Economics, Health Care

Medication non-adherence and the Obama administration’s misguided efforts to achieve health savings

Image Credit: Shutterstock

Image Credit: Shutterstock

It is well documented that patients’ failure to take prescribed medicines as directed costs a great deal. According to the New England Healthcare Institute, non-adherence amounts to $290 billion annually in unnecessary health care spending in the United States. Non-adherence can accelerate disease progression, lead to unnecessary disease complications, reduce patients’ functional abilities, lower quality of life, and even lead to death.

Despite this prime target for significant health care savings, the Obama administration’s most recent budget has no explicit agenda in this field, instead proposing additional rebates from pharmaceutical companies for drugs provided to low-income beneficiaries in Medicare Part D. As I wrote in April:

Drug rebates have been shown to operate just like taxes, and drug companies will respond to rebates as they would to a tax—by shifting costs to others to the extent possible. As drug costs may be one reason for patients to avoid taking their medicines, this shift could have the perverse effect of actually worsening adherence.

The rebate proposal for Part D comes after the increased Medicaid rebates and the new excise tax on brand drugs in the Affordable Care Act. In short, the Obama administration is pursuing a detrimental budget policy change — a hidden tax on pharmaceuticals — while ignoring a bigger policy matter that has even larger budget implications: improved medication adherence.

But don’t worry — here comes the FDA to the rescue. The agency recently announced a funding opportunity to address medication non-adherence and noted, “Nearly three out of four Americans report that they do not take their medication as directed. One in three people never fill their prescriptions.” Clearly a serious problem.

The FDA’s strategy? A two-year grant totaling $200,000 available only to one organization, the left-leaning National Consumers League (NCL). How should the money be spent? According to the FDA’s announcement:

The following are some specific objectives that FDA believes can further enhance the [NCL’s] “Script Your Future” campaign: (1) Addition of patient and family caregiver testimonials to the campaign Web site; (2) creation of a custom “I Will” tab on the “Script Your Future” Facebook page; (3) translation of the radio public service announcement from English to Spanish; (4) development of “Script Your Future-in-A-Box,” a turnkey package incorporating press background materials and other elements; and (5) organization of a public event in fall 2013 and a study to measure the reach of events, media, and partner engagement.

In other words, the FDA has planned a $200,000 rifle shot to one entity to enhance a social media campaign to tackle a $290 billion problem while elsewhere in the Department of Health and Human Services efforts continue to squeeze drug manufacturers with an additional de facto tax.

3 thoughts on “Medication non-adherence and the Obama administration’s misguided efforts to achieve health savings

  1. Alex, it’s great to see AEI scholars focused on and concerned with the major problem of prescription drug adherence in the United States. Too often America’s conservative scholars are tagged as heartless when they are just looking at presenting the facts. Indeed, people are getting sick and dying because they’re not taking prescribed medication, and shifting costs through rebates on Medicare Part D drugs wont’ solve it! I should say it could help a little, however, but it’s not a real solution.

    You forgot to mention the main reason why so many Americans are skipping taking medication: high drug prices. The numbers are almost unbelievable: 50 million Americans did not take prescribed medication in 2012 due to drug costs, according to the Commonwealth Fund:

    We agree that that the National Consumers League “Script Your Future” program will not be impactful but you should know that calling it “left-leaning” isn’t true. There’s nothing left or right leaning about that program. The program sponsors and partners include left-leaning groups for sure, such as AARP, but many of the funders are pharmaceutical companies and their main trade associations the Pharmaceutical Researchers and Manufacturers of America (PhRMA) and the Generic Pharmaceutical Association, as well as U.S. pharmacies. Here’s the source: One could argue that these companies support NCL’s adherence programs because they do nothing to actually challenge the status quo but present band aids, such as enhancing NCL’s social media campaign, as you point to.

    Alex, what’s the solution to high drug prices for Americans who are struggling? Your colleague, Roger Bate, recommends personal drug importation as helpful:

    Gabriel Levitt
    Vice President

    • Drug prices are certainly out of this world, but utilizing a pharmacist to reduce those costs has been proven over and over again to improve health outcomes and reduce health care costs. However, the patients compliance isn’t just a factor of cost. Many times, as a practicing pharmacy professional, I see patients who CAN afford their medications who are just as negligent in adherence to their medications as those who cannot afford them.

      Adherence is much more complex than just cost. It’s a complex mix of patient specific factors and economic factors which require the presence of a health care professional to improve. Until we expand the services of certain health care professionals (such as pharmacists) and encourage these new services to be reimbursed by the government and private insurances, we cannot address the problem of adherence.

      Utilization of the health care system has become routine and almost habitual in many cases. I have seen a much more responsible use of the system and of prescription drugs with the movement to higher deductible plans where patients are MORE responsible for the cost of their care and utilize the system only when necessary.

      Practicing PharmD

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