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Steep Co-Pays May Cause Some to Abandon Prescriptions

By Serena Gordon
HealthDay Reporter

MONDAY, Nov. 15 (HealthDay News) -- In these tough economic times, even people with health insurance are leaving prescription medications at the pharmacy because of high co-payments.

This costs the pharmacy between $5 and $10 in processing per prescription, and across the United States that adds up to about $500 million in additional health care costs annually, according to Dr. William Shrank, an assistant professor of medicine at Harvard Medical School and lead author of a new study.

"A little over 3 percent of prescriptions that are delivered to the pharmacy aren't getting picked up," said Shrank. "And, in more than half of those cases, the prescription wasn't refilled anywhere else during the next six months."

Results of the study are published in the Nov. 16 issue of the Annals of Internal Medicine.

Shrank and his colleagues reviewed data on the prescriptions bottled for insured patients of CVS Caremark, a pharmacy benefits manager and national retail pharmacy chain. CVS Caremark funded the study.

The study period ran from July 1, 2008 through Sept. 30, 2008. More than 10.3 million prescriptions were filled for 5.2 million patients. The patients' average age was 47 years, and 60 percent were female, according to the study. The average family income in their neighborhoods was $61,762.

Of the more than 10 million prescriptions, 3.27 percent were abandoned.

Cost appeared to be the biggest driver in whether or not someone would leave a prescription, according to the study.

If a co-pay was $50 or over, people were 4.5 times more likely to abandon the prescription, Shrank said, adding that it's "imperative to talk to your doctor and pharmacist to try to identify less expensive options, rather than abandoning an expensive medication and going without."

Drugs with a co-pay of less than $10 were abandoned just 1.4 percent of the time, according to the study. People were also a lot less likely to leave generic medications at the pharmacy counter, according to Shrank.

The medications most frequently abandoned were cough, cold, allergy, asthma and skin medications, those used on an as-needed basis. Insulin prescriptions were abandoned 2.2 percent of the time, but Douglas Warda, director of pharmacy for ambulatory services at the University of Chicago Medical Center, said this might be a cost issue, but it could also be that some people are afraid to inject insulin.

The study also found that antipsychotic medications were abandoned 2.3 percent of the time.

Drugs least likely to be abandoned included opiate medications for pain, blood pressure medications, birth control pills or hormone replacement therapy, and blood-thinning medications, according to the study.

Young people between the ages of 18 and 34 were the most likely to forgo their prescriptions, and new users of medications were 2.74 times more likely to leave their drugs behind.

Prescription orders that were delivered to the pharmacy electronically -- via the computer -- were 64 percent more likely to be abandoned than prescriptions walked into the pharmacy.

"We're definitely not saying that e-prescribing is bad; it's great, but there appear to be some unintended consequences," said Shrank.

There was no way to tell if people never tried to pick up their prescriptions, or if they went to retrieve them but chose to leave them behind because of the cost.

Warda said he believes that more patients might pick up their medications if the instructions from their physicians were clearer. For example, prescriptions for proton pump inhibitors were left at the pharmacy 2.6 percent of the time. These medications reduce the amount of acid in the stomach and can help prevent heartburn or more serious problems. "If the physician message is, 'You need to take these medications for two to three months and it will reduce your pain and help your body heal,' fewer people might abandon these medications," he said.

Plus, if cost is an issue for you, bring it up with your doctor ahead of time, he added. "Don't get blindsided at the pharmacy. Always ask your physician if there's a generic option, or if there's something cheaper that might work just as well. Sometimes people are embarrassed to say anything, but it's better to ask and get a medication you can afford.

"If you get to the pharmacy, and you can't afford the medication, follow up with your doctor or ask the pharmacist if there's a cheaper alternative," suggested Warda.

More information

For advice on reducing drug costs, visit the U.S. Agency for Healthcare Research and Quality.

SOURCES: William Shrank, M.D., assistant professor of medicine, Harvard Medical School, and division of pharmacoepidemiology and pharmacoeconomics, Brigham and Women's Hospital, Boston; Douglas Warda, Pharm.D., director of pharmacy, ambulatory services, University of Chicago Medical Center; Nov. 16, 2010, Annals of Internal Medicine

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