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Cut Drug Copayments To Bolster 'Adherence'
The Baltimore Sun
June 16, 2009
By Gary E. Applebaum, MD
President Barack Obama and congressional Democrats have promised to pass sweeping health reform legislation by year's end. But before they overhaul the entire U.S. health care system - and pledge trillions in spending - they ought to consider policies that transcend traditional political divides and have already proven successful.
Here's one such policy: improve patient "adherence" to doctor-ordered courses of prescription drugs.
In recent years, pharmaceuticals have been integral to improving Americans' health. Thanks to innovations in virtually all aspects of drug research, Americans are more productive, have lower mortality rates for many diseases and visit the hospital thousands of times less than they would otherwise.
Unfortunately, millions of patients don't always follow the drug regimens prescribed by their doctors. This widespread "non-adherence" - which may involve skipping doses, taking less than the recommended amount of a drug or ceasing to take a drug before the supply has run out - makes Americans less healthy and ends up increasing the cost of health care.
Three-quarters of adults prescribed drugs admit that non-adherence is a problem for them. Only half of those suffering from chronic diseases like diabetes and hypertension fully adhere to their medication regimens, according to an article in February's American Journal of Managed Care. A fifth of those with hypertension never bother to get their first refill, a 1997 study found.
Of course, many patients may deviate from their prescribed treatments because they're concerned about the cost. Ignoring a doctor's orders, though, can result in even higher medical bills down the road. After all, it's far cheaper to take a daily cholesterol-lowering pill than it is to deal with a heart attack.
Non-adherent patients with hypertension suffer 5.4 times as many poor clinical outcomes as those who take their medicines as prescribed. For non-adherent patients with heart disease, the likelihood of a poor outcome is 1.5 times higher.
All told, non-adherence costs the U.S. health care system between $100 billion and $300 billion a year, studies have shown. About 125,000 people die each year because of complications brought on by non-adherence, according to a 1998 article in Business Health.
These negative health consequences are tragic because they're so preventable. If we could simply improve patients' compliance with their doctors' orders, we could make significant gains in the overall health of the American public.
Increased rates of adherence also have the potential to save us billions of dollars.
If all patients suffering from elevated blood pressure received the appropriate drug treatment, the country could save $16.5 billion by avoiding nearly 90,000 deaths and 400,000 hospitalizations.
Increasing drug adherence among workers with rheumatoid arthritis would diminish lost productivity by 25 percent, netting the economy an extra $4.4 billion.
So, what's the best way to ensure that patients are taking the drugs they're supposed to?
Lower insurance co-pays for drug purchases would certainly help. Forcing patients to bear the brunt of drug expenses often causes them to stop taking their meds. Insurance policies should cover more of the cost, particularly for medicines that treat chronic diseases.
The long-term savings from such a change would be significant. Researchers recently found that eliminating co-payments for drugs called ACE inhibitors for diabetic Medicare patients would reduce spending by more than $1,600 per patient.
One study determined that eliminating a $10 copayment for cholesterol-lowering statins for certain patients could result in 90,000 fewer hospitalizations and 36,000 fewer emergency room visits each year.
Reducing use of such acute care could save more than $1 billion annually.
A health reform initiative that advances patient health and saves money may sound too good to be true. But improved prescription-drug adherence can accomplish both. As lawmakers strive to implement common-sense health reform, improved adherence is just what the doctor ordered.
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