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."