Rising health and pharmacy costs fuel noncompliance and switch to generics

ROCHESTER, N.Y. —Two new studies point to rising concerns among Americans over the growing costs of health care and health insurance. Worse, the new research indicated that many are shirking medical and dental checkups because they say they can’t afford them.

In a report released April 7, Wolters Kluwer Health said it found widespread and growing noncompliance with prescription drug therapy among patients who dropped off prescriptions but never came back to pick them up. The health research and consulting firm calls the practice “abandonment,” and said it is rapidly increasing as more Americans avoid prescription and other healthcare costs.

Looking at U.S. commercial plan claims for 2008, Wolters Kluwer found that prescription abandonment increased by 34% nationally compared with 2006—jumping from an average of 5.15% in 2006 to 6.8% in 2008. It also found that abandonment increased as the amount of the co-pay increased, especially for new prescriptions.

For example, the company noted, new prescriptions with co-pays of $100 or more carry an abandonment rate of just over 20%; while with co-pays of $10 or under, the abandonment is only 4%.

“Price sensitivity is clearly a factor as consumers decide to forego certain prescriptions altogether, including some for chronic conditions,” said Mark Spiers, president and CEO of Pharma Solutions at Wolters Kluwer. “This disturbing trend may have serious health implications and seems poised to continue especially if the economy deteriorates further.”

The study also showed significant and continuing gains by generic drugs as the issue of price becomes more critical. “Generic medications continue to make significant gains over brands by grabbing more than 60% of all U.S. prescriptions filled in 2008, and an even greater percentage of the subset of drugs that are taken orally,” Wolters Kluwer reported. According to the data, there were 2.4 billion prescriptions filled for generic drugs, and only 1.4 billion for brand-name medications—“an unprecedented spread of a billion prescriptions,” the company announced.

In March, Harris Interactive/HealthDay reported similar signs of distress shown by an online survey. Nearly half of U.S. adults, told Harris pollsters that they are “very to extremely worried about having to pay more for their health care or health insurance,” while only 8% said they are not worried at all.

Americans in the 45- to 64-year-old age group are most worried (56%), while the younger generation ages 18 to 34 years are least affected by concerns, Harris found. “As would be expected, those ages 65 years and older are least worried [22% not at all worried] due to their Medicare coverage, and they are followed closely by the 18 to 34 year olds [18% not at all worried],” pollsters noted.

Sixty-five percent of U.S. adults are “somewhat” or “extremely” worried about being able to afford medical care and prescription medications, researchers found.

“This results in proportions of U.S. adults not taking care of their health due to cost,” noted a report on the findings. “Most notably, one-third did not see a dentist although they needed dental care, close to one-third [28%] had a medical problem but did not visit a doctor, and one-fifth [22%] did not fill a prescription.”

The high levels of noncompliance because of the cost of medical care remain similar to 2007 and 2008 results, Harris reported. “Many people are very worried,” said Harris Poll chairman Humphrey Taylor. “But the number of those who have lost their insurance recently is not enough to increase the already large number of patients who are noncompliant—yet.”