Waste not, want not: Ways to avoid Rx waste
In its “2010 Drug Trend Report,” Express Scripts attributed much pharmacy-related waste to patients failing to follow three simple guidelines: Take medications as prescribed, take drugs that maximize clinical benefit for the lowest price and use the safest and cheapest delivery channel. While some of the suggested methods might not always be in retailers’ and patients’ best interest — such as using mail-order instead of visiting retail pharmacies — the $403 billion in pharmacy-related waste, projected to equal $1.2 trillion between 2010 and 2014, isn’t chump change, and both public and private payers pay attention such high numbers.
Still, many consumers have shown a willingness to change their behavior in ways that they think will help save money for the country, their employers and their health plans, according to research by the pharmacy benefit manager. Absolute majorities of consumers reported a willingness to use generic drugs, use home delivery and lose weight. Large percentages also said they would use a different retail pharmacy, use a limited physician network or pay higher premiums for their drugs.
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.
CVS fights disease in ethnic communities
CVS/pharmacy spent the last couple of months sponsoring nearly 300 free screening and consultation events in Atlanta, Washington, D.C., and Philadelphia targeting African-American communities.
Part of the chain’s To Your Health program, the events were an extension of the A Su Salud events targeting Hispanic customers in Los Angeles, Dallas, Houston and Miami. To Your Health started in Atlanta on April 17, moving on to Washington, D.C., on June 12 and Philadelphia on June 19.
The events were designed to target health issues prevalent in the ethnic population in those communities; for example, the rate of diabetes among African-Americans is 11.8%, compared with 6.6% of non-Hispanic whites, according to the American Diabetes Association. Among 195,000 patients screened during the A Su Salud events in 2009, 22% had diabetes, 28% had high blood pressure, 33% had high cholesterol and 36% were at high to moderate risk of osteoporosis.
“Chronic diseases like diabetes disproportionately affect the African-American population, and early detection can make a tremendous difference for a disease that must be managed for a lifetime,” CVS Caremark chief medical officer Troyen Brennan said. “We urge patients to find out if their blood glucose, blood pressure and cholesterol are within a healthy range.”
Nearly 26 million Americans are living with diabetes, according to the Centers for Disease Control and Prevention. Atlanta, one of the focus cities of the To Your Health campaign, is in what the CDC calls the “diabetes belt,” an area covering 644 counties in 15 mostly Southern states where diabetes prevalence rates are at least 11%. The area has a large African-American population, a group with a disproportionate risk of developing diabetes. Within the belt, 11.7% of people have diabetes, compared with 8.5% of people in the country as a whole.
African-Americans also are at higher risk of developing high blood pressure, also known as hypertension, than other groups. According to the CDC, 42.2% of African-American men and 44.1% of African-American women have the condition, compared with 31.2% of Caucasian men and 28.3% of Caucasian women, and 24.8% of Mexican-American men and 28.6% of Mexican-American women. Across ethnic groups, 31.8% of men and 30.3% of women have hypertension.