Tracking Down Patients Who Skip Their Drugs

For doctors, pharmacists and other health care experts, it’s a bitter pill to swallow: nearly a quarter of people who get a prescription don’t bother to fill it.

That gap leads to a variety of health issues, according to Marsha Raebel, a researcher for Kaiser Permanente’s Institute for Health Research in Denver. (KHN is not affiliated with Kaiser Permanente.)

“It sounds clichéd but some people simply just don’t realize that they need to finish their dosage—they feel fine so they stop taking their medication,” she said. Although people may avoid the drugs because of the price, Raebel says that the long-term benefits for those who stick to their medications mean, “they will have less health care costs in the future.”

The New England Healthcare Institute estimates that non-adherence “could result in as much as $290 billion per year in avoidable medical spending or 13 percent of total health care expenditures.”

“It’s an issue that our industry has been aware of for years,” said the chief health care strategist for CVS Caremark, Helena Foulkes.

Recently, Geisinger Health Systems, a hospital-based group in Danville, Pa., and CVS Caremark announced plans to study whether having physicians electronically file prescriptions to a pharmacy might allow better monitoring of drug use and help patients. Dr. William Shrank, of Brigham and Women’s Hospital in Boston who will lead the study, said the 18-month investigation will track a prescription from the moment it is submitted electronically to the pharmacy until it reaches the patient. If the patient does not pick up the prescription, he said, a “red flag” or some form of notification will be sent to the doctor. The researchers will focus on patients with chronic health conditions to see if improving their drug adherence can help reduce long-term health care costs.

During a recent CVS Caremark panel at the National Press Club, Foulkes noted the link between drug adherence and health care spending. She pointed to a study published in Health Affairs in January that found “across the board adherent patients spent significantly less than non-adherent patients.” Foulkes also said that “some 75 percent of the nation’s health care costs are spent on treatment of the chronically ill.”

Shrank said tracking prescriptions will create a “feedback loop that allows the pharmacist and the doctor an easy way to communicate.”

Geisinger, which has been cited widely for its streamlined system of health care, uses electronic health records–something federal officials are pushing other medical facilities to implement. Shrank said that Geisinger was a natural location for the study. “They are innovative, focused on quality improvement, and all the physicians prescribe electronically.”

skulkarni@kff.org