Health

The $289 Billion Cost of Medication Noncompliance, and What to Do About It

By Brian Fung

New recommendations focus on relatively inexpensive fixes that could significantly reduce health-care waste.

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Fillmore Photograph/Flickr

Last week, we explained how the United States spends $750 billion a year on wasted health care. Much of that comes from administrative costs and the ordering of unnecessary medical procedures.

But another major source of waste doesn't show up until after the doctor's visit. According to a meta-analysis published yesterday in the Annals of Internal Medicine, Americans are failing to comply with medication prescriptions for a variety of reasons -- and it's costing them anywhere between $100 billion to $289 billion a year.

In some 20 percent of cases -- and as many as 30 percent -- prescriptions for medication are never filled. Up to 50 percent of medications aren't taken as prescribed.

Medication noncompliance creates major headaches for patients and doctors alike down the road, and can sometimes be deadly. For example, someone with congestive heart failure who doesn't take their diuretics correctly, regularly, will often wind up in the hospital again and again. Failure to follow prescriptions causes some 125,000 deaths a year and up to 10 percent of all hospitalizations, the study's authors say.

As we're getting a better grasp on how individual behaviors affect the health-care system at large, we're trying to find ways to improve medication adherence. Among the recommendations in the analysis:

  • Switch to better packaging: At the consumer level, blister packs have been shown to boost compliance in patients with hypertension
  • Use case management and coordinated care more effectively: At the systemic level, appointing a pharmacist, doctor, nurse or other health professional to oversee a patient's care increased medication adherence among patients with hypertension, heart failure, depression and asthma
  • Invoke education and behavioral support: Phone calls, mailings, and even videoconferences may make a difference for high-cholesterol, high blood pressure, heart failure and heart attack patients
  • Give health professionals access to compliance data: If a doctor or pharmacist knows a patient has had trouble taking their pills regularly, they can take steps to intervene
  • Make drugs cheaper: Reducing out-of-pocket costs by trimming copays or expanding drug coverage led to a 14 percent decrease in the rate of heart-disease patients having their first vascular event (e.g., a stroke or heart attack), according to the meta-study. Even if they have medications in their cabinets, patients may be less likely to take them on schedule for fear of being unable to afford refills later. Improving drug affordability may therefore convince the thrifty to refill their prescriptions as needed rather than on the basis of their budgets

The fifth finding seems especially timely. It vindicates policy measures like Medicare Part D and the Affordable Care Act, the latter of which has saved seniors and the disabled some $4 billion on prescription drugs already, the Department of Health and Human Services found in July.

By saving lives and eliminating waste, increasing prescription adherence is good for the health industry and the broader economy. But as Richard Gunderman points out, health care at the individual level is still about real human beings. Even if it weren't true that better medication compliance led to reduced health-care costs -- something that other research implies but which the latest meta-analysis found little evidence for -- helping people take their medications (correctly) is still the right thing to do.