- The high cost of prescription drugs is what drives 67 percent of patients into medication non-adherence, according to the latest Truven Health Analytics-NPR Health Poll, contributing to a multi-billion-dollar issue that is of particular concern for population health management initiatives.
Ninety-four percent of patients with incomes under $25,000 per year stated that they did not fill or pick up their prescriptions due to the expenses involved, and more than 12 percent said that costs had led them to stop taking a medication before a provider recommended ending the treatment.
Despite the fact that cost is a major factor in adherence, just 16 percent of low-income individuals had used drug company rebates or coupons to help reduce the prices of their medications.
That number rises to 36 percent of individuals with incomes over $100,000 per year, indicating something of a disconnect between those who may be most in need of financial aid for maintaining adherence to treatment recommendations and those who are actually taking advantage of available options.
"While barriers to medication adherence appear to vary, some patients seem to be weighing the expense of prescription drugs as a factor in their decision to purchase and follow through with a full course of treatment," said Anil Jain, MD, Vice-President and Chief Health Informatics Officer, Value-Based Care, IBM Watson Health.
For better or worse in terms of their own health, patients are generally able to make very informed decisions about the expenses of prescription drugs.
Information about the cost of medications is widely available and appears easy to find, as 94.3 percent of respondents to the poll said they were able to find out the cost of their medications before filling or picking up the prescription if they decided to look for it.
However, relatively few patients did. Just 19 percent of seniors, 30 percent of low-income patients, and 27 percent of those with a high school education sought out pricing information before filling their prescription.
In contrast, 64 percent of patients aged 35 and under – commonly known as Millennials – and 42 percent of those making more than $100,000 a year proactively searched for costs.
Younger patients, wealthier patients, and those with higher levels of education were most likely to take an alternate route if they didn’t like what they saw: buying prescription drugs from a source outside of the United States.
Just over 20 percent of Millennials chose this option, compared to 5 percent of Baby Boomers. About a quarter of high-income individuals looked to international outlets for their medications, yet only 7.4 percent of individuals making less than $25,000 a year and just 5.2 percent of those making up to $50,000 per year did the same.
In addition to cost, the actual clinical impacts of taking a medication were a primary reason to avoid or stop a course of treatment. Only 29 percent of patients said that side effects prompted them to stop taking a medication, while just 14.5 percent said the treatment wasn’t working.
Just 2.6 percent said they forgot to continue their medication, although forgetfulness was the top reason why patients missed a dose at some point during the process.
US prescription drug spending has reached more than $320 billion a year, according to the CDC, representing a 9 percent increase between 2014 and 2015, which is the most recent data available.
The pressures of high costs to patients filter through to providers, employers, and payers, all of whom share responsibility for ensuring medications do their job to treat acute conditions and help manage longer-term chronic diseases.
In 2013, ExpressScripts stated that non-adherence produced $337 billion in costs for the healthcare system, which translates to nearly $10,000 in additional spending per individual.
Non-adherence to medications for some of the most common chronic conditions, such as diabetes, heart disease, and high cholesterol, also contribute to more than $8 million a year in avoidable hospitalization costs for every 100,000 lives, said a 2015 study by Healthentic.
The ExpressScripts study indicated that patient behaviors, such as forgetfulness, procrastination, and confusion over complicated multi-drug routines, were primarily responsible for high rates of non-adherence.
Simple, low-cost changes to prescription management techniques, such as medication synchronization programs, may be able to produce significant reductions in these particular behaviors, pointed out a 2016 study from Virginia Commonwealth University School of Pharmacy.
For every dollar spent on strategies to ensure that patients can collect all their prescriptions during a single appointment or pharmacy pick-up, the healthcare system may produce $37 in return.
But the Truven and NPR poll indicates that costs, not just absentmindedness, may play a much larger role in patient decision-making than previously thought.
"Further studies should be conducted to investigate barriers to adherence,” said Jain. “Meanwhile, healthcare providers and policy makers should consider how drug costs may impact adherence rates as they develop population health strategies."