Scripts going unfilled at 'unprecedented' rate

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Patients not taking or refilling medications on time costs the pharmaceutical industry billions each year. The housing bubble and recession have helped write a new chapter in the compliance story, as higher numbers of new prescriptions simply go unfilled because patients either cannot afford, or are unwilling, to pay for them.

The total number of prescriptions filled grew a modest 2.7% last year. Yet the rate of prescriptions submitted to a pharmacy but never picked up—known as abandonment—rose 24% in 2009 and is up 68% since 2006 among brand-name drugs, according to an analysis released today.

The down economy has led to more out-of-pocket expenditures and greater sensitivity to co-pays, especially for brand-name drugs, explained Dea Belazi, consulting practice leader, managed markets, for Wolters Kluwer Pharma Solutions. As they simultaneously gain more control over their healthcare, patients often are deciding to walk away, instead of fill, those new ‘scripts.

“What's peculiar is that the rate of increase among patients walking away is almost unprecedented,” Belazi told MM&M. “Over the last two years, pharma has been trying to understand the abandonment situation,” particularly in which parts of the country patients tend to abandon more.

Among commercial health plan patients, the abandonment rate for new prescriptions at the pharmacy reached 6.3% in 2009, the Wolters Kluwer Pharma Insight report shows. The abandonment rate for new prescriptions of brand-name drugs alone was 8.6%, up 23% from 2008 and nearly 70% since 2006.

“The [abandonment] trend that we are seeing is just going up and up and up,” said Belazi. The last quarter of 2009 showed the highest such rate in recent history (9.3%), with generics going unfilled at the same rate brands were in 2007 (5.5%).

Rising co-pays are one reason, albeit a small one. Abandonment increased even as co-pays remained relatively steady. The average co-pay for brand-name drugs was just $5 more in 2009 than it was in 2006 ($31 vs. $26).
 
Moreover, patient walk-aways climbed even as low-priced alternatives continued to flood the market. Data show 2.6 billion prescriptions were filled for generics in 2009 and 1.3 billion for brand-name medications.

Belazi pointed to macroeconomic factors—the housing crisis, subsequent recession and lower household incomes—as the main culprits behind patients' rising price sensitivity and soaring abandonment rates.
 
Health plan denials compounded the problem. Insurer denials for branded drugs were up just 1.4% from 2008. But taken together, patient abandonment and payer denials resulted in 14.4% of all new, commercial-plan prescriptions going unfilled in 2009, a 5.5% increase from 2008, according to the study.

Where can pharma go from here? Abandonment varies geographically. According to the study, it's highest in Delaware, North Carolina and Florida, all of which were above 10%. The highest denial rates for new prescriptions of brand-name meds include California, Delaware and Florida.

“Pharma is trying to get a handle on abandonment and segment regional variations, then create tactics and strategies to address it, such as coupon or voucher programs,” Belazi said. “Where abandonment rates or costs are higher, companies are able to support patients, so hopefully that part of the compliance equation begins to be in their favor.”
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