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The 3.3 percent rx dilemma.

Year: 2011
Type: article
Abstract: In recent years, a number of new studies have zeroed in on a common problem in pharmaceuticals management: Patients too often avoid filling the prescription they need. And there’s been a frequently cited link between the out-of-pocket cost of a drug and the likelihood that it will be shunned as sticker shock overrides the need for treatment. For the makers of biologics — next-generation therapeutics that often wind up on the most expensive tier in the formulary — it’s a trend that can’t be ignored. But in a recent study, a group of researchers found that if pharmaceutical benefit managers apply a simple test, they have a good shot at identifying which plan members are likely to avoid specific therapies. And, they added, payers need to reflect carefully on how they design their drug formularies to make sure that members adhere to a prescribed treatment regimen. Late last year, a team of investigators led by William Shrank, MD, at Harvard’s Brigham and Women’s Hospital, in Boston, drilled down into prescription drug data for a three-month stretch in 2008 and detailed just how many prescriptions actually got filled by pharmacists but were never picked up — and why. Reporting their findings in the Annals of Internal Medicine (Shrank 2010), the investigators concluded that 110 million prescriptions — 3.3 percent of the total number of prescriptions filled by pharmacies —were abandoned. Those drugs were returned to pharmacy shelves. Slightly fewer than half of those prescriptions were filled later with a different drug. But the rest were simply left at the pharmacy without any follow-up. William Shrank, MD, and his team found that 3.3 percent of filled prescriptions are abandoned at the pharmacy. “The total number of abandoned prescriptions in the population is great,” noted the team, “and every essential prescription abandoned could represent an important clinical concern if the patient does not subsequently restart the medication or identify a substitute.” There were two key factors that helped to determine which therapeutics were picked up and which ones were forgotten: Cost and need. Pain-killing opiates and antiplatelet medications were among the drugs least likely to be left behind. Antihypertensives, oral diabetic medications, and statins also had a low rate of abandonment. But proton-pump inhibitors, asthma medications, and insulin all registered among the drugs most likely to be ignored. Some therapies that weren’t critical to a patient’s health, such as certain dermatological agents, were also among the products most likely to be abandoned and returned to pharmacy shelves. Out-of-pocket costs clearly played a big role. Shrank and his colleagues found that a drug with a copayment of $10 or less was left at the pharmacy only 1.4 percent of the time. But the abandonment rate shot up to 4.5 percent when the cost to a patient broke the $50 mark. Low-cost generics were commonly picked up whereas a large concentration of abandoned drugs turned out to be branded medications.
Author: John Carroll
Language: English
Open Access status: green
OpenAlex ID: W243769019
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