Prescription Problem Children

Who is to blame for the high costs and enormous waste—+++an estimated $700 billion of it[[[http://www.reuters.com/article/idUSTRE59P0L320091026]]]+++—in the health-care system? Over the last year, just about every possible culprit has been trotted out: doctors who administer unnecessary tests, insurance and drug companies who hike premiums and prices for their own benefit, lawyers who spend both money and time on unwarranted malpractice cases. Here’s one you probably haven’t heard, though: grandmas who forget to refill their pill bottles promptly.

A +++new report[[[http://www.express-scripts.com/research/studies/drugtrendreport/]]]+++ from Express Scripts, a prescription-management company, says that $1 out of every $5 spent on prescription drugs goes down the drain—for an astonishing total of $163 billion wasted—simply because patients don’t take their meds in the ways they’re supposed to. They put off getting refills until it’s too late and then develop complications from going off their meds; they stick with high-cost brands instead of equally effective cheap generics; they get distracted and forget to pop their pills. “What’s striking is how much of this is due to inattention, procrastination, and forgetfulness—which explains why the classical economic theory approach has gotten us only part of the way to where we need to be with influencing health-care costs,” says Bob Nease, one of the study’s authors. “All of us in health care have thought if we just send a price signal, like substituting cheaper generics for brand-name drugs, people would respond rationally. But a lot of these behaviors aren’t reliant on financial incentives. It’s more about understanding real human behavior and addressing it head-on.”

Here are the biggest offenders the study found, with commentary from Nease, who is chief scientist at Express Scripts:

1. The Refill Procrastinator

Sure, he’ll get his prescription filled—tomorrow. Then he doesn’t, and as a result, he ends up not adhering to the regimen he should be on, with his health suffering as a consequence. “It turns out I am a Refill Procrastinator,” says Nease. “I take a generic medication for high blood pressure, and I do a very good job taking my pill every day. I’m a very conscientious person, so I’m usually on top of things. But things that come around every month, I have trouble with. Like oil changes: I’m always saying, ‘I’ll get around to that later.’” A few months ago, Nease noticed he could see the bottom of his pill bottle, which meant he was running low. “I knew what I needed to do,” he says. “Then, I’d go to work and forget and come home and say, ‘I’ll do it tomorrow.’ Pretty soon I had a gap in care.” The Refill Procrastinator can get himself into trouble if he waits too long to replenish his supply, especially if he has a chronic disease such as diabetes that requires constant vigilance. The solution, Nease says, is to get pills delivered to the home instead of having to head to the pharmacy every month. Express Scripts’s studies show that home delivery helps patients stay on their meds—and, after signing himself up for it, Nease knows that from personal experience.

2. The Sporadic Forgetter

If it’s a Monday, she’s on her meds. If it’s a Sunday, her schedule is off, so she forgets. [Author’s confession: This is me. I can’t recall a single time I’ve ever managed to take a medication regularly without missing a day or two.] Nease has a neat solution to this: Peg your pill-popping to something you do every single day. For him, it’s brushing his teeth. “My physician gave me what he called the toothbrush talk,” he says. “If you put your pill bottle on top of your toothbrush, after two weeks you’ll feel awkward brushing your teeth without taking your pill first.”

3. The Loyalist

His doctor prescribed the brand name, so that’s what he takes. Besides, he knows this drug is good, because, as the Express Scripts report puts it, he “saw an ad [for it] on TV and that guy seemed to be happy.” The Loyalist’s reluctance to try a generic leads to $51 billion wasted each year. That’s not including the billions of dollars that pharmaceutical companies spend promoting their products. We’ve +++written about this before[[[http://www.newsweek.com/id/158746]]]+++, but it bears repeating: generics are just as good!

4. The Active Decliner

She doesn’t have symptoms, probably because her prescription is working, and she thinks that’s evidence that she’s healthy and doesn’t actually need to take said pill. (As the report has it: “My doctor says I should take this medication regularly, but I can’t tell if it’s doing anything—really, I feel fine most of the time.”) The Active Decliner may also be put off by the cost of prescription drugs or by side effects. To fix this problem, the report recommends “clinician interventions”—i.e., the responsibility for this one is on doctors.

5. The Traditionalist

She could get home delivery of her med refills, but she’d rather do it old-school—go to the store, say hi to the pharmacist, pick up some milk while she’s at it. One problem: what if she can’t make it on the day her pills run out? Like the Refill Procrastinator, the Traditionalist would be better served by home delivery—and hey, if she really wants to see the pharmacist, she can swing by while she’s buying the milk. “What turns out to be a very potent way to approach this problem is a program where we stop people and just ask them, ‘Where do you want to get your medication?’” says Nease. “We saw a tripling of home delivery in 10 weeks.”