Skipped Medications Costs Billions A Year: Integrated Health Offers Solutions

by Colleen Haines, Anthem, Inc.

September 13, 2017

It’s time to solve a $300 billion a year problem. Not taking medications as prescribed results in unnecessary health care spending and lost productivity reaching $100 billion to $300 billion every year. In addition, medication non-adherence is responsible for:

By finding gaps in health care, like medication non-adherence, and closing them before people become seriously ill, we can help to cut this billion-dollar problem down to size. An important way to do this is to look at medical care and pharmacy care together.

The medical/pharmacy disconnect

Unfortunately, medical and pharmacy benefits often operate in silos. When medical and pharmacy benefits aren’t well-integrated, identifying gaps in patient health care (like not refilling prescriptions or missing important lab tests) can be delayed or missed.

Let’s bring all the pieces together

“Big Data” is in the news, but smart data is what’s driving improved health care. Bringing together robust medical and pharmacy patient data for millions of people, along with their medical benefit designs and pharmacy programs is part of what’s known as “total population health.” Crunching these numbers identifies not only important health problems but is also critical for building strong solutions.

Timely, comprehensive medical and pharmacy data and analysis means people with care gaps can be contacted sooner and prompt action can be taken. For instance:

  • Both patients and their doctors can be quickly alerted when health care gaps are found.
  • Once identified, patients can be directed to care management programs or other interventions to prevent disease progression with associated costly hospital stays and emergency room visits.

Look at the big picture to manage rising drug costs

Managing skyrocketing drug costs also calls for a holistic approach. We all want and need lower cost drugs, but a drug’s price tag is only part of the equation. A more expensive drug may actually result in lower total health care costs if it results in better health, with fewer doctor visits and hospital stays. Coordinated, robust pharmacy and medical data is needed to be able to comprehensively evaluate drug effectiveness in this way.

Health care and health benefits can be fragmented, but there are ways to close the gaps. Integrated health care programs are bringing medical and pharmacy together to manage costs and improve health outcomes.

Colleen Haines is vice president of Clinical and Specialty Pharmacy at Anthem, Inc.


This is part of a series of six blog posts about integrated health care. Check out the previous posts and keep an eye out for the next one.