What Is the FICO Medication Adherence Score?

FICO and Patient Adherence or Patient Compliance

Happy female doctor giving prescription to patient in clinic
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We're all familiar with credit scores and how they affect our ability to borrow money.

However, in 2011, the credit score company FICO announced a new scoring system that affects how patients experience healthcare. It's called the FICO Medication Adherence Score.

Here is what we need to know about the score and how it affects the care we receive:

FICO Medication Adherence Score

When it comes to borrowing money, we depend on high FICO credit scores, which are calculated using an algorithm designed by FICO (formerly known as Fair Isaac Corp.).

FICO pulls data from credit reporting agencies Equifax, Trans Union or Experion. The data are added, subtracted, compared and contrasted. Ultimately, we are assigned a number that tells other creditors how likely we are to pay back a loan; whether it's a new mortgage, a car loan, or a credit card. Those creditors pay a fee to FICO to get that information. It's a highly profitable business.

Now, FICO has developed a score called the FICO Medication Adherence Score. Instead of measuring how well we borrow and repay money, it measures how well we handle a drug prescription, which the company promotes as an indicator of how well we follow through on our doctors' treatment recommendations.

The algorithm scores patient adherence, using the prescriptions doctors write. The algorithm figures out who does or doesn't fill their prescriptions, how often patients order refills (whether we are using them too slowly or too quickly) and what those prescriptions are for - information that indicates what diagnoses patients have had, and more.

The more adherent an individual is, the higher the score.

FICO will purchase the data used in its algorithm from large pharmacies like Express Scripts, Medco, Rite-Aid, CVS and Walgreens.

While the company has not stated so, it may also purchase data from affinity cards - those cards you swipe at the supermarket that provide discounts (and also provide a wealth of information about whether you are buying too much red meat, not enough fish, too many snacks or sweetened soft drinks, etc.) When all that data are combined, each patient will be assigned a number from 0 to 500.

The number tells about the likelihood of taking the drug prescriptions as they were written for. The higher the number, the better.

FICO will profit by selling these scores. So the question is - who would pay for such scores? Who wants to know whether or not we are taking the drugs we have been prescribed? Also, what effect will this score have on us, our health and our access to health care?

Who Buys Medication Adherence Scores?

Right now we can only make educated guesses as to the revenue streams for these scores.

Health insurers are no longer allowed to reject an application for a patient's pre-existing condition. But nowhere does the law say that health insurance companies can't price their insurance according to an applicant's health. Applications ask some of the pertinent health questions, but the answers don't indicate how "good" the patient is about following his or her care plan. FICO hopes this new medication adherence score will. So insurers will buy applicants' scores from FICO to determine how much to charge us for health insurance.

Here are some examples in which the score might be utilized:

  • In general, any group that must subsidize patients for their healthcare will have some sort of interest in this score. The intent of the score is to provide a value that will indicate, in a relative fashion, how expensive a patient might be. Presumably, the higher the score, the less of an expense that patient might be (possibly relative to other patients with the same diagnoses.)
  • More and more Americans are entering the individual health insurance market every day as more employers stop offering health benefits. Companies that offer individual insurance may use this score to determine what to charge an individual for his healthcare, just as credit scores are used to determine what kind of interest rate someone is charged for a new mortgage or a car loan.
  • Pharmaceutical companies pour billions of dollars into selling their drugs and encouraging doctors to prescribe them. Statistics tell us that the majority of prescriptions are never even filled; meaning no income for the drug company. These FICO scores will give the companies more information about how to get patients to fill their prescriptions. They want you to take your pills - but only because you will pay for (or your insurance company will pay for) refills. Helping you raise your score will help them sell more drugs. Marketing promotions to raise our scores may comprise the ads and commercials we see in the future.
  • Just as they purchase and use credit scores, employers may choose to purchase your score from FICO and use your score for making insurance and human resource decisions.

Negative Reaction

Many experts believe this type of scoring is wrong-minded and relies on poor measures for rating patients.

For example, there are several reasons why patients don't adhere to their prescribed treatments, and they have nothing to do with how "good" patients are about taking their drugs. Such algorithms don't take into account such alternative reasons, nor do they accommodate problems when the wrong drug has been prescribed initially. They only take into account the purchase of a prescribed drug and whether or not it was refilled at the appropriate time.

Just as you need to understand how a credit score operates, you need to be aware of how this medication adherence scoring system works, how it will affect you and what and how much it will cost in the long run.

More About the FICO Medication Adherence Score

Please visit The FICO Medication Adherence Score: Benefits, Problems and How to Control It to learn what you can do to raise your FICO medication adherence score as high as possible.