I heard an excellent presentation today by George Paz, Chairman and Chief Executive Officer of Express, Scripts, Inc., a leading company in the pharmacy benefit management field (processing more than a million prescriptions a day). George said I could share some of his numbers with you. They were stunning to me and many others in the meeting we attended. See if you are surprised.
The topic is medication adherence -- what people do with those prescriptions that are written by doctors. I have written about this before, but George makes the case more tangible.
Of all patients who get a prescription, 24% either do not pick it up or don't begin using it.
Among those who begin taking their medication:
- For those with diabetes, the average adherence is 78.9%;
- For those with high blood pressure, the average adherence is 83.7%; and
- For those with high cholesterol, the average adherence is 84.7%.
Looking at it another way:
- For those with diabetes, 4 out of 10 patient comply less than 80% of the time;
- For those with high blood pressure, 3 out of 10 patient comply less than 80% of the time; and
- For those with high cholesterol, 3 out of 10 patient comply less than 80% of the time.
What happens when there is poor adherence? At a subsequent visit, the doctor sees persistent symptoms and assumes that the dosage is not working. The doctor then reissues the same drug at a higher dose and/or adds a second drug!
George estimates that poor adherence to drug regimens in these categories of chronic disease adds $22 to $34 billion in increased costs because the patients' conditions deteriorate to the extent that hospitalization is needed. He did not quantify the cost of drugs that are purchased by the insurance companies and never used by the patient, but that should be added in, too.
In all the debates about cost control and improving quality care, I have heard very little on this topic, particularly from payers. I have heard some suggest that insurers do not have a strong interest in the matter because they perceive that patients will churn out of their membership ranks. If we were cynical, we could say that they don't mind if people don't use as many drugs. They avoid the short-term costs, and the long-term costs are likely to be paid by the next company or by Medicare. Is it fair and accurate to suggest that?