Forgetfulness, procrastination related to prescription drugs costs $163 billion in wasteful healthcare spending

Express Scripts is the first organization ever to quantify the hidden healthcare costs of very common behaviors related to prescription drugs, such as forgetfulness and procrastination, estimating the annual wasteful spending at $163 billion.

The Express Scripts 2009 Drug Trend Report, released today, quantifies changes in drug spend on a year-to-year basis and details the costly effects of irrational behaviors on pharmacy-related costs. Express Scripts, one of the nation's largest pharmacy benefit managers, has produced the Drug Trend Report for each of the past 14 years.

The Express Scripts 2009 Drug Trend Report creates a set of personas, such as Robert the Loyalist, to illustrate common behaviors that contribute to the billions we waste each year. Express Scripts is the first company to apply behavioral science to address healthcare challenges that individuals, policymakers and employers have faced for years.

"The good news is that these potential savings in the pharmacy benefit are tied to one of the few variables in healthcare we can readily influence: behavior," said Steven Miller, MD, senior vice president and chief medical officer at Express Scripts. "This research shows that in terms of achieving lower costs and improved outcomes, healthcare reform starts in the home."

Miller added, "If we optimized every individual's behavior relating to prescription drugs, we could achieve savings that in five years would cover the projected costs of the recently passed national healthcare reform legislation."

The $163 billion in wasteful spending results from three key factors:

• $106 billion from medical costs of non-adherence to therapy.
• $51 billion in missed opportunities related to lower-cost medication alternatives, both brand and generic.
• $6 billion in missed opportunities related to lower-cost options for delivery of medications.

The 2009 Drug Trend Report is the first to link spending to both market forces and behavioral factors. Overall, the drug spend for the United States increased 6.4 percent in 2009, reversing a pattern of lower drug trend increases in previous years, the report says. Market forces drove trend up by 8.3 percent, while behavior drove down trend by nearly 2 percent.

For example, within traditional prescription drugs, Express Scripts clients saved $1.4 billion through the increased use of generics and lower-cost brands. More than of half that savings, $790 million, came from Express Scripts' behavior-centric programs in partnership with clients. Those savings were over and above some market factors that also helped hold down spending, such as the expiration of branded patents, which allows development of lower-cost generic drugs.

Through the lens of behavior, Express Scripts also has broken down the behavior-related waste by therapy class. For example, more than one-third of the annual spend (35.5 percent) on high cholesterol medication could be saved with better behavior.

Bob Nease, chief scientist at Express Scripts, said, "We have good cause for optimism that the behaviors causing this vast waste in healthcare can change. Express Scripts' advanced application of behavioral science to healthcare, which we call Consumerology, has proved very successful in achieving behavior changes through programs that are fully voluntary."

Other notable trends found in the Drug Trend Report include that diabetes is the top driver of total cost increases in the traditional drug sector because of growth in utilization and cost per prescription. Spending for drugs used to treat viral infections increased by approximately 25 percent primarily because of increased prevalence of use for agents used to treat influenza.