Rising drug costs reflect medication-taking behaviors

The total waste to the healthcare system attributed to medication-related patient behaviors is a whopping $163 billion annually, according to the most recent Drug Trend Report, produced by pharmacy benefits manager Express Scripts.

These suboptimal behaviors include brand loyalty, refill procrastination, sporadic forgetfulness, actively declining medications, and insistence on using traditional pharmacy delivery of chronic medications rather than home delivery.

On the encouraging side, adherence rates across therapeutic classes remained constant or increased from 2008 to 2009. In an analysis of 24 therapeutic classes, adherence rates to most of these classes top 80%, as measured by the medication possession ratio (MPR), a commonly used metric for tracking how frequently people take their prescribed medications.

The report notes that:

Adherence to specialty medications (ie, medications for inflammatory conditions such as rheumatoid arthritis, drugs for multiple sclerosis, drugs to treat cancer, etc) is affected by the behaviors of actively declining a prescribed medication, procrastination in refilling prescriptions, and sporadically forgetting to take medications.

Looking to behavioral science for clues

Application of behavioral sciences could achieve pharmacy savings beyond those achieved through the use of voluntary programs and financial incentives to improve adherence, according to the report. Such programs have encouraged members to choose lower-cost medications through tactics known as framing (use of carefully selected wording to evoke intended responses), social persuasion, and loss aversion (making people work harder to avoid losses than to pursue gains).

Mandatory home delivery programs and awareness-building programs such as home delivery education have been used to boost home delivery use, including offering a monetary incentive for a first-time home delivery generic fill.

Total drug spending declined by 2.3% for Express Scripts clients who participated in behavior-changing programs.

Diabetes represents the number-one driver of higher drug spending, according to Express Scripts. A recently published study (J Med Econ. 2010. Epub ahead of print) found a trend toward lower total and diabetes-related healthcare costs among those diabetics who switched to mail-order pharmacy. The researchers conducted a long-term observational cohort study of the MarketScan Commercial Claims and Encounters Database, which includes health data from more than 20 million people and approximately 100 payers that can be linked to track detailed patient information across sites and over time, maintained by Thomson Reuters (Healthcare) Inc.

Included were 14,600 individuals who switched to mail-order pharmacy after at least 6 months in retail pharmacy and 43,800 patients who remained in retail pharmacy for at least 18 months.

The average adjusted adherence increased from 63.4% while using retail pharmacy to 84.8% after switching to mail order. Total healthcare and total medical costs were an average of $34.32 and $37.54 lower per member per year in the mail-order group and the retail group, respectively. Diabetes-related medical costs were an average of $19.14 lower in the mail-order group (pharmacy costs in this group were $14.13 higher).