Saving for a More Secure Future

As health care spending continuesto surge, it is not surprisingthat so much attention is beingfocused on the cost of prescription drugs.

A recently published federal studyestimates that drug spending grew by6.5% to reach $213 billion last year, andthat growth will accelerate over thenext decade, driven partly by newapprovals and higher drug use overall. Italso concludes that even though moreblockbuster drugs are due to becomeavailable as generics, generic dispensingrates are likely to level off, reducingthe potential for further savings.

Of course, rising drug costs shouldbe a matter for concern—but are theythe biggest problem? For years, studieshave pointed to the massive expenseresulting from the way drugsare used, rather than what they costto buy.

Lyle Bootman, PhD, dean of theCollege of Pharmacy at the University ofArizona and former president of theAmerican Pharmaceutical Association,and coresearchers analyzed the cost ofdrug-related morbidity and mortality,including factors such as the additionalcare needed in hospitals, long-term carefacilities, and other settings. Dr. Bootmanargues that even a conservativeestimate puts the real annual cost at$90 billion to $100 billion, and that thefigure could be far higher, at around$180 billion. In other words, for everydollar spent on drugs, almost as muchmay be spent treating the consequencesof drug misadventures.

Clearly, if we can reduce these problems,the potential to save money aswell as lives is enormous. This is anarea where we can play a key role—although a major obstacle presentsitself. Today, financial incentives inhealth care are structured mainly todrive short-term savings in areas suchas generic use. If those incentives wererestructured to reward approaches thatprevent medication problems, theycould drive much bigger savings thanthose achieved by trimming the cost ofindividual drugs.

The emerging medication therapymanagement programs provide aglimpse of the possible future. Usingthese early programs as examples, payerscould develop incentives that wouldreward community pharmacies forassuming a critical advisory role in thehealth care system. This would allow usto rely more on these services and lesson dwindling prescription reimbursements.It is also up to us, however, toshow our willingness to participate. Bydoing so, we will help ensure a futurethat is both more secure and even morevaluable to others.

Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of NorthCarolina at Chapel Hill.