Medical problems and death resulting from prescriptions inaccurately prescribed or taken, costs an average of $528.5 billion annually – 16 percent of the total U.S. healthcare budget in 2016 – according to a research study at the Skaggs School of Pharmacy at the University of California San Diego.
Non-optimized medications, as they’re called, are an increasing problem that can cause new health problems or even death.
“Ideally, when you’re sick, a health care professional prescribes you a medication, you take it as directed and you get better,” said Jonathan Watanabe, PharmD, PhD, associate professor of clinical pharmacy in the Skaggs School of Pharmacy. “But what happens a lot of the time is the medication regimen is not optimized. In other words, the prescription may not be exactly appropriate for your indication — not quite the right medication or dose — or you just don’t take the medication for whatever reason, don’t take them as directed, or the medication causes an adverse event or a new health problem.”
Researchers gave the example of a patient with the flu failing to fill a prescription and later ending up in the emergency room with more serious symptoms, costing the patient, hospital and the insurance company. Prescriptions can also create new health problems. For example, an ACE inhibitor to lower blood pressure may cause a cough, making the patient buy cough medicine that increases blood pressure with the side effect of sleepiness and possibly a fall. “In that case, the drug treatment is functioning like a new disease,” Hirsch said.
Results from incorrect prescriptions can include, emergency department visits, hospitalization, long-term care, medical appointments and additional medications.
“Our study also clarifies that the cost of $528.4 billion is due to much more than simply nonadherence, which has been a misinterpretation of prior estimates, but also includes any situation when the medication regimen is not optimized to correctly and safely treat something treatable,” Watanabe said.
Researchers estimated the average cost for one person suffering from treatment failure or a new medical problem caused by a drug is $2,500. That total does not include transportation, caregiving, lost productivity, etc.
So, what’s the answer?
Better coding and tracking systems for patients will improve monitoring of outcomes from medication and help prevent problems, according to Watanabe, and more streamlined tracking systems are currently being rolled out in many health systems. Watanabe’s team also proposes expanding comprehensive medication management – doctors working in collaboration with pharmacists to ensure medication and dosage are accurate for each patient. In California, pharmacists have provider status, which means they can initiate, change or end a patient’s prescription in a collaborative agreement with prescribers.
Watanabe’s team would like to see comprehensive medication management programs expanded so that pharmacists have access to complete medical records, better communication with other healthcare professionals involved in the patient’s care and input as medication is prescribed - similar to what is now taking place at many U.S. Veterans Affairs clinics.
“Non-optimized medication therapy is a massive avoidable cost. If medications were prescribed, monitored and taken properly, we wouldn’t face this cost, and patients would be healthier,” Watanabe said.
This data was last updated in 2008 before the Affordable Care Act got 20 million more people health insurance, which increased the likelihood of prescription mistakes. In 2008, the costs were estimated at $290 billion annually, about 13 percent of health care spending at the time.
“We’ve experienced increased medical costs and we now have the Affordable Care Act, which gave 20 million more people access to prescription drugs and, as a result, more chances for nonadherence and medication-related health issues,” he said.
The study’s findings are already being used in support of several national initiatives to improve medication management.
“Pharmacists and pharmacies are the most readily available health care access point for most people, and their role will likely expand as the healthcare landscape shifts to emphasize more community-based and ambulatory care,” Watanabe said. “Simply put, pharmacists can help optimize medication regiments to produce the best outcomes at the lowest cost.”
Watanabe led the study with Jan Hirsch, PhD, professor of clinical pharmacy and chair of the Division of Clinical Pharmacy at Skaggs School of Pharmacy, and Terry McInnis, MD, of Laboratory Corporation of America and the Get the Medications Right Institute.
This research was supported, in part, by the National Institutes of Health Loan Repayment Program through the National Institute on Aging.
The analysis is published in the March 26 online issue of the "Annals of Pharmacotherapy."