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The Staggering Cost of Non-Optimized Medications



Let’s do the numbers, shall we?
The United States spends more on healthcare than any other developed country in the world.

 

 

Despite this, health outcomes in the US lag far behind those in other OECD countries. This is true for everything from hospital admission rate, to medical error rate, to mortality rate.  If you follow healthcare, you have heard these factoids over and over and over…and over.

 

Runaway healthcare costs remain a growing problem. Healthcare spending grew 4.6 percent in 2018, reaching $3.6 trillion or $11,172 per person according to the Center for Medicare and Medicaid Services, and shows no signs of slowing down any time soon.

 

Prescription drugs represent a significant chunk of these total annual healthcare expenditures, with estimates ranging from $325 to $500 Billion each year.

 

Drug prices and the opaque mechanisms by which medications are routed from manufacturers to patients through a web of Pharmacy Benefit Managers(PBMs), wholesalers, specialty pharmacies and insurance providers (all at a markup) has come under scrutiny by both Congress and the White House. There is increasing bipartisan(!) public support for actions aimed at reducing prescription drug costs and expenditures.


Drugs work, but only if…
Most people agree that medications are helpful in alleviating symptoms, allowing for the management of chronic conditions and generally helpful in maintaining or improving overall health and wellbeing for those that are sick. They also agree that prescriptions are generally too expensive, and that they don’t work as well as they should given the price.

 

 

Several media and academic reports have suggested that the problem with medications not driving expected results such as improved health (better clinical values) and reduced costs (fewer hospital stays) is primarily one of access (cost, convenience) and behavioral economics (forgetfulness, lack of health awareness). This is widely referred to as the “medication adherence problem”, which has been a hot topic for years across government, academia, and private enterprise. Many technology and tech-enabled service companies have raced into this space with a host of apps, connected pill bottles, chatbots and call center services.

 

While important, the two issue-sets above, the “medication adherence problem”, are only part of why patients are not seeing the expected results.

Patients are frequently not on the safest and most effective medications for their conditions.

It is crucial to remember that these powerful medications only work if the following criteria are ALL met:


1. A person is correctly diagnosed with a condition that requires medication therapy
2. A person is written a prescription for the correct type of medication for their conditions
3.  A person is receiving a prescription for the correct dose of the medication required for it to have a clinical impact
4.  A person is able to afford their medication
5.  A person is able to collect or receive their medication as needed
6.  A person is educated to take their medications in the correct manner
7.  A person is able to take their medications as needed, without discontinuation because of harmful side effects
8.  A person is not taking any other medications or supplements that may have a harmful effect in combination with this medication
9.  A person has a reliable way of obtaining and taking their medication in a consistent manner
 
These criteria do not even take into account other critical considerations which include:
  • Whether a person is being prescribed the most optimal medication for their condition
  • Whether a person’s care team is fully aware of the patient’s current and ever-changing health status
  • Whether a person’s unique circumstances are being taken into account, including their demographics, geographic location, unique social needs, and behavioral profile
Source: Omada Health

 

Not addressing ALL of the former, and not considering ALL of those latter points is defined as “Non-optimized” use of medications.

These issues are directly responsible for an innumerable number of negative health outcomes, including 33 million hospitalizations and 125,000 deaths each year in the US.

Total healthcare spending due to non-optimized medications is over $528 Billion a year in the US. That is more than the value of Disney, Costco and Coca Cola combined and represents one in every six healthcare dollars spent.

Adapted from Watanabe et al. Ann Pharmacother. 2018 Sep;52(9):829–837

 

The good news is, these issues have been shown to be highly preventable. Comprehensive medication management programs by clinical pharmacists in collaborative practices with physicians and other prescribers are an effective and scalable approach to curbing this particular aspect of the healthcare crisis. The development and expansion of these programs will help ensure that patients everywhere are receiving optimal care.

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