January 10, 2022

Rx abandonment

The high cost of skipping meds. (And what to do about it.)

Abandoned prescriptions. It’s such a problem in healthcare that the National Center for Biotechnology Information (NCBI) coined a name for it back in 2011: The 3.3% Rx dilemma. That’s because a study conducted at Harvard’s Brigham and Women’s Hospital in Boston found that 3.3%–about 110 million–of prescriptions pharmacists fill annually are abandoned by patients.

The study also found that slightly less than half of those prescriptions were later filled with a different medication. That means about 55 million patients are skipping their meds altogether. 

There are two very consequential repercussions.

  1. Patient health. Medications are prescribed because a patient clinically needs the therapy. It stands to reason that not taking prescribed meds will likely lead to worsening health.
  2. Cost (for everyone). The price tag for not picking up meds is staggering, no matter who you are. 
  • Manufacturers lose as much as $600 billion annually.
  • Pharmacists lose approximately $25 per prescription (the cost of filling and restocking). 
  • Patients who skip meds in the short term are likely to spend more on their health in the long term if the result of not taking a prescription is a worsening condition. 

Prescription abandonment is also a component of a bigger problem. That problem is called medication non-adherence. Basically, it means patients not taking medications as prescribed (not filling–or filling but not taking–meds). It’s estimated to cause 125,000 deaths, 10% of hospitalizations and cost the U.S. healthcare system between $100 and $289 billion every year. 

Worsening health (or even death) is dire. 

The financial costs don’t equate, but they are onerous nonetheless. Each one of us pays, in the form of higher prices for therapy, higher premiums for insurance, diminished healthcare resources, lost work productivity, etc. etc. 

So, what are the causes? 

Cost: It is a cruel irony that the main cause of a problem that costs us all so much is, well, cost. 

The study from Harvard’s Brigham and Women’s Hospital linked out-of-pocket cost to the likelihood of abandonment. Medications with a copay of $10 or less were only abandoned 1.4% of the time. But for meds with a copay of $50 or more, the abandonment rate jumped to 4.5%.

Exacerbating the cost problem is the fact that patients overpay for prescriptions 23% of the time, according to a recent study by the University of Southern California Schaeffer Center for Health Policy & Economics.

Access: Another frequently cited cause for skipping meds is lack of–or barriers to–access. A few examples:  

  • A patient who is too sick or elderly to get to the pharmacy
  • A patient who lives in a pharmacy desert
  • A patient’s healthcare literacy
  • Time and effort it takes to go to the pharmacy (avg. wait time for Rx is 45 mins.)
  • Difficult prior authorizations (79% of doctors say patients have abandoned Rx due to PAs)
What can be done about cost?

That is the billion-dollar question. And to date, there is no single or simple answer. The complexity of the prescription supply chain with all of its stakeholders–manufacturers, pharmacy benefit managers, insurers and pharmacists to name a few–requires a systematic approach on a patient-by-patient basis. One that is capable of identifying multiple variables at each step of the supply chain and formulating a response.

At Gifthealth, we believe technology provides the best way forward. Our platform is designed to crunch the available inputs and produce a simple output. You can think of it as a series of conditional statements. For example, if there is a prior authorization required, submit it electronically. If there is a rebate or coupon, apply it automatically. If paying cash is actually more affordable than a copay, provide the cash price to the patient. Of course, there are many other variables involved, but technology is capable of identifying which of them are relevant in real time and calculating the best possible solution. 

What can be done about access?

Technology can’t do it all alone. In the physical world, more medications still need to get into the hands of more patients. Process innovations are the second part of an overall strategy. For us, that includes providing free national medication delivery, setting up a single point of contact for all stakeholders, making simplicity a cornerstone of the experience and using good old-fashioned human-to-human communication.  

What’s next?

The next best thing to a crystal ball is data. The more patients we help, the more we can anticipate what comes next and design a micro solution to the macro problems that cause prescription abandonment and non-adherence. If that kind of patient-by-patient approach seems painstaking, it is, but technology makes it possible– more efficiently and faster than ever before. 

The main point is that innovation, whether driven by technology or process, cannot be static. It must constantly evolve. Each patient presents the potential for a new opportunity to optimize. What’s next, we can’t say for certain. But we can speak in probabilities based on what we know. The more we know, the greater the probability of a better future outcome.

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