Express Scripts develops predictive model to combat non-adherence

Pharmacy benefit manager giant Express Scripts has developed a predictive model, ScreenRx, to combat  what its chief scientist calls “the most costly healthcare issue in America” – non-adherence. And today the company is putting a number to that cost with the release of its 2011 Drug Trend Report: $317.4 billion.

That figure is more than America’s combined annual cost of treating diabetes, congestive heart failure, and cancer, the company said in a news release.

“The most sobering fact we found is that non-adherence is killing us – literally and financially,”  ExpressScripts’ Bob Nease, PhD, said in an interview with Drug Topics. 

To create ScreenRx, Nease said, the company took a cue from the most successful screenings for medical conditions, using more than 400 factors to help identify which patients are most at risk for not taking their medications.

“We decided to treat non-adherence as if it were a medical condition,” he said. “We needed to identify people who are at risk … and do something.”

ExpressScripts collects information about patients, their physicians, medical conditions, and prescribed therapies to determine who will most likely be at risk. Those patients will receive tailored interventions such as pill boxes, bottles that beep, and auto-refill programs. “We’re also looking at text messages,” Nease added.

He said that the No. 1 factor in non-adherence is forgetfulness – 69% of those who stop taking medications either forget to take them or fail to refill prescriptions. Cost is a factor for 16%, and 15% of those at risk have clinical concerns –  they don’t think the drug is working or they don’t want to take medications.

Among those most at risk for non-adherence are young people, parents with young children, and males with female physicians. Zip codes are another strong indicator.

ScreenRx will be used at first for patients taking medications for high blood pressure, diabetes, high cholesterol, asthma, and osteoporosis. Patients with multiple sclerosis will be added later, Nease said.

He noted that studies show that medications can prevent patients with high blood pressure from having strokes and those with high cholesterol from having heart attacks. Deaths from both those diseases can be prevented by making sure patients take their pills, he added.

The Drug Trend Report also includes some other interesting numbers:

• Spending on prescriptions drugs in the United States increased 2.7% in 2011, the smallest increase in the 18 years Express Scripts has been recording the statistic.

• Average member copayment is down to $12.02 from $12.10 in 2010 and $13.46 in 2006.

• Fewer than 50% of patients take their medications as prescribed.

Nease acknowledged that he, too, occasionally forgets to take his medication.

“I have a morning routine,” he said, “but when that routine gets disrupted by travel, or whatever, that’s when I sometimes forget.”