According to the Health Policy Institute, 66% of American adults take at least one prescription medication, and 27% take 10 or more.[i] Those numbers have risen in recent years due to the prevalence of and demand for physical and mental/emotional health therapies. But medications and treatment plans only work when patients adhere to them.
Pharmacies have unique visibility into what prescriptions are picked up and what factors influence their abandonment. In other words, pharmacies have a unique opportunity to help identify and reverse trends and keep patients adherent, while also keeping drug costs in check for their businesses.
Why do prescriptions get abandoned?
Many patients have neglected to pick up a prescription at one time or another. It’s easy to do by mistake, given the pace of everyday life and the fact that most prescriptions are sent electronically. (Think about it: it’s a lot easier to forget about a prescription you never saw.) Intentional abandonment due to high out-of-pocket (OOP) costs is also widespread; a recent 2022 survey found that nearly half of American consumers chose not to pick up a prescription because of the expense.[ii]
In 2012, nearly half of all prescriptions in the US were electronically prescribed and, at that time, 0.82% of them went unclaimed at an average cost of $25.02 each to the pharmacy.[iii] Nine years later, in 2021, 94% of prescriptions were electronically prescribed.[iv] More than 9 in 10!
A 2010 Harvard study showed that 3.27% of first prescriptions – medications newly prescribed to a given patient – were abandoned, and new medication users were 2.74 times more likely to abandon their prescriptions than existing pharmacy customers.[v] Furthermore, e-prescriptions were 1.64 times more likely to be abandoned.
The strongest predictor of abandonment is cost.[vi] The same 2010 study found prescriptions with a copay of $10 or less abandoned at a rate of 1.4%. More than 3% of those with a $30-40 copay and nearly 5% of those with $50+ copays were abandoned. Younger patients, assumedly with less income and fewer reasons to frequent the pharmacy, were more likely to abandon prescriptions, and certain drugs were more likely to be abandoned than others.
Additional research in 2017 showed 69% of patients abandoned prescriptions when the cost share was more than $250, versus only 11% if out-of-pocket costs were $30 or less. New patients abandoned more than 30% if copay coupons weren’t available, compared to only 12% of those for which high OOP costs could be offset.[vii]
Who cares? Health care providers and pharmacies.
Well, we all should. Estimates show that better use of medicines could eliminate $213 billion in annual US healthcare costs.[viii]
Firstly, medications only work if patients take them. Delayed or avoided medication therapies can lead to worsening conditions and more urgent, costly care. That’s not to mention the adverse impact of poor health on patients’ daily lives and our communities at large.
Secondly, the abandoned prescriptions must be returned to stock (RTS), which consumes considerable pharmacy time and resources.
It’s important to consider all of the pharmacy’s resources for any given prescription:
- Cost of goods for the physical prescription, including the drug itself, the vial, the label, the paperwork and a bag, at a minimum
- The time and expense to file a claim with a pharmacy benefit manager (PBM)
- Pharmacist or technician time to dispense and verify the prescription[ix]
- Automated systems and/or pharmacy staff time to notify patients that orders need to be picked up
- Cost of inventory tied up in the pharmacy will-call areas
- When prescriptions aren’t picked up within a reasonable timeframe (commonly 10 to 14 days), time to find the prescription in will call for RTS*
- The time required to disassemble and relabel the prescription and remove it from the patient’s record in the pharmacy management system (PMS)
- Time to reverse the PBM claim, plus potential penalties and DIR fees
Of that 3.27% of first prescriptions abandoned at the pharmacy we referenced earlier, 1.77% were returned to stock but never filled and 1.5% were returned to stock and later filled at the same pharmacy or a different one.[x] In other words, 1.5% of first prescriptions were filled twice – using 2x the goods, 2x the pharmacy or technician labor, 2x the claims; doing all those steps twice and wasting RTS and reversal time in between.
