In the Journals

More than $500 billion wasted in nonoptimized prescriptions

Jonathan Watanbe
Jonathan H. Watanbe

The estimated yearly cost of drug-related morbidity and mortality caused by nonoptimized medication therapy — those prescriptions that are unfilled, contribute to a new health problem or are not exactly the right medication or dose — was more than half a trillion dollars in 2016, according to findings recently published in Annals of Pharmacotherapy.

A 2008 estimate showed such spending was $290 billion annually, or 13% of U.S. health care spending in that year, according to researchers.

“A more current estimate of the cost related to nonoptimized medication utilization can serve as a linchpin in policy, payment and health care delivery system reform,” Jonathan H. Watanabe, PharmD, MS, PhD, associate professor of clinical pharmacy at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, and colleagues wrote.

“These are important elements as we contend not only with the cost of medications, but also with the impact of prescription drugs on overall medical costs, patient outcomes and the valuation of interventions to optimize medication use,” they added.

For the new estimate, researchers inflated costs to 2016 amounts and analyzed data from several Kaiser Family Foundation reports, journal articles, and surveys from HHS, the Agency for Healthcare Research and Quality and CDC. This provided underutilized prescription drug use and average pathway costs for a patient who experienced a new medical problem, a treatment failure or a combination of the two.

The estimated yearly cost of drug-related morbidity and mortality caused by nonoptimized medication therapy — those prescriptions that are unfilled, contribute to a new health problem or are not exactly the right medication or dose — was more than half a trillion dollars in 2016, according to recently published findings.
Photo Source:Shutterstock

Watanabe discussed the findings and ways to bring the costs down in an interview with Healio Family Medicine.

“The average cost of a long-term care stay jumped out as a major cost driver, albeit fairly uncommon,” he said. “If long-term care stays can be averted by improving medication use, it would be a massive system benefit.”

“More thoughtful attention from the health care team, particularly pharmacists, is necessary to ensure that the medication and/or medication regimen is designed to successfully treat the indication,” Watanabe continued. “Another important aspect is vetting to assure that another possible medication would not be more effective and safe for the ailment, and the rest of the patient’s health profile has been incorporated into the selection of the medication regimen. More effort is needed to ensure the patient is able to take the medication as prescribed, which includes determining if the medication is affordable.”

He also said the findings should prompt primary care physicians to discuss medications with their patients.

“[This] includes reconciling their medications to ensure they know all of the medications their patients are using, including over-the-counter medications and medications prescribed from other specialists. Ideally, have the patient bring in all of the medications, herbals, supplements, and as-needed medications to be reviewed,” Watanabe said. “Encourage the patient to review their medications with their pharmacist and develop a medication action plan. Work with the patient to look for opportunities to improve adherence by making the regimen less complex or decreasing pill burden.” – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

Jonathan Watanbe
Jonathan H. Watanbe

The estimated yearly cost of drug-related morbidity and mortality caused by nonoptimized medication therapy — those prescriptions that are unfilled, contribute to a new health problem or are not exactly the right medication or dose — was more than half a trillion dollars in 2016, according to findings recently published in Annals of Pharmacotherapy.

A 2008 estimate showed such spending was $290 billion annually, or 13% of U.S. health care spending in that year, according to researchers.

“A more current estimate of the cost related to nonoptimized medication utilization can serve as a linchpin in policy, payment and health care delivery system reform,” Jonathan H. Watanabe, PharmD, MS, PhD, associate professor of clinical pharmacy at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, and colleagues wrote.

“These are important elements as we contend not only with the cost of medications, but also with the impact of prescription drugs on overall medical costs, patient outcomes and the valuation of interventions to optimize medication use,” they added.

For the new estimate, researchers inflated costs to 2016 amounts and analyzed data from several Kaiser Family Foundation reports, journal articles, and surveys from HHS, the Agency for Healthcare Research and Quality and CDC. This provided underutilized prescription drug use and average pathway costs for a patient who experienced a new medical problem, a treatment failure or a combination of the two.

Researchers estimated that the annual cost of prescription drug-related morbidity and mortality resulting from nonoptimized medication therapy was $528.4 billion in 2016 U.S. dollars (plausible range = $495.3 billion to $672.7 billion). The average cost of one person’s new medical problem was $2,610 (plausible range = $2,374 to $2,848); treatment failure was $2,481 (plausible range = $2,233 to $2,742); and the combination of the two was $2,572 (plausible range = $2,408 to $2,751).

The estimated yearly cost of drug-related morbidity and mortality caused by nonoptimized medication therapy — those prescriptions that are unfilled, contribute to a new health problem or are not exactly the right medication or dose — was more than half a trillion dollars in 2016, according to recently published findings.
Photo Source:Shutterstock

Watanabe discussed the findings and ways to bring the costs down in an interview with Healio Family Medicine.

“The average cost of a long-term care stay jumped out as a major cost driver, albeit fairly uncommon,” he said. “If long-term care stays can be averted by improving medication use, it would be a massive system benefit.”

“More thoughtful attention from the health care team, particularly pharmacists, is necessary to ensure that the medication and/or medication regimen is designed to successfully treat the indication,” Watanabe continued. “Another important aspect is vetting to assure that another possible medication would not be more effective and safe for the ailment, and the rest of the patient’s health profile has been incorporated into the selection of the medication regimen. More effort is needed to ensure the patient is able to take the medication as prescribed, which includes determining if the medication is affordable.”

He also said the findings should prompt primary care physicians to discuss medications with their patients.

“[This] includes reconciling their medications to ensure they know all of the medications their patients are using, including over-the-counter medications and medications prescribed from other specialists. Ideally, have the patient bring in all of the medications, herbals, supplements, and as-needed medications to be reviewed,” Watanabe said. “Encourage the patient to review their medications with their pharmacist and develop a medication action plan. Work with the patient to look for opportunities to improve adherence by making the regimen less complex or decreasing pill burden.” – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.