How Much Does Medication Nonadherence Cost the Medicare Fee-for-Service Program?

Abstract

Background: Medication adherence is associated with lower health care utilization and savings in specific patient populations; however, few empirical estimates exist at the population level. Objective: The main objective of this study was to apply a data-driven approach to obtain population-level estimates of the impact of medication nonadherence among Medicare beneficiaries with chronic conditions. Research Design: Medicare fee-for-service (FFS) claims data were used to calculate the prevalence of medication nonadherence among individuals with diabetes, heart failure, hypertension, and hyperlipidemia. Per person estimates of avoidable health care utilization and spending associated with medication adherence, adjusted for healthy adherer effects, from prior literature were applied to the number of nonadherent Medicare beneficiaries. Subjects: A 20% random sample of community-dwelling, continuously enrolled Medicare FFS beneficiaries aged 65 years or older with Part D (N=14,657,735) in 2013. Measures: Avoidable health care costs and hospital use from medication nonadherence. Results: Medication nonadherence for diabetes, heart failure, hyperlipidemia, and hypertension resulted in billions of Medicare FFS expenditures, millions in hospital days, and thousands of emergency department visits that could have been avoided. If the 25% of beneficiaries with hypertension who were nonadherent became adherent, Medicare could save $13.7 billion annually, with over 100,000 emergency department visits and 7 million inpatient hospital days that could be averted. Conclusion: Medication nonadherence places a large resource burden on the Medicare FFS program. Study results provide actionable information for policymakers considering programs to manage chronic conditions. Caution should be used in summing estimates across disease groups, assuming all nonadherent beneficiaries could become adherent, and applying estimates beyond the Medicare FFS population.

Association between long-term adherence to class-I recommended medications and risk for potentially preventable heart failure hospitalizations among younger adults

“…However, adherence to these medications appears to be important for the long-term management of HF regardless of ejection fraction status [8]. Prior studies that have examined a subset of guideline-recommended medication categories have found that adherence is associated with improved outcomes, such as decreased risk for hospitalization [9–11], reduced healthcare costs [12, 13], and improved survival [9, 11, 14].…”

Unrealized potential and unrecognized value: Community‐based pharmacy practice is reinventing itself—Join the movement

“…Nonadherence to chronic disease treatments is a significant issue. Lloyd et al estimated that, if 25% of Medicare beneficiaries with hypertension in the United States became adherent to an effective regimen, $13.7 billion could be saved annually by Medicare . Integrating pharmacists into the care management of chronic disease patients has demonstrated achievement of clinical outcomes and a positive return on investment, including in the community pharmacy …”

A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers

“…Among older adults with epilepsy, the odds ratio of utilization of inpatient services was 0.66 among patients adherent to antiepileptic drugs compared with nonadherent patients and 13.2% less cost on the total direct health care costs [ 14 ]. Similarly, a population-level evaluation of the economic impact of nonadherence to medications used for the treatment of diabetes, heart failure, hyperlipidemia, and hypertension among Medicare beneficiaries in the United States demonstrated that improvement in adherence would result in an annual reduction of 117, 594 emergency department visits and over 7 million inpatient hospital days among patients with hypertension [ 15 ]. Likewise, reductions in these health care costs would also be realized in patients with hyperlipidemia, diabetes, and heart failure [ 15 ].…”