November 1, 2011 
I was digging through some adherence materials, and I stopped on the NEHI graphic from their report “Thinking Outside The Pillbox” which first quantified the impact of non-adherence at $290B (a number which everyone uses now).
I don’t remember every posting it on the blog so I’m sharing it now. I think it hits on the key topics that we all talk about:
- We have to get it right from the beginning with the drug regiment.
- Cost can be an issue so if possible address it.
- But, the biggest issues are with understanding (literacy), side effects, creating a habit, and many other things that require education and ongoing intervention and support for the patient.
[Note: NEHI has now releasesdd their roadmap on Medication Adherence which I’ll review in a subsequent post.]
Enabling Healthy Decisions 
Couldn’t help but to also add, I wish PBM spread pricing was only $1.00 per script. We frequently see generic spread where the pharmacy is paid $3.50 and the member and plan sponsor are charged $50.00 for a one month supply. Do the math.
The consumer and the plan sponsor absolutely feel the impact. Most of the country has moved to high deductible health plans that include Rx under the deductible and coinsurance.
With increasing frequency, employers are establishing high deductible health plans (HDHP). An estimated 18 million Americans were covered under this type of plan in 2010. A HDHP typically has an annual deductible of at least $1,200 for individual coverage and all expenses (except some preventive visits), including pharmacy costs, go toward the deductible. In the most common claim scenario, it’s the prescription drug cost that accumulates to satisfy the member’s deductible and out-of-pocket expenses. In some families, the prescription cost is the primary source of medical care cost, particularly in plans where maintenance check-ups and other wellness services have no co-pay or out-of-pocket exposure.
Spread pricing results in higher consumer costs. It is not unusual for generic prescription charges to be $30-$50 above the actual claim cost. But more important, may be the affect on compliance and cost of care. While not being specifically studied, it’s reasonable to believe that compliance diminishes as the cost of prescriptions increase by 400% or more. The impact of multiple members of a family, on multiple medications, can be dramatic.
The bigger issue that this illustration does not address is the negative impact that PBM spread pricing practices have on adherence. Based on what I see in the market, generic spread pricing makes $290 billion a drop in the bucket.
I’m not sure I understand what spread pricing has to do with adherence. The consumer doesn’t feel the impact of this in most cases. Even in a percentage copay example, the consumer would only feel 20% of the spread pricing so if the PBM makes a $1.00 on the Rx in spread then the consumer has a $0.20 higher copay which would have no impact.
And, cost is only one of many factors in adherence and typically not the primary barrier.