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Moving from the Cost of Medication Nonadherence to the Cost of Nonoptimized Medication Therapy

By Ken Perez, VP of Healthcare Policy and Government Affairs, Omnicell, Inc.

A Google search on “the cost of medication nonadherence” will return several articles that present $100 billion to as much as $300 billion as the annual cost of medication nonadherence in the United States. This blog post will address some recent, significant rethinking of that important medication nonadherence cost impact number.

The low end of the range of the existing number comes from seminal work by physicians Lars Osterberg and Terrence Blaschke, whose article, “Adherence to Medication,” appeared in the Aug. 4, 2005 issue of the New England Journal of Medicine. Osterberg and Blaschke concluded, “Of all medication-related hospital admissions in the United States, 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion a year.”

The high end of the range, $300 billion, is a little more interesting and controversial. It is a rounded-up figure from a 2009 research brief produced by the New England Healthcare Institute (NEHI), “Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease.” NEHI estimated that nonadherence along with suboptimal prescribing, drug administration, and diagnosis could result in as much as $289 billion in annual avoidable medical spending. The $289 billion is presented in a table in the appendix of the research brief. NEHI itself rounded it up $290 billion in the introduction of the document, and countless others have in turn rounded that figure up to $300 billion and misdescribed it as solely pertaining to medication nonadherence.

Most saliently, the $289 billion estimate encompasses far more than medication nonadherence. As Timothy Aungst articulated in his November 2019 Digital Apothecary website article, “Medication adherence is not a $300 billion problem,” it is an estimate of drug-related problems, including adverse reactions to therapy, drug choice problems, dosing problems, drug utilization issues (including nonadherence), drug interactions, and failures of therapies.

What then is a credible measure and more recent estimate of the costs of the aforementioned drug-related problems? Pharmacy researchers Jonathan Watanabe and Jan Hirsch, formerly of the UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, and physician Terry McInnis, addressed this question in their article, “Cost of Prescription Drug-Related Morbidity and Mortality.” Appearing in the March 1, 2018 issue of the Annals of Pharmacotherapy, the article estimated that the annual cost of prescription drug-related morbidity and mortality resulting from nonoptimized medication therapy, including medication nonadherence, was $528.4 billion in 2016 U.S. dollars.

Watanabe, et al. compiled data from the Centers for Disease Control and Prevention, the Department of Health and Human Services, the Kaiser Family Foundation and peer-reviewed journals. They also examined other sources about nonadherence, adverse drug events, new medical problems caused by medication therapy, and prescriptions written for inaccurate medications or doses. In addition to estimating the economic cost, the researchers concluded that nonoptimized medication therapy results in 275,689 deaths per year.

Focusing on nonoptimized medication therapy—with its significant economic and human costs—rather than just medication nonadherence is a more intellectually sound, holistic approach that will better serve the pharmacy profession and the healthcare system in general.