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PARSIPPANY, N.J. — Improper use of medications by patients and health care providers adds more than $200 billion a year to the nation’s health care tab, a study released last month by the IMS Institute for Healthcare Informatics says.
That unnecessary spending the report notes, represents 8% of the country’s total annual health care expenditures and amounts to millions of avoidable hospital admissions, outpatient treatments, pharmaceutical prescriptions and emergency room visits for patients.
“As our study makes clear, drugs are often not used optimally, resulting in significant unnecessary health system spending and patient burdens,” IMS Institute executive director Murray Aitken says. “Those avoidable costs could pay for the health care of more than 24 million currently uninsured U.S. citizens. Reaching a meaningful level of consensus and alignment among stakeholders, based on measured and proven success models, is a key step to unlocking the $200 billion opportunity identified in our study.”
The IMS report — “Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity From Using Medicines More Responsibly” — looks at six areas that contribute to unnecessary costs: medication nonadherence, delayed evidence-based treatment practice, misuse of antibiotics, medication errors, suboptimal use of generics and mismanaged polypharmacy in older adults.
The report concludes that, taken together, these areas result in an estimated 10 million hospital admissions, 78 million outpatient treatments, 246 million prescriptions and 4 million emergency room visits every year.
The study found significant opportunities for improvement to ensure that patients receive the right medicines at the right time, and that take them in the right way.
The report notes, however, that progress is being made to address some of the challenges that drive wasteful spending. Researchers point out, for instance, that adherence to medication among large populations of patients with hypertension, hyperlipidemia and diabetes has improved between 3% and 4% since 2009.
The IMS report finds that medication nonadherence accounts for the largest portion of avoidable cost. Patients not adhering to their doctor’s medication guidance experienced complications that led to an estimated $105 billion in annual avoidable health care costs, the report says.
Delays in applying evidence-based treatment to patients lead to $40 billion in annual avoidable costs, IMS says, with delays in diabetes cases having the greatest impact. Another $34 billion is being wasted because of the misuse of antibiotics.
With the toll that medication misuse is having on the nation’s health care spending getting more attention in recent years, more efforts are under way to address the underlying causes of avoidable spending and to improve medication use.
For instance, IMS notes, more attention is being paid to novel interventions, critical assessments of established solutions and unique models of stakeholder cooperation.
Many of these initiatives, the report says, involve a greater role for pharmacists, an integrated approach to addressing patient issues, alignment of financial incentives and greater use of health care informatics to guide decision making and monitor progress.
Community pharmacy advocates say the report drives home a point that they have been making for several years: Pharmacists can have a major impact on patient health and are important to the effort to drive down health care spending.
“As the face of neighborhood health care, community pharmacies have contributed mightily to the progress that the IMS Health report has found in the areas of improved medication adherence and the use of generic drugs,” National Association of Chain Drug Stores president and chief executive officer Steve Anderson says.
“By identifying $200 billion per year in avoidable costs, the report serves as an invitation for policy makers, private payers, employers, the entire health care delivery system and patients to better leverage the value of community pharmacy to improve health and health care affordability.”
