Health Care Spending Spikes Due to Improper Diabetes Drug Adherence

A new report published by Express Scripts indicates that commercially-insured patients who were adherent to their diabetes treatment regimen had a lower rate of emergency department visits and hospitalizations, which avoided more than $210 million in spending in 2016, according to a press release.

Diabetes is a costly condition that affects more than 30 million Americans. An additional 84 million have prediabetes, which places them at a high risk of developing type 2 diabetes.

In the new study, Express Scripts analyzed diabetes drug utilization among 1.4 million members to determine which strategies are working and where there could be improvements in patient outcomes and lowering drug costs.

Notably, the pharmacy benefit manager (PBM) found that patients who were adherent to oral diabetes drugs had 235 fewer emergency department visits and 50 fewer inpatient hospitalizations per 1000 patients. Patients who were adherent spent $500 less on healthcare compared with nonadherent patients, resulting in a total decrease of $210 in healthcare spending in 2016, according to the study.

Nonadherent patients were found to have 1.3 times higher medical costs. These patients also had 4% higher total healthcare costs compared with adherent patients, a difference of $11,176 versus $10,683, respectively.

Although not all complications can be avoided, costs for adherent patients who had diabetes- related complications, such as blindness, diabetic foot pain, or chronic kidney disease, were 9.4% lower compared with nonadherent patients in 2016, according to the study.

In 2016, employers spent more than $9000 in medical expenses per patient with diabetes, a 3-fold increase over patients without the condition.

Express Scripts reported that patients with diabetes had 3 times the number of inpatient hospitalizations and twice as many emergency department visits compared with patients without diabetes in 2016.

Since emergency department use and hospitalizations cost 4 times and 2 times as much for patients with diabetes compared to those without the condition, respectively, proper adherence has the potential to save millions of healthcare dollars.

Additionally, Express Scripts found that nonadherence to diabetes drugs also ups how much is spent, with emergency department use costing 1.5 times more and hospitalizations costing 1.6 times more compared with adherent patients, according to the study.

In 2016, 85% of patients used oral diabetes drugs, with nearly 70% of patients using metformin or sitagliptin (Januvia). Importantly, adherence to oral diabetes drugs increased 3.6% between 2014 and 2016, according to the PBM.

Express Scripts also found that in 2016, adherence to oral diabetes drugs was highest among patients 65 years and older at nearly 75%. While adherence was nearly 65% among patients aged 45 to 64 years, the PBM indicates that improvements can be made.

Among younger patients aged 20 to 44 years, less than half were adherent to diabetes drugs, which highlights the most significant opportunity to improve adherence, according to the release.

The new report also shows that 90-day prescriptions sent through Express Scripts Pharmacy home delivery may lead to greater adherence, with 81% of patients receiving this type of prescription remaining adherent. Only 68% of patients who received a 90-day supply through retail pharmacies were adherent, according to the report.

While medication adherence improves health and lowers healthcare spending, there is an opportunity to further achieve these goals by focusing on prevention, implementing sustainable lifestyle changes, and improving adherence.

Patient behavior, including forgetfulness and procrastination, pose significant barriers to medication adherence. Express Scripts is currently pioneering and testing several potential solutions to improve adherence, according to the release.