Lowering the Cost of the Medication Poor-Adherence Epidemic
On average, patients see their pharmacist eight times more frequently than their primary care physician, something I experienced in my years working as a retail pharmacist. I got to know many people well, learning their medical histories and behaviors. As I said regularly to my patients, in order for the medication to work, you need to take it as prescribed. It may have seemed like a needless request, but, in reality, poor medication adherence is a healthcare epidemic, affecting more people and costing the U.S. healthcare system more than any single disease.
October 20, 2021
Medications are the wonders of modern medicine — curing infections, making organs work better, balancing glucose levels, keeping people alive. Prescription medication is the most common form of clinical therapy, withtwo-thirds of the adult U.S. population using prescription drugs . On average, patients see their pharmacist eight times more frequently than their primary care physician, something I experienced in my years working as a retail pharmacist. I got to know many people well, learning their medical histories and behaviors. As I said regularly to my patients, in order for the medication to work, you need to take it as prescribed. It may have seemed like a needless request, but, in reality, poor medication adherence is a healthcare epidemic, affecting more people and costing the U.S. healthcare system more than any single disease. Its impact is felt profoundly in the workplace,where employees miss between two and 10 work days per year due to non-adherence .
By one estimate , non-adherence causes 125,000 deaths, 10 percent of hospitalizations and costs the healthcare system more than $290 billion annually in emergency room visits, hospital admissions or physician visits — roughly 13 percent of all healthcare spending.Twenty to 30 percent of medication prescriptions are never filled and half of medications for chronic illness are not taken as prescribed . Unfortunately, the cost of medication is a major factor in the adherence epidemic. Despite the prevalence of prescription drugs, the cost of medication in the U.S. is the highest amongdeveloped countries . In the last five years, prescription drugs have risen by 26% for Members of self-insured employer health plans, who are feeling the brunt of the inflation:Twenty years ago prescription drugs accounted for just 7 percent of healthcare spending, but, now, employer groups allocate as much as half of their healthcare spending toward prescription benefits .
The impact of rising costs has been direct and harmful, putting patients in the difficult position of having to choose between their physical and financial health, a dilemma I heard first-hand in patient consultations. Among adults who report poor health,25 percent of people aged 51-64 say that they have taken less medication than prescribed in the past two years because of the cost . Behind the chilling numbers are people, employees and their employers who feel the effects of absenteeism or increased hospitalizations as a result.
Over the years, there have been initiatives taken to address the issues affecting adherence. Mostly, they have not begun with a large enough footprint to fundamentally change the model. The adherence problem is an element of the larger health experience, involving health literacy, access, transparency and medication management; there is so much more we can do to drive greater medication adherence in all patient populations by engaging consumers in different ways than before. But let’s start with the pocketbook issue of cost.
This week,Transcarent and Walmart announced a groundbreaking partnership whose potential impact on adherence can’t be overstated. Walmart’s unparalleled physical reach — most of the country lives within 10 miles of a store — and equally significant buying power on medications has driven down the cost of many drugs and made them more accessible. Walmart’s $4 Rx plan is still a major milestone in the history of healthcare, and the company’s recent launch of ReliOn™ NovoLog® vials and FlexPens® will save customers 58 percent to 75 percent off the cash price of branded insulin products. That’s huge.
Transcarent will now be able to make Walmart’s advantageous everyday low-cost pricing and locations directly available to self-insured employers on a scale that could significantly improve adherence rates for a large segment of the workforce. Think about it: self-insured employers’ Members represent half the country’s population. What could access to lower-priced drugs mean to patients, no longer having to make agonizing choices between their health and their finances? What could it mean to employers?
Partnering with Walmart presents a unique opportunity to reverse the medication adherence epidemic. It starts with cost, but it’s only the start, a promising foundation for what will need to be an all-out intervention on solving the challenges that, too often, come between patients and their medication.