Is Non-Adherence Waste? Should I Be Financially Responsible?

Someone was telling me last night that 50% of pharmacy spend is waste.  He had several good reasons, but one intrigued me.  It’s the concept around waste due to non-adherence.

If I take a statin for 7 months and then stop therapy, is that a waste?  Did those 7 months of use do any good?  Once I stop, my cholesterol likely goes back up.  So, my employer has now paid for me to get better and essentially, I just flushed their money down the toilet.

Therefore, should I be financially responsible for that waste?  I’m not likely to get billed, but I could see an aggressive plan which stopped covering my drugs until I once again became compliant.  Why not?  Or after I’d been adherent for a period of time then they might reimburse me for the drugs I paid for out of pocket.

Would this work?  I doubt it.  People would likely get their drugs and pour them down the drain just to appear adherent.

Could I be responsible?  Probably not without addressing some of the root causes such as health literacy and the lack of explanation by physicians.  Since some patients leave not knowing the name of the drug, the side effects, their length of therapy, or the fact that they have to call for a refill, there is a lot to be addressed systemically.

Waste…probably.  Addressible…maybe not.

3 Responses to “Is Non-Adherence Waste? Should I Be Financially Responsible?”

  1. Interesting question but the cost is not always in term of money with the spread of TB in the US, stopping an antibiotic therapy for TB has more than just financial impact. It does spread even more and become resistant to antibiotic.

    But why they are stopping, usually because they cannot afford the drug, so why not paying the patient for the patient to take the drug in those cases…

  2. This is an approach talked about for smoking cessation: reimburse the cost of the drugs after a participant has been nicotine free for 6 months.

  3. Just a thought:
    1. Patient pays for their therapy
    2. If they reach certain goals (e.g., target LDL, compliant for 6 months) then plan reimburses full amount PLUS an incentive payment

    I haven’t run the numbers through this thought experiment. But if we believe the medication has value such as lower admissions, total costs or increased productivity than there might be value in such a plan.

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