*Note: an inefficient RTS process can eat up hours and hours of pharmacy staff time over a week, and not doing it will drive up PBM penalties and switching/DIR fees.
Again, better prescription medication management would reduce US healthcare costs by an estimated 8%.
What can pharmacies do about it and what difference does it make?
Undoubtedly, pharmacy workers are often overworked, stressed and strapped for time, so adding additional tasks for patient follow-up and RTS to their plates isn’t ideal. But innovative will-call technology like scripClip substantially streamlines the RTS process and makes it easier to identify the patients and aged prescriptions that require attention.
scripClip’s RTS feature enables pharmacy staff to instantly display all prescriptions in will call by the drug name or NDC number, copay amount or the number of days in will call. Therefore, they can readily identify patients with higher copays, more-likely-to-be-abandoned medications, aging orders or history of abandonment to prioritize proactive and personalized patient follow-up. Staff can also identify if higher-cost medications are in will call for another patient and can effectively be reallocated for someone waiting in the pharmacy and ready to take it home, thus reducing lost customers and sales.
Suppose prescriptions are, unfortunately, ready for RTS. scripClip makes it easy to run a report, light up all orders for quick retrieval and print RTS vial labels, thus cutting RTS time down from, say, hours over the course of a week to a few minutes a day, so there’s no excuse not to do it. Take it from Kubat HealthCare, for example.
We know patient memory, health literacy, willingness to adhere, pharmacy access and expenses all play a role in potential prescription abandonment. Sometimes an automated reminder isn’t enough, as evidenced by 2021 research showing well over 2% of prescriptions are abandoned despite automated voice and text reminders.[xi] Patients may need consultation about the medication, education about drug interactions, guidance on the importance of adherence, reassurance about their providers’ treatment plans, coupons to help offset the OOP costs, help with transportation or delivery, or simply an extra nudge to make the trip to the pharmacy.
Plus, the time saved by prioritizing patient follow-up and avoiding RTS work frees up pharmacy staff to provide more revenue-generating services and a personal touch when patients come to the pharmacy – making it the outstanding hub of patient care it should be.
In short, pharmacies that leverage scripClip for will-call management and RTS functions realize:
- Improved PBM compliance and lower fees
- Improved patient medication adherence, health outcomes and pharmacy loyalty
- Improved prescribing provider relationships
- Increased revenue and improved cashflow
- Lower expenses, better inventory management and increased labor efficiencies
- Heightened staff satisfaction
Citations:
- [i] https://www.singlecare.com/blog/news/prescription-drug-statistics/
- [ii] https://www.prnewswire.com/news-releases/why-is-this-still-a-thing-half-of-consumers-have-abandoned-a-prescription-at-the-pharmacy-because-of-cost-301523399.html
- [iii] Doucette WR, Connolly C, Al-Jumaili AA. Estimating the cost of unclaimed electronic prescriptions at an independent pharmacy. J Am Pharm Assoc (2003). 2016 Jan;56(1):58-61. doi: 10.1016/j.japh.2015.11.005. PMID: 26802922.
- [iv] https://www.statista.com/statistics/864380/share-of-us-e-prescriptions/
- [v] https://scholar.harvard.edu/nkc/publications/epidemiology-prescriptions-abandoned-pharmacy#
- [vi] https://www.healthleadersmedia.com/finance/medication-cost-factors-prescription-abandonment
- [vii] https://catalyst.phrma.org/69-percent-of-patients-abandon-medicines-when-cost-sharing-is-more-than-250
- [viii] https://catalyst.phrma.org/69-percent-of-patients-abandon-medicines-when-cost-sharing-is-more-than-250
- [ix] https://pubmed.ncbi.nlm.nih.gov/24564809/
- [x] https://scholar.harvard.edu/nkc/publications/epidemiology-prescriptions-abandoned-pharmacy#
- [xi] https://pubmed.ncbi.nlm.nih.gov/33813921/