MAP: Bad Rx Decisions Cost Poor US States

Apr 23, 2013
The U.S. wasted $418 billion in 2012 on bad medication-related decisions, and the impact was most deeply felt in those states that could least afford it.

The U.S. wasted $418 billion in 2012 based on bad medication-related decisions, and the impact was most deeply felt in those states that could least afford it, according to new research Express Scripts released this morning.

While these costly decisions impact the entire nation, our analysis shows that they have a disproportionate effect on the poorest states. Mississippi, which has the lowest median household income in the country, had the most wasteful spending, totaling $1,622.76 per resident. The other low-income states that top the list in unnecessary pharmacy-related costs include Louisiana, Arkansas, Alabama, Kentucky, Tennessee, South Carolina, New Mexico and Oklahoma.

Poorest states in the US

Our nation pays a huge price for bad medication-related decisions, and it is clear that the price is even more costly for those at the lowest end of the economic spectrum. The good news is that our country can save billions of dollars for patients, employers and the government – and achieve healthier outcomes – simply by driving better decisions within the pharmacy benefit.

The Costly Pharmacy-Related Decisions That Lead to Healthcare Waste

Waste was defined as extra medication-related spending that provided no additional clinical benefit. This includes the use of high-priced prescription drugs and pharmacies when clinically equivalent or superior alternatives existed, as well as unnecessary medical expenses that could have been avoided by patients adhering to their medication therapies.

More specifically:

  • $55.8 billion was spent unnecessarily on higher-priced medications when more affordable, clinically equivalent alternatives were available.
  • $93.1 billion could have been saved if patients would have used the most cost-effective and clinically appropriate pharmacies, including home delivery and specialty. This savings includes $33.5 billion in lower drug costs, as well as $59.6 billion in avoided medical costs attributed to the higher adherence rates associated with home delivery and specialty pharmacies.
  • An additional $269.4 billion was spent on avoidable medical and pharmacy expenses as a result of patients not remaining adherent to their medication treatments. This total does not include the $59.6 billion in adherence savings directly associated with better pharmacy choices.

According to our research, the most wasteful one-third of states spent between $1,404.82 and $1,622.76 per capita in avoidable costs. States with high levels of waste were found to be primarily located in the southern region of the country — an area also associated with higher rates of chronic disease. States with the lowest levels of avoidable costs were predominantly in the Midwest and Northeast. Vermont wasted the least amount per capita among all states in the U.S. yet still experienced an average of $1,004.39 in unnecessary costs per resident.

Enabling Better Decisions and Healthier Outcomes

It’s hard to believe, but when we consider associated medical expenses, bad pharmacy-related decisions waste more money than what the country spends in total on prescription drugs. To help eliminate these unnecessary costs for the country, Express Scripts applies Health Decision Science℠ to enable patients to make better drug choices, pharmacy choices and health choices.

Better decisions mean healthier outcomes.


Steve Miller, MD, is presenting this data today at the Express Scripts Outcomes Symposium in Orlando, Fla.

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