San Diego—Just because a drug is prescribed, that doesn’t mean it always is the correct dosage of the ideal medication and that patients will take it as directed with no adverse effects.

That’s why a new study in the Annals of Pharmacotherapy proposes expansion of comprehensive medication-management programs by clinical pharmacists working with physicians and other prescribers. Otherwise, the authors warn, costs will continue to rise, and desirable patient outcomes will decline.

Researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego estimate that illness and death resulting from nonoptimized medication therapy costs $528.4 billion annually, which represents 16% of total United States healthcare expenditures in 2016.

“Ideally, when you’re sick, a health care professional prescribes you a medication, you take it as directed and you get better,” explained lead author Jonathan Watanabe, PharmD, PhD. “But what happens a lot of the time is the medication regimen is not optimized. In other words, the prescription may not be exactly appropriate for your indication—not quite the right medication or dose—or you just don’t take the medication for whatever reason, don’t take them as directed, or the medication causes an adverse event or a new health problem.”

For the study, data from a range of sources, including the federal government and the national Nursing Home Survey, were analyzed, looking at health outcomes related to treatment failure or new treatment-caused medical problems, including emergency department visits, hospitalization, long-term care, medical appointments, and additional medications.

Calculating the cost of each possible consequence, researchers estimated the total annual cost of illnesses and deaths that result from nonoptimized medication therapy to be $528.4 billion, with a plausible range of $495.3 billion to $672.7 billion. Estimates did not include nonmedical costs such as transportation or caregiving or indirect costs related to lost productivity.

The last time those costs were calculated in 2008, the estimate was $290 billion annually, or about 13% of U.S. healthcare spending at that time.

“We’ve experienced increased medical costs and we now have the Affordable Care Act, which gave 20 million more people access to prescription drugs and, as a result, more chances for nonadherence and medication-related health issues,” said Watanabe, who adds that the new study “clarifies that the cost of $528.4 billion is due to much more than simply nonadherence, which has been a misinterpretation of prior estimates, but also includes any situation when the medication regimen is not optimized to correctly and safely treat something treatable.

“Pharmacists and pharmacies are the most readily available health care access point for most people, and their role will likely expand as the health care landscape shifts to emphasize more community-based and ambulatory care,” Watanabe said. “Simply put, pharmacists can help optimize medication regiments to produce the best outcomes at the lowest cost.”
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