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Medication Cost Factors in Prescription Abandonment

HealthLeaders Media Staff, November 23, 2010

Abandoned prescriptions constitute a small but significant component of nonadherence, according to a paper published in the Nov. 16 issue of the Annals of Internal Medicine.

Research by Harvard, Brigham and Women's Hospital, and CVS Caremark researchers found a direct correlation between the amount of a patient's out-of-pocket co-pay and the likelihood of prescription abandonment: Patients having a co-pay of $50 are almost four times more likely to abandon a prescription at a pharmacy than those paying $10. The study also found that e-prescriptions are 65% more likely to be left at a retail pharmacy by patients than are hand-written ones.

William H. Shrank, MD, of Brigham and Women's Hospital, and colleagues, identified prescriptions bottled at a national pharmacy chain and linked them to claims data from a national pharmacy benefits manager to determine how often prescribed medications were not picked up at the pharmacy. They looked at more than10.3 million prescriptions.

In what the researchers believe to be the first study to comprehensively evaluate abandoned prescriptions, they concluded 3.27% of pharmacy-bottled prescriptions went unfilled, and more than half the time the patient did not fill an alternate prescription for the same medication at any pharmacy.

Among the findings:

  • Cost is the strongest predictor of abandonment. The data shows a 1.4% prescription abandonment rate for patients with co-pays of $10 or less, a 3.4% rate for patients with co-pays between $30 and $40, and a 4.7% rate for patients with co-pays of $50.
  • Patients with first-fill prescriptions are three times more likely to abandon prescriptions than those obtaining refills.
  • Younger patients are more likely than older ones to abandon medications.
  • Opiates, anti-platelets, and statins were the least likely to be abandoned; insulin and proton pump inhibitors were more likely to be.
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