Abandoned Prescriptions

Prescription drugs are a mainstay for treatment of many conditions, particularly chronic diseases.  The use of pharmaceuticals is believed to lead to fewer hospitalizations and other medical costs, so a great deal of attention has been focused on ensuring that patients take their drugs as prescribed.  The problem of non-adherence starts, however, with the failure of many patients to even get a prescription filled or to pick up one that has been called into a pharmacy.  A study reported in the Annals of Internal Medicine analyzed why patients don’t even get their prescribed drugs.   (Annals Article)

The researchers used data from a large national PBM and a large retail pharmacy chain to evaluate the characteristics of the drugs, including copay amounts, and the status of the patient as a new or continuing user.  Over ten million prescriptions for over 5 million patients were evaluated.  Of the initial prescriptions for a product, 3.27% were abandoned, and of those 1.77% were not filled at another pharmacy and 1.5% ended up being filled and picked up elsewhere by the patient.  Low rates of abandonment were for pain meds, antiplatelet drugs, anti-hypertensives, statins and diabetic drugs.  Higher rates occurred for acid-reflux, asthma and use-as-needed drugs, such as cold medicines.  Brand-name drugs were abandoned more than generics, which may be related to the fact that drugs with copays of less than $10 were abandoned only 1.4% of the time, a rate that rose steadily to 4.5% for drugs with $50 or greater copays.

Copay amount was the factor most strongly associated with abandonment.  Income also was related significantly to not picking up the drug, with high income patients being 21% less likely to abandon a prescription.  Young people were more likely than seniors to abandon drugs, which again could be related to cost and income.  People with comorbid conditions were more likely to not pick up the drug, and the more prescriptions at a time, the more likely one wouldn’t be picked up.  New users had higher abandonment rates than recurrent ones.  E-prescriptions were 64% more likely to be abandoned, which seems a little strange.  Maybe once a patient has made the effort to personally deliver the prescription, they are more likely to follow through, although that would not apply to drugs called in by the doctor.

While the rate of abandonment seems low, the absolute number is high and the clinical consequences potentially significant.  There is also a cost to filling and restocking a prescription which is not picked up.  Since cost appears to be the major issue, doctors need to talk to patients and be aware of the economics before writing a prescription.  Because new prescriptions are abandoned more frequently, extra care needs to be taken to explain their importance to the patient.  E-prescribing practices need to be evaluated in light of the higher abandonment rate, although it may just be that patients don’t have the opportunity they do with a written script to just not take it to the pharmacy in the first place.  But it could also lead doctors to assume that patients are taking the prescribed drug when a significant number aren’t.