CVS Caremark Research Finds Correlation Between Amount of Patient Co-pay and Prescription Abandonment

WOONSOCKET, R.I., Nov. 16, 2010 /PRNewswire/ -- A new study by Harvard, Brigham and Women's Hospital and CVS Caremark researchers has found a direct correlation between the amount of a patient's out-of-pocket co-pay and likely abandonment of the prescription, with patients having a co-pay of $50 almost four times more likely to abandon a prescription at a pharmacy than those paying $10. The study also found that e-prescriptions are 65 percent more likely to be left abandoned at a retail pharmacy by patients than are hand-written prescriptions.

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The CVS Caremark-sponsored study published this week in the Annals of Internal Medicine is the first to systematically evaluate rates and predictors of prescriptions abandoned at the pharmacy.

"Sticker shock is an important driver of prescription abandonment," said lead author of the study, William Shrank, MD, MSHS, of Brigham and Women's Hospital and Harvard. Shrank said the study also outlines and validates a simple prediction rule that pharmacists can apply to help them assess whether patients are at risk to abandon their prescriptions.

"This research gives us new insight into an area of non-adherence that we did not have before and shows we have opportunities to change patient behavior," said Larry J. Merlo, president and chief operating officer of CVS Caremark. "We need to be more attentive to reasons why patients may be abandoning prescriptions and work to help them stay on their medications.  We continue to be a strong proponent of e-prescribing because we recognize the benefits it can provide, such as improving the accuracy and quality of prescription delivery and reducing paperwork to make pharmacy care more efficient."

The team of researchers reviewed all prescriptions dispensed at CVS/pharmacy locations between July 1 and September 30, 2008.  Of the prescriptions that were abandoned, more than half were never filled at any pharmacy, while some were filled at other pharmacies at a later date.  The team concluded that the pharmacy industry would benefit from learning more about prescription abandonment, which they said is an addressable factor impacting patient adherence to their medication.

The researchers said the higher rate of abandonment for e-prescriptions appears to occur because patients with written prescriptions must proactively bring the request for medications to the pharmacy, while patients with e-prescriptions are not required to take any step to begin the prescription filling process.  In addition, the rate of e-prescription abandonment appears high because pharmacies are able to track them as abandoned versus paper prescriptions that are never actually brought to a pharmacy.

The researchers said that if the 3.27 percent abandonment rate observed during the study period is applied to the 3.6 billion prescriptions filled at pharmacies in 2008, approximately 110 million prescriptions would be abandoned.

The researchers outlined a predictive model for pharmacists to apply to help them recognize likely candidates for abandonment that includes:

• Reviewing the individual's benefit plan and tiered co-pays.  The study said cost is the strongest predictor of abandonment. The data shows a 1.4 percent prescription abandonment rate for patients with co-pays of $10 or less, a 3.4 percent rate for patients with co-pays between $30 and $40 and a 4.7 percent rate for patients with co-pays of $50.
• Understanding past pharmacy behavior. Patients with first-fill prescriptions are three times more likely to abandon prescriptions than those who are re-filling their medication.
• Identifying the age of the patient. Younger patients are more likely than older patients to abandon their medications.  
• Reviewing the drug class.  The study found that opiates, anti-platelets and statins were the least likely to be abandoned, while insulin and proton pump inhibitors were more likely to be abandoned.

The prescription abandonment study is part of the CVS Caremark research effort aimed at better understanding how consumers interact with their pharmacy so that they stay adherent to their medications. The study is the work of CVS Caremark's previously announced three-year collaboration with Harvard University and Brigham and Women's Hospital to research pharmacy claims data to better understand patient behavior around medication adherence.

Past industry studies show one-quarter of people receiving prescriptions never fill their first prescriptions, and patients with chronic diseases such as diabetes and coronary artery disease adhere to their ongoing medication regimen about half of the time. Non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. health care system estimated at about $300 billion annually.

About CVS Caremark

CVS Caremark is the largest pharmacy health care provider in the United States. Through our integrated offerings across the entire spectrum of pharmacy care, we are uniquely positioned to provide greater access, to engage plan members in behaviors that improve their health and to lower overall health care costs for health plans, plan sponsors and their members. CVS Caremark is a market leader in mail order pharmacy, retail pharmacy, specialty pharmacy, and retail clinics, and is a leading provider of Medicare Part D Prescription Drug Plans. As one of the country's largest pharmacy benefits managers (PBMs), we provide access to a network of more than 64,000 pharmacies, including approximately 7,100 CVS/pharmacy® stores that provide unparalleled service and capabilities. Our clinical expertise includes one of the industry's most comprehensive disease management programs. General information about CVS Caremark is available through the Company's Web site at http://info.cvscaremark.com.

SOURCE CVS Caremark