Adherence, generics to reduce $403bn in waste

The latest drug trend report from pharmacy benefit manager Express Scripts estimated that if patients using maintenance medications used cheaper therapies when possible, adhered to their medication therapies and used home delivery, it could eliminate $403 billion in pharmacy waste every year.

Of course, nobody can control everything patients do at all times, and all patients on maintenance medications using home delivery instead of going to the pharmacy would mean fewer face-to-face interactions between patients and their pharmacists and less cost-saving medication therapy management, even if, according to Express Scripts, it could contribute to $88.3 billion in annual savings. 

Nevertheless, what Express Scripts 
called harnessing the “good intentions” of patients could still cut that $403 billion in waste by a third. According to the report, the biggest portion of potential savings, $258.3 billion, could come from improvements in adherence, with reduced hospital admissions, emergency room visits, doctor visits, laboratory tests, additional therapy and other costs.

“Don’t let behavior fool you,” Express Scripts chief scientist Bob Nease said. “Patients’ behavior is often misleading and doesn’t represent their underlying intentions. Our research and experience show that most patients, when presented with a choice, make decisions that lower costs and improve their health — decisions that also are in the plan sponsor’s best interest.”

Medication nonadherence happens for a number of reasons, but not because patients desire poor health outcomes. For example, according to a recent study published in the journal Archives of Internal Medicine, patients taking cardiovascular drugs appear to become less adherent when they have to see multiple physicians and make frequent trips to the pharmacy. The study — conducted by researchers at Brigham and Women’s Hospital in Boston, Harvard Medical School and CVS Caremark — analyzed data from 1.8 million patients taking statins and 1.5 million taking angiotensin receptor blockers or angiotensin-converting enzymes between June 2006 and May 2007. They found that greater complexity in prescribing and filling prescriptions resulted in lower levels of adherence, and those with the least refill consolidation had adherence rates 8% lower than those with the most, concluding that strategies to reduce the complexity of prescribing and filling prescriptions could help improve adherence.

One possible way to improve adherence is to reward patients for it. HealthPrize Technologies, for example, has developed an online and mobile app that provides patients with cash rewards and interactive games designed to encourage them to take their medications as prescribed and directed. One study, which the company conducted in January, found that patients given such incentives were adherent 88% of the time. At the time of publication, HealthPrize was planning to partner with RealAge to conduct a study of asthma patients who had taken the RealAge Test.

Another “good intention” detailed in the Express Scripts report is using cheaper medications. The report found that $56.7 billion was wasted due to use of higher-cost medications that generate no additional health benefit. The report included a Harris Interactive study showing that 82% of patients using branded drugs would actually prefer generics. According to the Generic Pharmaceutical Association, the main trade group representing generic drug manufacturers, use of generics saved $139.6 billion in 2009.

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