Post date: Feb 23, 2012 3:59:33 PM
The blogsphere is abuzz about Surescripts February 1 press release announcing increased adherence with e-prescribing. The study does not appear to be publicly available so my impressions from press release may not accurately reflect the study. That said my initial impressions are that the term "costs" used loosely. Cost to whom should be asked? One should also ask if e-prescribing is the only way to improve adherence?
Surescripts relies upon the Roebuck et al (2011) study which estimated that adherence for four vascular conditions reduced medical spending by the ratios cited by Surescripts (3 to 10 times less). We will need to see what kind of medications have increased first fill adherence in the Surescripts study. These ratios are based on vascular diseases and Fischer et al (2010) reported adherence less than 30% for chronic diseases even though the overall adherence was 78% (similar to Surescripts study).
The Roebuck et al study also says "one should not necessarily expect to see immediate reductions in medical costs from improved medication adherence. This is a particularly salient point for insurers with short time horizons." Can improvements in first fill adherence rates be generalized to continued adherence, especially if costs to patient becomes an issue?
The Roebuck et al (2011) study summarized its study: "Our findings indicate that programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings." What is the cost of e-prescribing? Why has the elimination of patient co-payments for chronic medications, known to increase adherence, been lost in the discussion? See Sipkoff (2004) which includes quoting Mark Fendrick that "We believe that some people should indeed get their drugs for free, and for a small class of people, should even be paid to take them".
It seems e-prescribing just shuffles the costs around to different categories that may or may not be included in a "cost" number. Higher adherence means more medication costs to the patient to save payers the cost of hospitalization. E-prescribing means medical practices and pharmacies pay for the cost of systems and transaction fees to increase adherence so that payers avoid the cost of hospitalizations.
Given that Surescripts press release is claiming the benefit ratio from chronic vascular diseases, one must ask if payers paying the co-pay of an at-risk population might be cheaper than the billions already spent on e-prescribing. I hope someone does the math.
Sources:
Fischer, M, Stedman, M, Lii, J, Vogeli, C, Shrank, W, Brookhart, M & Weissman, J 2010, 'Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions', Journal of General Internal Medicine, Vol. 25, no. 4, pp. 284-90.
Roebuck, MC, Liberman, JN, Gemmill-Toyama, M & Brennan, TA 2011, 'Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending', Health Affairs, Vol. 30, no. 1, pp. 91-9.
Sipkoff, M 2004, Not So Much of a Reach: Let Sick Pay Less for Drugs, October, January 18, 2007, <http://www.managedcaremag.com/archives/0410/0410.benefitbased.html>.