The High Price of Low Adherence to Medication

Jul 21, 2015

Express Scripts’ new white paper explores the direct and indirect costs to consumers and plan sponsors when patients don’t take medicines as directed.

Click to download.

  • Accountable Care Organization (ACO)
  • Commercial
  • Medicaid
  • Medicare
  • Public Exchanges
  • Asthma
  • Diabetes
  • High Blood Cholesterol
  • High Blood Pressure/Heart Disease
  • Pulmonary Hypertension
  • Mutiple Sclerosis
  • Inflammatory Conditions

When patients don’t take their medicines as directed, the consequences can include worsening health and added medical expenses. Yet researchers have found that more than half of the patients in many disease states are not adherent to their medication therapies.

In the United States, the estimated direct and indirect costs of nonadherence totaled $337 billion in 2013, the most recent year for which figures are available. With total healthcare spending in the United States averaging $9,255 per person in 2013, about one dollar of every nine spent was wasted because patients didn’t take their medicines as directed.

Express Scripts has released a white paper exploring the direct and indirect costs of medication nonadherence. This white paper:

  • Discusses why patients don’t take their medicines as prescribed,
  • Outlines methods to predict and prevent lapses in adherence and
  • Describes how encouraging patients to follow doctors’ orders can help keep overall healthcare costs in check

The white paper can be downloaded here.

The Problem and Solutions

Up to 30% of prescriptions are not filled. Even when patients do fill their prescriptions, they may miss doses, take the wrong dose, stop treatment early or never start. The reasons for their lack of adherence include behavioral issues, such as forgetfulness or procrastination; cost issues; and clinical issues, such as side effects.

Early identification of these patients paves the way for successful interventions before significant problems arise. The key to this approach is reaching out to patients before they are late to fill a prescription. ScreenRx®, Express Scripts’ adherence solution, utilizes predictive analytics to identify patients at risk of nonadherence, and the specialist pharmacists, nurses and other clinicians at Express Scripts’ 20 condition-specific Therapeutic Resource Centers (TRCs) provide personalized interventions to help them stay on their therapies. The TRCs are available to all members, wherever they fill their medications. However, Express Scripts has found that using home delivery increases the likelihood of being adherent by an average of 11% to 19%.

In addition to proactive outreach of patients at risk for nonadherence, plan sponsors can use plan design to encourage members to fill their prescriptions. For example, value-based insurance design (VBID) may enhance adherence by reducing or eliminating copayments and deductibles.

Adherence Pays Dividends

By implementing proven strategies to increase adherence, plan sponsors can moderate their costs and reduce waste.

Members benefit too: Simply by taking their medicines as directed, the patients may need fewer emergency room visits, hospitalizations and extra tests – and, most importantly, enjoy better health.

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