Steep Co-Pays May Cause Some to Abandon
MONDAY, Nov. 15 (HealthDay News) -- In these tough economic
times, even people with health insurance are leaving prescription
medications at the pharmacy because of high co-payments.
This costs the pharmacy between $5 and $10 in processing per
prescription, and across the United States that adds up to about
$500 million in additional health care costs annually, according to
Dr. William Shrank, an assistant professor of medicine at Harvard
Medical School and lead author of a new study.
"A little over 3 percent of prescriptions that are delivered to the pharmacy aren't getting picked up," said Shrank. "And, in more than half of those cases, the prescription wasn't refilled anywhere else during the next six months."
Results of the study are published in the Nov. 16 issue of the
Annals of Internal Medicine.
Shrank and his colleagues reviewed data on the prescriptions
bottled for insured patients of CVS Caremark, a pharmacy benefits
manager and national retail pharmacy chain. CVS Caremark funded the
The study period ran from July 1, 2008 through Sept. 30, 2008.
More than 10.3 million prescriptions were filled for 5.2 million
patients. The patients' average age was 47 years, and 60 percent
were female, according to the study. The average family income in
their neighborhoods was $61,762.
Of the more than 10 million prescriptions, 3.27 percent were
Cost appeared to be the biggest driver in whether or not someone
would leave a prescription, according to the study.
If a co-pay was $50 or over, people were 4.5 times more likely
to abandon the prescription, Shrank said, adding that it's
"imperative to talk to your doctor and pharmacist to try to
identify less expensive options, rather than abandoning an
expensive medication and going without."
Drugs with a co-pay of less than $10 were abandoned just 1.4
percent of the time, according to the study. People were also a lot
less likely to leave generic medications at the pharmacy counter,
according to Shrank.
The medications most frequently abandoned were cough, cold,
allergy, asthma and skin medications, those used on an as-needed
basis. Insulin prescriptions were abandoned 2.2 percent of the
time, but Douglas Warda, director of pharmacy for ambulatory
services at the University of Chicago Medical Center, said this
might be a cost issue, but it could also be that some people are
afraid to inject insulin.
The study also found that antipsychotic medications were
abandoned 2.3 percent of the time.
Drugs least likely to be abandoned included opiate medications
for pain, blood pressure medications, birth control pills or
hormone replacement therapy, and blood-thinning medications,
according to the study.
Young people between the ages of 18 and 34 were the most likely
to forgo their prescriptions, and new users of medications were
2.74 times more likely to leave their drugs behind.
Prescription orders that were delivered to the pharmacy
electronically -- via the computer -- were 64 percent more likely
to be abandoned than prescriptions walked into the pharmacy.
"We're definitely not saying that e-prescribing is bad; it's great, but there appear to be some unintended consequences," said Shrank.
There was no way to tell if people never tried to pick up their
prescriptions, or if they went to retrieve them but chose to leave
them behind because of the cost.
Warda said he believes that more patients might pick up their
medications if the instructions from their physicians were clearer.
For example, prescriptions for proton pump inhibitors were left at
the pharmacy 2.6 percent of the time. These medications reduce the
amount of acid in the stomach and can help prevent heartburn or
more serious problems. "If the physician message is, 'You need to
take these medications for two to three months and it will reduce
your pain and help your body heal,' fewer people might abandon
these medications," he said.
Plus, if cost is an issue for you, bring it up with your doctor
ahead of time, he added. "Don't get blindsided at the pharmacy.
Always ask your physician if there's a generic option, or if
there's something cheaper that might work just as well. Sometimes
people are embarrassed to say anything, but it's better to ask and
get a medication you can afford.
"If you get to the pharmacy, and you can't afford the medication, follow up with your doctor or ask the pharmacist if there's a cheaper alternative," suggested Warda.
For advice on reducing drug costs, visit the
U.S. Agency for Healthcare Research and
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