April 2010 · Vol. 22, No. 05
Fewer and fewer patients take
their prescription meds, and you
need to know why
Surveys shed light on the variables that influence
a patient’s drug-taking behavior and on a disturbing trend in adherence
Some findings of a new study of the US pharmaceutical market are not exactly what the doctor ordered. An analysis by Wolters Kluwer Pharma Solutions suggests that economic conditions have changed at least one aspect of patient behavior: Patients expect to participate more fully in decisions about the drugs that are prescribed for them—and when they do participate, they often disagree with their physician.1
That disagreement sometimes manifests in surprising ways. For example, more patients are abandoning prescriptions at the pharmacy;that is, they submit the script to the pharmacy but never pick up the actual drug. In 2009, members of commercial health plans abandoned new prescriptions at a rate of 6.3%, a 24% increase over 2008. That finding suggests that consumers are becoming more price-sensitive, especially to brand-name medication. The abandonment rate for new prescriptions of brand-name drugs was 8.6% in 2009, up 23% from 2008 and an astounding 68% since 2006.1
The study also reveals that 66% of prescriptions filled in 2009 were generic, up from 60% in 2008 and 50% in 2005.1
“Today, patients wield more power and are more inclined to exert that influence in decisions about their prescription drugs,” said Mark Spiers, president and chief executive officer of Wolters Kluwer Pharma Solutions. “During tough economic times, consumers tend to think more with their pocketbooks. We’re seeing increasing price sensitivity to co-pays, and bolder moves by patients in making decisions about their drug therapy. Turning to low-cost generics and, in some cases, walking away from prescriptions altogether are behaviors that help cushion the economic blow.”1
Health plans also exert an influence
The study suggests that health plans continue to influence prescription decisions. Denials for new prescriptions of brand-name drugs were down 1.4% over 2008, but up 22.5% since 2006. Denials represent prescriptions that are submitted to a pharmacy but rejected for reimbursement by a patient’s health plan.1
Taken together, patient abandonment and payer denials meant that 14.4% of all new, commercial-plan prescriptions went unfilled in 2009, up 5.5% from 2008.1
Many health plans encourage widespread use of generic medications. For example, community-based programs sponsored by Blue Cross and Blue Shield companies and employers led to expanded consumer use of generic prescription drugs, according to a survey by the Blue Cross and Blue Shield Association.2
That survey found that generic drug use among plan members increased from 60% to 65% between 2007 and 2008—an increase of more than 8%. The analysis of prescription use among 51 million subscribers in 32 Blue Cross and Blue Shield companies found that expanded use of generic drugs generated at least $2.5 billion in savings. The Blue Cross and Blue Shield Association attributed the marked increase in generic drug use to increased education and promotion, provider incentives, and other variables, such as introduction of $4 generics (30-day supply) at Walmart and other large retailers.2
How much is too much?
In a separate study of patient behavior that focused on two classes of drugs—tumor necrosis factor (TNF) blockers and multiple sclerosis (MS) biologic agents—Gleason and colleagues determined the out-of-pocket expenses associated with prescription abandonment. When an individual claim’s out-of-pocket expenses exceeded $100 for a TNF blocker, or $200 for a MS drug, patients were more likely to abandon the prescription.3
That study also noted that the almost 8 million members of the Federal Employees Health Benefits Program spent an out-of-pocket maximum that ranged from $50 to $400 for a 30-day supply of a drug and from $1,500 to $7,000 annually. Investigators analyzed data from the program for November 2008 to April 2009. They determined that, for the median household income of $50,233, the out-of-pocket expense for a single specialty medication could represent as much as 9% of gross income.3
1. Patients take more power over prescription decisions [press release]. Bridgewater, NJ: Wolters Kluwer Pharma Solutions; March 16, 2010.
2. Generic drugs can be good for your health and your wallet [press release]. Washington, DC: Blue Cross Blue Shield Association; April 9, 2009.
3. Gleason PP, Starner CI, Gunderson BW, Schafer JA, Sarran HS. Association of prescription abandonment with cost share for high-cost specialty pharmacy medications. J Manag Care Pharm. 2009;15(8):648–658.
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