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Medication Adherence and Out of Pocket Costs

By Clive Riddle, March 25, 2016

While out of pocket costs impact consumer demand and utilization for healthcare services in various degrees for all aspects of care, the relationship is perhaps the most direct for prescriptions. This direct relationship is due to both the relatively lower average cost per prescription compared to the per unit cost of most other health care services, along with the behavioral economics implications that a prescription typically delivers delayed results, while most other healthcare services provide perceived potentially immediate results.

In this context, Truveris, a pharmacy benefits solutions provider, has just released study results examining medication adherence based upon out of pocket prescription costs. They found that “85 percent of prescriptions are filled when the price at the register is around $30. Once the cost of a prescription surpasses $50, the rate starts a notable decline, dropping to 76 percent. The number of prescriptions filled drops even further, to 65 percent, when the cost is $90 and above.”

Kristin Begley, Chief Pharmacy Officer at Truveris tells us “as healthcare costs continue to burden Americans, there is ample evidence of increased prescription costs leading to discontinuation of medications in order to save money. We’re seeing a troubling trend that when drug prices reach a certain level, consumers are simply walking away, not filling the prescriptions and, in effect, gambling on their health. This should be an urgent wake-up call across the healthcare spectrum.”

Taking things a step further, a Geisinger study published in the February 2016 issue of The American Journal of Managed Care “shows that instituting a zero prescription co-pay for its chronically ill employee population resulted in a positive cost saving and return on investment.”

The Geisinger study found “that a zero co-pay drug program for its chronically ill employee population was associated with positive cost savings and a return on investment of 1.8 over five years….More than 200 prescription medications were selected to be eligible for the $0 co-pay program; those selected were designated for chronic conditions like high blood pressure, cholesterol and diabetes management and were preventative in nature. Geisinger researchers say that VBID implementation within the context of a wider employee wellness program targeting the appropriate population can potentially lead to further positive cost savings.”

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