Drug abandonment compromises quality of care, pharmacy productivity

Key Points

Consumer out-of-pocket cost is the leading reason for healthcare plan members' failure to pick up filled prescriptions (drug abandonment), according to the healthcare data company Wolters Kluwer Pharma Solutions. The firm reports that by the second quarter of 2010, the drug-abandonment rate had risen 550% in 4 years.

During that quarter, nearly 1 in 10 new prescriptions for brand-name drugs was abandoned by a member with commercial health-plan coverage.

The healthcare data company analyzed 80 million claims that pharmacies make each month for payment - about 40% of the total market.

According to a study conducted by CVS Caremark, Harvard, and Brigham and Women's Hospital, 3.27% of prescriptions filled at CVS pharmacy locations between July 1 and September 30, 2008, were abandoned.

The CVS Caremark, Harvard, and Brigham and Women's Hospital study is the first comprehensive study of drug abandonment, linking retail and insurance claims to help change behavior, said William Shrank, MD. An assistant professor of medicine at Harvard Medical School, he is affiliated with Brigham and Women's Hospital and is lead author of the study.

Continuum of nonadherence

While 3.27% of patients abandoned their prescriptions, nearly half of these patients purchased a prescription for a drug in the same class at a pharmacy within 30 days. Although it seems like a small percentage, it translates to 110 million abandoned prescriptions (out of 3.6 billion prescriptions filled at pharmacies in 2008).

Drug abandonment is part of the continuum of nonadherence to healthcare. According to a recent New England Healthcare Institute (NEHI) study, medical spending resulting directly from nonadherence accounts for up to $290 billion per year, or 13% of total healthcare expenditures.

Who abandons?

The study is part of a CVS Caremark effort to research how consumers interact with their pharmacies, so that they can be encouraged to remain adherent to their medications.

According to Shrank, the study data outline and validate a simple rule that pharmacists can apply to help them assess whether patients are likely to abandon drugs, providing an opportunity to intervene if necessary and improve medication use along the continuum of care.

The basis for a predictive model can be derived from the following study data:

Complication: Specialty drugs

Paul Setlak, regional clinical executive, Abbott Laboratories, headquartered in Chicago, said that drug abandonment is an ongoing issue, but it has not become prevalent enough to gain much attention. However, he expects that the problem will accelerate as more specialty drugs hit the marketplace.

"Patients might pay once or twice for a high-cost specialty drug but feel that if they are not receiving value for the money or that the drug is not living up to expectations, they will not return for the next prescription," Setlak said.