-
related conditions, the U.S. again
lags other countries in terms of
adherence on Medisafe, coming
in only ahead of Chile and Columbia. Surprisingly,
patients were most adherent when they took six
or more medications, with antiplatelet agents and
anticoagulants having the highest rates of adherence.
Importantly, those on vasodilators had the lowest
rate of adherence at 74%.
HIV
In the HIV therapeutic area, the U.S. is
behind many countries, with 83% adherence.
Canada has the highest rate at 89%. The FDA has
warned that if HIV patients skip their doses, they
can develop strains resistant to their prescribed
medications —and even others they have not taken
yet. On medisafe, those between the ages of 40 and
50 have the best adherence rates, and adherence

7. SHARE: Medisafe Annual Adherence Index July 2018 7
varies slightly by drug class, with NNRTIs being
the highest (85%) and NRTIs the lowest (79%).
Compliance is steady throughout the week, but
dips slightly on Fridays and Saturdays.
NEUROLOGY
Other disease areas of interest are neurology
and gastrointestinal. For neurologic treatments,
the U.S. trails all other nations analyzed in terms
of adherence (77%). For all countries, the weekend
is the most challenging time; however, patients
are most adherent in the morning. Those with
epilepsy and migraines are the most compliant
(82%), but those with Parkinson’s are the least
(74%). The top reason for skipping doses was forgot/
medicine not nearby (35%); 25% said they did not
need the dose. Cost was the least chosen reason
(1%). While those with Parkinson’s appeared the
least compliant, the top 2 medicines in terms of
highest adherence were, in fact, treatments for
Parkinson’s (93% each). These were Merck’s Sinemet
and GlaxoSmithKline’s Requip, both also available
as generics. GSK’s Lamictal for seizures came in
at 70%, rounding out the top 10.
GASTROENTEROLOGY
For GI meds on Medisafe, Germany topped
all other countries in terms of adherence, with the
U.S. tied with the UK, Brazil, and Australia (77%).
As with neurological meds, weekends were toughest
in terms of adherence. Patients were most adherent
in the morning, but that adherence tapered off

8. SHARE: Medisafe Annual Adherence Index July 2018 8
throughout the day. Those with esophagitis and
duodenal ulcers were most adherent (80%), followed
by those with diarrhea and ascites (79%). Those
with diabetic gastroparesis were the least (71%).
Broken down by company, J&J had the highest
adherence rates (81%), with Mylan coming in second
(80%). Patients mostly indicated they missed doses
because they forgot, meds were not nearby or they
didn’t feel they needed them.
ADHERENCE RATES
BY DRUG
Medisafe can also provide adherence rates by drug.
In oncology drugs, , for example, Amgen’s Xgeva for
bone cancer saw an adherence rate of 91%, followed
by Bristol-Myers Squibb’s Sprycel for leukemia at
90%. Counterintuitively, adherence rates rose as
the number of medications taken increased.
Looking at oncology drugs more broadly, the U.S.
was in the back of the pack at 79%, coming in ahead
of Israel and Chile (74%). Adherence rates varied by
type of cancer, with thyroid coming in at 96%. On
the flip side, adherence for pancreatic cancer treat-
ment was low, coming in at 60%, which is surpris-
ing given the mortality rate of the disease. Patients
were adherent steadily across the week, and were
most adherent before breakfast and before dinner.
With psychiatric drugs, adherence rates are slightly
lower, but are fairly consistent across drugs. Pfizer’s
Pristiq, a treatment for depression, came out on
top with an 86% adherence rate. Other drugs were
85% or 84%, with the lowest being Prozac, which
is available as a generic, at 82%. Once again, the
U.S. lagged, tying Australia as the second-to-
least adherent (78%), coming ahead of Columbia.
Weekends were challenging in terms of adherence.
Strikingly, adherence remained strong in the evening
hours, in contrast with other therapeutic areas.
Those taking autism medications had the highest
adherence rates, while those with ADHD had the
lowest. At 81%, SSRIs/SRNIs/NDRIs had the highest
rate of adherence, and ADHD meds had the least
adherence.
Although medication nonadherence is a huge
problem, particularly in the U.S., Medisafe’s app
offers a chance to gain insights into where, when,
and why patients skip doses. Having this knowledge
can help industry, clinicians, and patients ensure
medications are taken properly, leading to both
improved health and lower healthcare costs. l
[U1]https://www.hopkinsmedicine.org/healthlibrary/conditions/
cardiovascular_diseases/cardiovascular_disease_statistics_85,P00243
[U2]http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/
MakeChangesThatMatter/Types-of-Blood-Pressure-Medications_
UCM_303247_Article.jsp#.Wv8n5O4vypo5
Medisafe is the leading personalized medication management platform addressing
all major causes of nonadherence. Far more than a pill reminder app, Medisafe is a
cloud-based platform that personalizes content, resources and interventions — such as
educational videos, coupons and motivational messages — based on each user’s regimen,
condition and specific circumstance.Visit medisafe.com/insights for more information.