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Is prescription medication compliance worse now than it was before the COVID-19 pandemic?

Matt Li Post Covid Compliance

BuzzRx surveyed  more than 15,000 Americans during October 2020 to explore the effects of the pandemic on prescription compliance and affordability. Some of the key findings were:

  • 46% of people reported struggling to pay for their prescriptions—89% of those surveyed have insurance
  • 69% reported struggling to pay for prescriptions for themselves or their family members with a chronic illness.
  • Over 1 in 3 (34%) reported not filling a prescription due to cost and 37% reported rationing pills (skipped or split pills).
  • Over 1 in 4 survey respondents (28%) have had to choose between buying food and medicine at least once in the past 6 months. 26% never had to make this decision before the pandemic.

While many people may occasionally forget to take their medications as prescribed, not taking medications due to affordability can be dangerous. The World Health Organization (WHO) defines adherence as the “extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a healthcare provider.” Medical News Today reports that around 40–50% of people do not take medications to manage chronic conditions as prescribed[1]. So why is this figure so high and what can be done?

There are many reasons for non-compliance, with cost being a major factor. Many drugs are extremely expensive, even for those with adequate health insurance. This may lead to people splitting pills, skipping doses, or simply never filling their medications. The BuzzRx survey found that for those individuals who reported struggling to pay for prescriptions, 34 percent did not fill a prescription due to cost and 37 percent rationed pills (skipped or split doses). Tracking the implications of medication nonadherence is challenging and doctors may never fully know how well their patients are complying with instructions.

By some estimates, each year, drug nonadherence causes approximately 125,000 preventable deaths in the United States and $100 billion to $290 billion in avoidable costs[1]. It may also cause up to approximately 10% of hospitalizations annually, which also drives up total healthcare costs[2]. For example, a recent study conducted by Express Scripts found that people who were non-adherent to their oral diabetes medications had 4% higher total healthcare costs compared to those who were compliant[3]. Not taking medications as prescribed for many chronic conditions is dangerous and can also cause relapses and worsening of symptoms.

Does having insurance improve medication compliance? 

The BuzzRx survey found that having health insurance did not offset the financial stress of affording prescriptions. 89 percent of survey respondents who reported that they struggled to afford prescriptions because of financial hardships caused by the pandemic noted that they have health insurance. This could be due to prescriptions not covered by a plan’s drug formulary, or a plan requiring that high deductibles must be met before prescription coverage begins. In the past ten years, deductibles have risen 111 percent[4]. The average individual deductible is now $1,655, double the average from a decade ago[5]. And according to eHealth’s 2020 ACA Index Report, the average family plan deductible for 2020 (across all family sizes) was $8,439, an increase of 5 percent from the previous year. Not only are prescriptions not affordable, but health care, in general, is too costly for many people--especially those who are self-employed. 

How can insurance companies help improve prescription compliance? 

One promising step towards improving medication adherence from a policy level is through value-based insurance design, or V-BID[6]. According to the CDC, the goal of V-BID is to decrease the cost of health care while increasing the effectiveness of health services. The main philosophy behind this new health care approach is that the value of any health care service varies in the context of each patient’s health status. V-BIDs will be most successful for employers if they consider the needs, demographics, and perspectives of their employees when designing the appropriate V-BID approach for their employee population. 

When implemented, this health insurance structure can bring select drug copay costs down to zero or nearly zero for covered patients. Value-based insurance plans can have a significant positive impact on medication adherence rates of the individuals as compared to plans with copays or other out-of-pocket costs. Additionally, the value-based insurance design provides significant value to the insurance companies themselves. Medication adherence rates will be significantly higher for patients with zero out-of-pocket costs, which lead to better health outcomes. This could potentially decrease the need for future health care for the same medical issue.

For countless reasons, it’s important to take medications as prescribed. If a medication is too expensive or not covered by insurance, talk to your doctor about less expensive alternatives, drug manufacturer coupons, cost-saving 90-day supplies, or prescription discount cards, like BuzzRx. Our mission to help everyone afford the medications they need to be healthy.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499/
  2. https://qualitysafety.bmj.com/content/27/11/902
  3. https://www.hfma.org/topics/operations-management/article/contain-costs-by-addressing-financial-barriers-to-medication-adh.html
  4. https://www.kff.org/health-costs/press-release/average-family-premiums-rose-4-to-21342-in-2020-benchmark-kff-employer-health-benefit-survey-finds/&sa=D&source=editors&ust=1621625749589000&usg=AOvVaw0MXOvLTNmUphx5j4gXUhcK
  5. https://www.kff.org/health-costs/press-release/benchmark-employer-survey-finds-average-family-premiums-now-top-20000/#:~:text=The%20average%20single%20deductible%20now,workers%20over%20the%20past%20decade.
  6. https://www.ncsl.org/research/health/value-based-insurance-design.aspx