"Diabetes Dilemma" Report Finds Room for Improvement in Medication Adherence

A new report from Express Scripts examines patterns of costs and utilization associated with adherence to diabetes medications among a commercially insured population. Using 2016 data from 1.4 million enrollees, the report concluded that adherence is increasing, which will result in more avoided hospitalizations and lower spending, but there is still room for patients to improve their adherence.

The good news, according to the report, is that people who are adherent to their oral diabetes medications are reducing spending and utilization by staying out of the emergency department (ED) and hospital. Per each 1000 adherent patients, there were 235 fewer ED visits and 40 fewer hospitalizations compared with those who were not adherent. Each adherent patient was responsible for $493 less in total healthcare costs, even including pharmacy spending.

On the other hand, the costs of nonadherence were significant. Nonadherent patients had incurred 1.3 times higher total medical costs (excluding pharmacy) than their adherent counterparts ($8436 vs $6681, respectively). Among diabetes patients who experienced complications, nonadherent patients had over $2000 more in plan costs than those who were adherent ($10,381 vs $8011, respectively).

Extrapolated to the 11.6 million Americans with private insurance who are being treated for diabetes, these findings indicate that better medication adherence has the potential to avoid over $210 million in healthcare spending annually.

Part of the efforts to improve adherence include targeting interventions toward populations that will need additional help staying adherent to their regimens. The report identified patients aged 20 to 44 as the group with the lowest adherence rate, at just under half. In contrast, nearly 75% of those aged 65 and older and 65% of those aged 45 to 64 were adherent.

Researchers also observed a relationship between longer medication supply and adherence, as filling 90-day prescriptions was linked to better adherence than with 30-day supplies. For instance, 81% of those receiving a 90-day supply from Express Scripts’ home deliver program and 68% of those purchasing a 90-day supply at retail were adherent. Rates of adherence for patients purchasing 30-day supplies at retail were less than 50%.

“Medication adherence pays off in a meaningful way for patients and plan sponsors, in both better health and lower total healthcare costs,” a press release from Express Scripts concluded. “Yet, there is substantial opportunity to continue reducing costs and improving outcomes by applying an increased focus on the prevention of type 2 diabetes, sustainable lifestyle modifications and greater adherence to diabetes medications.”