Can Pharmacy Subscription Models Improve Medication Adherence, Costs?

Amazon Pharmacy's RxPass, a subscription program offering Amazon Prime members access to 60 generic medications for a $5 monthly fee, led to increased enrollment in prescription refills, extended medication supply days, and reduced out-of-pocket (OOP) costs.¹

Amazon Pharmacy's RxPass program shows promise in boosting medication adherence and reducing costs.| Image credit: Tada Images - stock.adobe.com

Medication nonadherence remains a critical public health challenge, contributing to significant morbidity, mortality, and health care costs. These results highlight the potential of subscription models to promote healthier behaviors and lower financial barriers.

The retrospective cohort study is published in JAMA Network Open.

“To our knowledge, this is the first study to evaluate a subscription model to access prescription medications, and we found that the program was associated with increased medication refills, days’ supply, and reduced out-of-pocket costs,” wrote the researchers of the study.

The current US pharmaceutical market is the largest globally, with high drug spending and profitability, and influenced by market competition rather than government pricing controls.² However, innovative approaches such as transparent pricing models offer hope for a more affordable and accessible future for patients.

In this study, the researchers aimed to evaluate the associations of program enrollment with medication refills, days’ supply, and OOP costs.¹

Data were collected on individuals younger than age 65 who were Amazon Prime members but not enrolled in Medicare or Medicaid. Participants included an exposure group of individuals enrolled in RxPass within 6 months of its launch and a control group of individuals residing in ineligible states but having clicked on the enrollment webpage. Weighting and adjustment models were applied to balance covariates such as demographics, payment type, and Zip code–level socioeconomic factors, while sensitivity and subgroup analyses addressed potential confounders like prescription transfers, anticipatory filling behaviors, and the most common medication classes.

The primary outcome was the total days’ supply of program medications per person per month (PPPM), and secondary outcomes were prescription refills and OOP costs.

After propensity score matching, the cohort included 5003 RxPass enrollees (mean [SD] age, 45.9 [11] years) and 5137 control participants (mean age, 45.8 [11.1] years).

Enrollment in the subscription program was associated with a significant increase in medication adherence metrics. The days’ supply of program medications increased by 10.39 days PPPM (95% CI, 10.29-10.48), a 27% rise.

Prescription refills also saw a 29% increase, with an additional 0.19 refills PPPM (95% CI, 0.19-0.19). Furthermore, OOP costs for program medications decreased by $2.35 PPPM (95% CI, $2.37-$2.33), reflecting a 30% reduction, underscoring the program's potential to enhance medication adherence and reduce financial burdens.

The researchers acknowledged some limitations to the study. Although the inverse probability weighting approach and doubly robust model reduced bias and achieved good balance between the exposure and control groups, unmeasured time-varying factors may still have confounded the analysis. Additionally, the inability to observe prescription refills at other pharmacies could have influenced results, as individuals in the control group may have been more likely to transfer prescriptions elsewhere. Furthermore, the study's inclusion criteria, limited to company members, restricted the generalizability of findings to the broader US population.

Despite these limitations, the researchers believe the study findings highlight the benefits of a pharmacy subscription platform on increased medication refills, days’ supply, and reduced costs.

“This program may also support medication refills and days’ supply since it includes many first-line and second-line therapeutic options for several common chronic conditions, such as hypertension, hyperlipidemia, and depression,” wrote the researchers. “Patients taking medications to manage 1 or more of these disease states can fill most of their medications through the program, avoiding the need to fill prescriptions outside this program. This one-stop-shopping approach to medication management for chronic diseases may reduce cognitive burden of separate prescription fills.”

References

1. Yeung K, Wilden D, Gupta V, et al. Pharmacy subscription program and medication refills, days’ supply, and out-of-pocket costs. JAMA Netw Open. 2025;8(1):e2456392. doi:10.1001/jamanetworkopen.2024.56392

2. Santoro C. The future of pharmacy, trends, threats, transformations. AJMC^®. January 10, 2025. Accessed January 27, 2025. https://www.ajmc.com/view/the-future-of-pharmacy-trends-threats-transformations.