How do we get patients ? especially those with chronic conditions like diabetes and hypertension ? to take their medications faithfully?
Hundreds of billions of dollars are riding on the answer. Spending on prescription medicines in the U.S. annually amounts to $301 billion, about 10 percent of the nation?s total health care tab. But almost as much ? $290 billion ? is spent each year dealing with the medical effects of Americans not taking their drugs correctly, according to the New England Healthcare Institute.
Continue ReadingGetting patients to comply with their prescriptions could significantly cut health care costs.
It won?t be easy. Consider that researchers offered heart-attack survivors a seemingly irresistible incentive to take their medicine: ?free? drugs with no co-payments. But the free drugs only modestly improved the survivors? adherence rates, according to a study published online recently in The New England Journal of Medicine. If free drugs don?t do much, what could make a more significant dent in the problem? Pharmacists could. But the federal government doesn?t recognize them ? unlike most other health care professional ? as providers, which minimizes their role in helping patients correctly take their medicine and squanders tens of billions of dollars in potential savings.
Research shows that if pharmacists played a treatment role in addition to filling prescriptions, they could considerably lower health care costs. At Kaiser Permanente Colorado, for example, pharmacists set out to help patients with coronary artery disease hit their blood pressure and cholesterol targets.
Working under physician-approved protocols, the pharmacists monitored drug therapies, adjusted dosages, ordered lab tests and added medications when needed. The results? An 89 percent reduction in patients? overall mortality and a nearly $22,000 annual savings in health care costs per patient, according to a 2007 study.
One of the largest physician-pharmacist collaboration projects is in Asheville, N.C. The city first hired pharmacists to work with its employees who had diabetes in 1997, seeking to improve their health and lower treatment costs.
The results exceeded expectations. From 1997 to 2001, the city reported that annual direct medical costs per worker dropped, on average, by $1,200 to $1,872. The city has since expanded the project to cover other chronic diseases, including hypertension and asthma. It saves an estimated $4 for every $1 invested.
These kinds of improved health outcomes and cost savings could become more widespread if Congress changed provider law to make the expanded services performed by the pharmacists at Kaiser and in Asheville part of standard health insurance coverage.
The training today?s pharmacists undergo qualifies them for provider status. They must complete a four-year postgraduate program focused on managing complex medications ? more than 10,000 prescription drugs and counting ? that are central to today?s drug treatments.
This knowledge is increasingly in demand. Already, more than half all Americans have one or more chronic diseases, and for 90 percent of them medications are the first-line of treatment. Health experts expect chronic-disease rates to rise as the population grays.
Yes, allowing pharmacists to play a treatment role in patient care, and collect fees for doing it, may initially increase medical costs. But over time, as the Asheville project demonstrates, it saves money.
When you factor in improved patient adherence to prescribed drug regimens because of regular pharmacist oversight, overall savings could be significant.
The Affordable Care Act offers an opportunity to put new pressure on Congress. Under the health care law, every plan sold on the new insurance exchanges will be required to cover a set of ?essential health benefits,? like physician services and hospitalizations. The Department of Health and Human Services and the individual states are to decide the definition of those benefits. Making pharmacist-supervised medication management an essential benefit would help bring our health care system into the 21st century.
R. Pete Vanderveen is dean of the School of Pharmacy at the University of Southern California.
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