Cost of Medication Non-Adherence: 33- 69% of Hospitalizations

This video provides an in-depth exploration of the critical and often underestimated problem of medication non-adherence in healthcare, highlighting its profound impact on patient outcomes and healthcare costs. Dr. Eric Bricker, the speaker, challenges the common assumption that patients consistently take their prescribed medications, revealing a significant breakdown in the adherence process. He systematically presents compelling statistics from the CDC to underscore the magnitude of this issue, demonstrating how non-adherence leads to a substantial portion of hospitalizations and imposes a massive financial burden on health plans and employers.

The presentation details the lifecycle of a prescription, illustrating how adherence rates drastically decline at each stage. Out of every 100 prescriptions written, only 50-70% are filled, 48-66% are picked up, a mere 25-30% are taken correctly, and only 15-20% are correctly refilled. This cumulative failure results in approximately 50% of patients being non-adherent at any given time. Dr. Bricker emphasizes that this hidden problem is not just a medical issue but a significant financial drain, directly impacting the efficacy of treatments and the overall health of a population.

A core focus of the video is quantifying the financial ramifications of non-adherence, particularly for employer-sponsored health plans. Dr. Bricker calculates that 33-69% of all hospitalizations are attributable to medication non-adherence, which translates to roughly 16% of a health plan's total annual costs. Using a hypothetical 1,000-employee plan with $10 million in annual healthcare costs, he demonstrates that $1.6 million is wasted due to non-adherence, equating to $133 per employee per month across the entire plan, or a staggering $323 per non-adherent employee per month. This detailed financial breakdown serves to highlight the urgent need for effective interventions.

Finally, the video delves into the primary reasons for non-adherence, revealing surprising insights. Contrary to popular belief, cost is not the leading factor. The top reasons cited by patients are forgetting (42%), running out of medication (37%), and being away from home/medication (27%), with cost ranking fourth at 22%. This crucial distinction reframes the problem, shifting the focus from financial barriers to behavioral and logistical challenges. Dr. Bricker concludes by asserting that medication non-adherence is a solvable problem, advocating for reminder interventions such as phone calls, text messages, and in-person or virtual appointments, which have been proven to significantly increase adherence rates.

Key Takeaways:

• Pervasive Non-Adherence: A staggering 50% of patients are non-adherent to their prescribed medications at any given point in time, indicating a widespread and critical healthcare challenge.
• Major Cause of Hospitalizations: Medication non-adherence is a primary driver of hospital admissions, accounting for 33% to 69% of all hospitalizations, underscoring its severe impact on patient health and healthcare system strain.
• Breakdown in Prescription Process: The journey from prescription to correct usage is fraught with failure points; only 50-70% of prescriptions are filled, 48-66% are picked up, 25-30% are taken correctly, and a mere 15-20% are refilled correctly.
• Significant Financial Burden: Medication non-adherence contributes to approximately 16% of an employer's total health plan costs, representing a substantial financial drain that often goes unrecognized.
• Quantifiable Employer Costs: For a hypothetical 1,000-employee health plan spending $10 million annually, non-adherence accounts for $1.6 million in wasted costs, or $133 per employee per month across the plan.
• High Cost Per Non-Adherent Individual: The financial impact is even more concentrated on individuals, with each non-adherent employee costing their plan nearly $4,000 per year, or $323 per month.
• Primary Reasons Are Not Cost-Related: The leading causes of non-adherence are behavioral and logistical: forgetting (42%), running out of medication (37%), and being away from home (27%), with cost being a less frequent reason (22%).
• Medication Efficacy Depends on Adherence: Medications are scientifically proven effective only when taken correctly, as demonstrated in clinical trials; non-adherence negates their intended therapeutic benefits.
• Hidden Problem: Non-adherence is an "unseen problem" in healthcare, as there are no immediate indicators for employers or providers, yet its consequences are profound and costly.
• Solvable Through Interventions: Medication non-adherence is a solvable problem, with reminder interventions (e.g., phone calls, text messages, in-person/virtual appointments) proven to significantly increase adherence rates.
• Challenge Assumptions: Healthcare stakeholders, especially employers, should not assume patients are taking their medications correctly but rather assume the opposite, given the high rates of non-adherence.
• Focus on Behavioral Solutions: Interventions should prioritize addressing the top reasons for non-adherence—forgetting, running out, and being away from home—rather than solely focusing on cost.

Tools/Resources Mentioned:

• CDC (Centers for Disease Control and Prevention): The primary source for the statistics and data presented in the video, specifically referencing a CDC Grand Rounds video.

Key Concepts:

• Medication Non-Adherence: The failure of patients to take their medications as prescribed by their healthcare providers, encompassing not filling prescriptions, not taking them correctly, or not refilling them.
• Adherence Rates: The percentage of patients who consistently follow their prescribed medication regimen.
• PEPPM (Per Employee Per Month): A common metric used in healthcare finance to express costs on a per-employee, per-month basis.

Examples/Case Studies:

• Hypothetical 1,000-Employee Health Plan: Dr. Bricker uses a scenario of a 1,000-employee health plan with $10 million in annual healthcare costs to illustrate the financial impact, calculating that $1.6 million (16%) is attributable to hospitalizations caused by medication non-adherence. This breaks down to $1,600 per employee per year or $133 per employee per month across the entire plan, and $3,874 per year or $323 per month for each of the 413 non-adherent employees within that plan.