January 6, 2011 
I’ve argued many times that prescription costs should (in many cases) go up not down. But, the evidence to support that has often been anecdotal or from studies that people have struggled to replicate.
CVS Caremark just released the results of their study “Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending” in the January issue of Health Affairs.
- Looked at pharmacy and medical claims
- 135,000 patients
- Patients with with one of more of the following – congestive heart failure, diabetes, hypertension, and dyslipidemia
“There have been many studies through the years that suggest adherence can save on health care costs, but the issue has not been central to health care cost discussions because those studies did not establish a causal link. We took the research further and what we found is that although adherent patients spend more on medications – as much as $1,000 more annually – across the board they spend significantly less for their overall health care costs” by Troyen A. Brennan, MD, MPH, EVP and Chief medical Officer of CVS Caremark (source)
The savings associated with being adherent were:
- Congestive heart failure = $7,823
- Diabetes = $3,756
- Hypertension = $3,908
- Dyslipidemia = $1,258
It will be interesting. Will this replace the “Sokol study” that everyone has historically quoted? Will this lead to a rush of adherence programs for key conditions such as those studied here? Will others try to replicate this study?
I for one hope this changes the conversation from “prove the ROI” to show me how to best improve adherence across categories and segments of the population. (To learn more about how Silverlink works with clients on adherence, you can go to our microsite.)
Enabling Healthy Decisions 
The problem of adherence has been known for quite some time. In 2009, the New England Healthcare Institute estimated the cost of adherence to be $290 billion. That’s $290,000,000,000 in extra doctor visits, extra hospital admissions, extra emergency room visits, extra prescriptions … caused by non-adherence. Incredible! — for more see http://boxcuttersinc.wordpress.com/2010/12/28/the-290-billion-dollar-problem/
Before that, in 2007, the National Council on Patient Information and Education proclaimed “poor adherence with medication regimens has reached crisis proportions”. And, there were others before these two organizations to recognize the problem.
What is ironic is that the player who would profit most directly from improving adherence — the pharmaceutical industry (better adherence, more drugs sold) — did not conduct this study. Rather, it took CVS Caremark (PBM/retail pharmacy) to “discover” what seems so obvious: take what your doctor ordered and you’ll get less complications later.
So, that raises the question: who will lead the charge in improving adherence (doctors, insurers, pharmacists, patients …)?
Interesting the population used (primarliy Medicare patients). Effectiveness of adherence on overall costs may be population specific — not able to achieve total savings in younger people.