Adherence Arena: What is the real cost of non-adherence?
The higher the rate of non-adherence, the greater our sense of urgency should be
By on Jul 18, 2011Consider this deceivingly simple question: How much pharmaceutical revenue is forfeited every year in the US due to medication non-adherence?
Try looking this one up and you'll be surprised at the range out there.
The lowest one I have come across is only $30 billion. The highest I have seen is $280 billion.
The number I tend to use for presentation purposes is $177 billion, but I always find myself questioning it. I think the number is too small.
Why such extreme disparity? To me, this is alarming.
If you believe the number is only $30 billion, you might lend a certain sense of urgency to addressing the problem.
If you believe the number is actually a large multiple of $30 billion, it arguably becomes pharma's number one problem-and opportunity-full stop.
I know from IMS data that prescription sales in the US are about $300 billion annually.
So let's start there and do some back-of-the-napkin calculations.
Let's say that the WHO, for example, is correct in their assessment that overall compliance rates are about 50% (including in advanced countries like the US).
First, it's hard to know what that means, exactly. Does that include new prescriptions written but never filled, before pharmacies and insurers can even track them?
Does that include patients who decide to stop taking the medication altogether (non-persistence), and then how, exactly, is their "zero percent" compliance figured into the overall equation going forward?
For the sake of simplicity, let's just go with that number in the absence of being able to clarify every nuance.
That would mean, roughly, that the industry loses one script due to non-adherence for every script that is filled, meaning that about $300 billion is left on the table every year.
Think about more detailed data for a specific class of drugs: statins.
According to one careful study, if you consider patients who actually fill their initial statin prescription (perhaps only 75 percent of all comers, according to other studies), only about 40 percent of those patients continue to fill their prescription at one year.
In other words, a full 60 percent have stopped taking it, and that number accounts for medication switches within the class.
Now consider a specific drug, Lipitor ($7.2 billion in the US in 2010), and consider what Lipitor revenues could have looked like if you could actually make a significant dent in the adherence problem.
Forget trying to get new customers. Just focus on keeping the old ones longer than a few months.
On a different note, consider the number of averted heart attacks and strokes (a more important angle, but I wanted to focus on a simple revenue point here).
I don't know which organization or think tank would be best to take on the challenge of determining the most accurate "lost revenue due to medication non-adherence" number, but I am pretty confident that the number is higher than most of us have been led to believe.
Why does this matter? The higher the number, the greater the sense of urgency, and the greater deployment of resources to improve the business (and public health) crisis that it is.
Katrina S. Firlik, MD, is co-founder and chief medical officer ofHealthPrize Technologies, LLC. Prior to HealthPrize, she was a practicing neurosurgeon in Connecticut. She is also the author ofAnother Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside.