Report: $134B wasted on medications because of patient apathy

An annual survey on drug price trends suggests that the U.S. wastes $134 billion on medications every year because patients don't follow up on their intentions to take their drugs or switch to generics.

The Express Scripts drug trend report, released Thursday, found that getting everyone to switch to cheaper drugs and mail-order pharmacies could help save $403 billion a year. The report's groundbreaking conclusion, however, is that one-third of that could be saved if the millions of people who have already made such decisions simply followed through.

"We have been barking up the wrong tree," said Robert Nease, chief scientist for research and new solutions at Express Scripts, a pharmacy benefit manager and mail-order pharmacy. "And this study is opening our eyes to the real problem - the real problem is that people want one thing, but they never get around to doing it."

The conclusion was informed by a Harris Interactive poll that found that 82 percent of patients on brand-name medications said they wanted to switch to generics and 70 percent of patients who used retail pharmacies to refill their prescriptions wanted to switch to home delivery. Mail-order pharmacies provide lower prices, fewer medication errors and better adherence than retail outlets, according to Express Scripts.

The report suggests that heath plans and employers have been using the wrong incentives, such as education campaigns and co-pays. Instead, they could require patients to actively decide whether to opt for generics or home delivery, much like many employers require workers to opt out of company 401(k) plans.

The healthcare system has made the "assumption that there's a tight connection between what patients want and what they do," Nease said. "After all, that's the rational for a co-pay differential, educating people, having them have more skin in the game... But the effects have been frankly disappointingly small."

Nease added that the research could have major repercussions for healthcare reform, particularly its focus on wellness and prevention. He warned that hitting patients over the head with prevention messages they already know and agree with risks turning them off.

"What happens when you keep on sending that kind of information?" Nease said. "We train them to associate us with junk mail and spam. But what happens when we actually need to educate them about something they don't know? They're less likely to do it. That's the real cost of this."

The annual report is widely read by lawmakers and federal regulators, particularly those who run the Medicare prescription drug program. Express Scripts Vice President Steven Miller said the company has ongoing conversations with Medicare officials about experiences in the private sector such as getting people to choose mail-order delivery, but he emphasized that it has to be voluntary.

"We are adamant that you have to preserve choice," he said. "Because what happens is when you're told what you have to do, you bristle automatically and it turns off your thinking."