Better Drug Use Could Bring Huge Savings

Wiser use of prescription drugs could bring big savings for the U.S. health care system. A new report estimates the total at $213 billion each year. That's about 8% of the nation's annual health care costs. The IMS Institute for Healthcare Informatics published the report. The institute is part of IMS Health. This company uses its data on prescriptions written by doctors to provide advice to drug companies and others. The report defined 6 ways that better use of drugs could save money. For example, patients could help by taking medicines as prescribed. That would produce the biggest savings, $105 billion, the report said. Doctors and patients also could use generic drugs instead of brand names when available. They could avoid antibiotics for diseases caused by viruses. Doctors could prescribe medicines when guidelines recommend them and use tools to prevent prescribing errors. In addition, older adults often take many medicines. Steps to reduce the number or prevent mistakes in taking them also could prevent costly problems. In all, the report said, wiser medicine use could prevent 6 million hospital stays, 4 million trips to the emergency room and 78 million doctor visits each year. The Associated Press wrote about the report June 20.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

The United States spends a lot more money on health care per person than any other country in the world. But we are far from No. 1 in quality of health care. In fact, among 17 of the leading industrialized nations, the United States ranks dead last.

Drug costs make up a large part of the more than $2.7 trillion spent on U.S. health care. At least $213 billion of that money could be saved by proper and appropriate use of medicines, a new report says.

The report comes from the IMS Institute for Healthcare Informatics. It identifies six things that can be improved to address the problem.

Medicine non-adherence. This is the term doctors use to refer to people not taking prescribed drugs as directed, or not taking them at all. This can result in much more costly care down the road. Those costs are often much greater than the cost of the drug. For example, not taking a statin drug to lower cholesterol could lead to a very expensive heart attack for someone with coronary artery disease. Not taking drugs as prescribed accounted for almost half of the estimated $213 billion.

Under-prescribing of medicines that evidence shows are effective and more than worth the cost. This primarily applies to drugs that help prevent major complications of common conditions. Doctors must screen for these conditions and then follow the guidelines on drug treatment if the condition is found. An example would be testing for and treating hepatitis C in baby boomers and in high-risk people of all ages. Treating people who are infected can greatly decrease the risk of cirrhosis, liver cancer and the need for a liver transplant. Another example is identifying atrial fibrillation, an abnormal heart rhythm. Then drugs can be prescribed to prevent stroke. Attention to this problem could save an estimated $39 billion.

Excess use of antibiotics. This is happening less often. But many patients still receive antibiotics for upper respiratory infections, simple bronchitis and ear infections that get better just as fast without these drugs. In addition, the antibiotics are too often prescribed to be taken longer than necessary. The costs are more than those just related to the drugs. The side effects, such as severe allergic reactions and diarrhea, can lead to a stay in the hospital.

Medicine errors. This covers errors related to:

• Prescribing the wrong drug or the wrong dose of drug
• Filling or dispensing the wrong drug
• Not giving the drug as it was intended to be given

Not taking full advantage of approved generic drugs. Many patients are still reluctant to take generics, even ones that have very long safety records. And many doctors don't mention generic options unless the patient asks.

Taking too many medicines. This has become a huge problem, especially in older people with multiple medical issues. Doctors often add medicines based on new symptoms. However, they seldom tell patients to stop drugs or lower doses unless they have side effects.

What Changes Can I Make Now?

Even if you have excellent health coverage, you are likely paying a larger fraction of your health care bills these days. For most of us, out-of-pocket expenses are up. These include copays for drugs and visits to the doctor's office and emergency department. So you probably have a direct personal interest in bringing costs down.

You can save money on drugs. As your doctor starts to write a prescription, here are some things to ask that can lower how much you pay:

• Are there lifestyle changes I can make to either avoid taking this drug or at least start at a lower dose?
• Can I get a generic version?
• If no generic is available, is there another option that costs less and works as well as what you are prescribing? And is this brand the one preferred by my insurance company?
• Can I split this pill in half? For many drugs, the higher dose doesn't cost much more than the lower dose. By splitting a higher-dose version in half, you can save a lot of money.

After you have a prescription, you can save in other ways, too.

• Consider buying a three-month supply of drugs that you know you will take for a long time. Examples include drugs for high blood pressure, diabetes and high cholesterol. You may save on insurance copays if you do this and order by mail.
• Talk with your pharmacist about ways to save money. Given the thousands of drugs on the market today, your doctor may not know about all the options.

What Can I Expect Looking to the Future?

Besides the $213 billion we can save with smarter medicine use, there are many hundreds of billions more to be saved on health care. And we can save the most by preventing diseases with a healthy lifestyle, starting in childhood.