What Pills Don’t we Take??

I am always fascinated when I see a study that asks a question that no one would normally ever think to ask. In today’s Annals of Internal Medicine, Drs. William Shrank, et al. do just that.

Using the records of a large pharmacy benefits manager, the group decided to see what kinds of prescriptions get filled, but never picked up by patients. The results are very instructive:

1) The top reason to “abandon” a prescription was sticker shock. If the co-pay was $40- $50, people were 3-1/2 times as likely to walk away, and if over $50, over 4-1/2 times as likely to leave it behind.
Lesson: Doctors should understand the costs of the medications they use and find cost-effective alternatives (or alternatives with lower co-pays), if they want their patients to follow through. There are opportunities for doctors and pharmacists to work collaboratively here.

2) New prescriptions are abandoned at three times the rate of ones previously taken.
Lesson: Doctors need to take the time to explain new prescriptions–the rationale for their use, instructions, cautions, and realistic expectations for results. They also need to listen for any questions patients might have before sending them off.

3) Insulin is one of the medications abandoned most often.
Lesson: We need better drug delivery systems, better training for self-administration training and better support for diabetic patients. Needless to say, not filling this one could be dangerous. Whatever happened to the transdermal insulin shot that was supposed to be the next best thing?

4) An electronically-submitted prescription is more likely to be abandoned than one that is hand-carried. (Of course, we don’t know how many hand-carried ones never get to the pharmacy.)
Lesson: If there is a concern about compliance, a hand-carried prescription will put more initiative on the patient, and will also reduce the cost inefficiencies and medical record errors caused by drugs that are electronically filed but never filled or taken.

5) These “prescription abandonments” is all very expensive, as well as potentially harmful. In this cohort, 3.27% of the 10 million prescriptions filed were not picked up. Of those, a little more than half were never replaced and the rest were replaced within 30 days by another drug in the same class. Extrapolating to the 110 million prescriptions written annually, these “abandonments” cost the health care system half a billion dollars a year in pharmacy work, plus untold dollars in potentially adverse outcomes.

Last lesson: Looking at data we never examined before can tell us a lot about effective physician-patient communication and potential barriers to real care.

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3 Responses to What Pills Don’t we Take??

  1. Karen Overturf says:

    Number 4 bothers me. The communication issue is clear, but why would a pharmacist not call a patient to let him/her know a prescription is ready for pick-up? It seems that having a way for a patient to have something in hand that is not a prescription, perhaps a “copy only – electronic prescription submitted” for a patient to carry to his pharmacist so that the patient knows the correct medicine is dispersed would be excellent. My doctor makes sure I carry my prescription, even though it’s recorded on computer and printed. If I call and request something, then it is electronically submitted, but then my doctor’s nurse calls me and tells me it has been, and I can go pick it up. I shall be sure to tell her (again) how wonderful a physician she is when I see her this month!

    It does help to have patients who are savvy about medical conditions and know how and when to communicate with the doctor. How do we educate for that?

    Did this article mention the percentage of the total medications that did not get picked up, and (if they knew) the number of medications that were not picked up because of other circumstances (in the case of diabetics, perhaps, those people might have found themselves in the hospital?)

    Again, Dr. Power, you have given us some insightful food for thought!

  2. Karen Overturf says:

    I had forgotten my question about making patients more aware of their health issues, and how to communicate. What if we were to ask AHRQ to add a section to “Health Classes” (previously P.E.) regarding “What to do when…” and how to observe oneself when going through some potentially serious symptoms? How many people would recognize depression and suicide issues, the onset of infections of various small and major organs, what to do if you notice something before it gets serious, etcetera? Can you imagine how that would change how people age, and perhaps they would learn to age well, without running to the doctor at the wrong time or for the wrong reasons?

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