Interview: Medication non-adherence at the ‘root’ of drug pricing row

The government and pharmaceutical companies have been at an impasse for months over NHS pricing for new branded medicines. Amid recent reports that Keir Starmer is about to ‘cave’ and raise drug prices, experienced pharmacist and CEO of The Medication Support Company, Norman Niven, told The Pharmacist that the row is ‘hiding the real problem’: medication non-adherence.

The ‘silent killer’ of medication non-adherence

‘Medication non-adherence is one of healthcare’s most persistent, intractable, and costly challenges’ says Mr Niven, a leading expert on the topic. ‘It leads to poorer population health which creates a raft of downstream problems, from hospital re-admissions to an increased burden on the social care sector.’

Medication non-adherence – when a person’s behaviour does not match the recommendations for their prescribed treatment – falls into two distinct categories: intentional and non-intentional.

‘It’s easy to understand unintentional non-adherence; sometimes people, especially older people, simply forget to take their meds,’ Mr Nivan says. ‘But intentional non-adherence represents a different class of problem. It is much more significant in terms of numbers, and it is a silent killer.’

This second type of non-adherence is when a patient consciously decides to stop or alter prescribed treatment, often due to personal beliefs, cost, side effects, or doubt in the medication’s effectiveness.

The problem is difficult to quantify because non-adherence usually takes place behind closed doors but the cost to the NHS is enormous, Mr Niven says.

After staff costs, medication is the biggest expenditure for the NHS. It spends over £19bn each year buying medicines, according to NHS England, and pharmacies have dispensed over one billion prescriptions annually in the last several years, according to NHS Business Services Authority (NHSBSA) data.

In the UK, the generally recognised level of prescribed medicine non-adherence is 50%, which could mean that of the £19bn spent last year on medicines, £9.5bn were either not taken as recommended or not taken at all.

There is also a risk to patient safety if certain medications are taken incorrectly, so taking the right dosage at the right time is ‘vitally important’.

Medication non-adherence is at the root of VPAG row

For months, the UK government and pharmaceutical companies have been locked in a standoff regarding the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG) – a five-year deal that sets a cap on the growth of NHS medicine spending.

If that growth exceeds the agreed rate, then pharmaceutical companies must pay back the excess. But as of August 2025, the spending increase was much higher than forecast leading some pharmaceutical companies to pause or withdraw investment into the UK.

Keir Starmer is now set to increase NHS medicine spending, but this deals with the effects of the problem and ignores the ‘root cause’, says Mr Niven.

Pharmaceutical companies have no idea how much money they are losing to medication non-adherence, he explains. ‘It’s like a leaky pipe. It doesn’t matter until there’s a drought.’

‘Instead of quibbling over the price the NHS pays for drugs, we should be making sure that prescribed medicines are taken properly – addressing the problem at source,’ he says.

‘If the government, NHS, and pharma companies cooperated in implementing existing technology-based services, which have a demonstrable impact on non-adherence, then there would be no need for those levels of taxation on pharma companies.’

Seeing patients take their medication ‘the only way’ to solve non-adherence

The system developed by Mr Niven’s company is a remote audio-visual system (PAMAN) in a patient’s home. Trained pharmacy technicians – working for The Medication Support Company – can then phone the patient’s home and watch them take their medicines.

‘They can offer advice, intervene, and provide reassurance as needed,’ Mr Niven says. ‘Witnessing patients at home taking their medication is the only way to ensure the right drug is taken, at the right time, at the right dosage.’

‘Our system makes that possible and our pharmacy technicians become a trusted source of advice and support.’

He adds that, in the past, nobody wanted to take responsibility for medication non-adherence. The social care sector has done the most to tackle the problem, but using The Medication Company’s in-house monitoring system to communicate with people at home has eased pressure on carers, and the local councils funding them.

‘When patients follow their medication regime there’s also far fewer instances of “switching” which occurs when patients tell their doctor that their meds aren’t working when in fact, they haven’t been taking them properly. The result is that the doctor will switch to another medication, creating waste and a false impression of efficacy,’ he says.

Pharmacists can play an important role in combating medication non-adherence by referring patients to his service, says Mr Niven.

He urged the NHS to engage more with similar services which tackle the groups of people most at risk: the elderly, people living with mental health issues, and people needing Time Critical Medication such as anti-epileptics, insulin, or Parkinson’s medication.