Follow-ups may prevent prescription abandonment

August 27, 2019
Valerie DeBenedette

Valerie DeBenedette is managing editor of Drug Topics.

Nonadherence to a medication regimen is a problem in all of medicine, not just rheumatology. About 50 percent of all medications for chronic diseases are not taken as prescribed. Put another way, about two in every three Americans who have regular prescriptions aren’t taking them or aren’t taking them on schedule.

Nonadherence to a medication regimen is a problem in all of medicine, not just rheumatology. About 50 percent of all medications for chronic diseases are not taken as prescribed. Put another way, about two in every three Americans who have regular prescriptions aren’t taking them or aren’t taking them on schedule.

In addition to nonadherence-in which the patient has picked up the prescription but doesn’t take it correctly-there is prescription abandonment which includes patients who never pick up the prescription from the pharmacy.

Why don’t patients pick up their prescriptions? A large 2010 study looked at data on first prescriptions from a large retail pharmacy chain and a large pharmacy benefits manager. It found that, over the course of three months and more than 10 million prescriptions, about 327,00 were abandoned. A big factor is cost.

Prescriptions with copayments of $40 to $50 and prescriptions that cost more than $50 were 3.40 times and 4.68 times more likely, respectively, to be abandoned than those with no copayment. New users of medications had a 2.74 times greater probability of abandoning the prescription than those who were already using the medication. Prescriptions that were sent to the pharmacy electronically were also less likely to be picked up than those with paper scripts. One limitation to this study was that it included only patients who had health insurance with prescription coverage, which means that abandonments due to cost may be underreported.

According to a 2019 study conducted in six pharmacies in North Carolina, 73 patients failed to pick up 124 prescriptions over a 60-day period. The most common reason given, for 32 percent of patients, was that he or she forgot about the prescription. Eighteen percent said they didn’t pick up the prescription because of the drug cost and 11 percent said transportation issues prevented them from picking up their prescription.

This study noted that the pharmacies in the study offered services such as medication synchronization, where the patient can pick up all his or her refill prescriptions in one visit each month, and adherence packaging, where medications are portioned out into a pill cases, blister cards, or packets that are marked with the day and time they should be taken.   

Nonadherence, including prescription abandonment, for any reason is associated with poorer treatment outcomes, increased morbidity and mortality, and higher healthcare costs.

According to the "Medicines Use and Spending in the U.S." issued in 2016, "More than one in four specialty brand prescriptions are abandoned during the deductible phase, which is three times greater than the abandonment rate when there is no deductible."

"The vast majority of specialty medications used in rheumatology are single source therapies with no equivalent generic product or therapeutic alternative. Therefore, patients are left without access to effective therapeutic alternatives, and prescription abandonment ensues," according to a statement issued by the American College of Rheumatology in 2018.

Often a rheumatologist may not know a patient never picked up the prescription. “In some cases, when that happens, we only find out about it on the next visit,” says Suleman Bhana, M.D., FACR, a rheumatologist in practice in the Hudson Valley of New York State. Specialty pharmacies may send him messages about patients who fail to pick up their prescriptions, but not other pharmacies, he adds.

How can rheumatologists help patients become more adherent or prevent prescription abandonment? One step is to ask patients about any issues they have in obtaining or using the prescription, Bhana says. Ask about the patient’s health insurance and what the copays are for a given medication. Ask if the patient has any transportation issues that make getting to the pharmacy difficult.

Programs such as GoodRx.com, WebMDRx, ScriptSave WellRx, and NeedyMeds.org can help patients find better prices for their prescriptions.

Both chain and independent pharmacies often offer services to patients that can help reduce prescription abandonment and improve adherence. Some are as simple as home delivery of prescriptions, while others can include special packaging or medication synchronization. Pharmacists can also advise patients about patient assistance programs from pharmaceutical manufacturers that can help them afford a medication that carries a high copay or that is not covered by their insurance.  

 

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