The environmental landscape for pharmaceutical manufacturers and retail pharmacies is marked with landmines, yield signs, and cautionary wild cards: health reform, supply chain dynamics, specialty drug pricing, pharmacogenomics, and the high burden of chronic disease among them.

But the crux of the challenge for achieving optimal outcomes has less to do with these factors than it does with consumer behavior: specifically, the chasm between what people/health consumers say they want versus what people actually do. Express Scripts calls this “The Intent-Behavior Gap,” and it’s the theme of the company’s 2010 Drug Trend Report, Complex Challenges, New Solutions.

The cost of sub-optimal pharmacy behaviors are huge: in 2010, pharmacy-related waste was more than $403 billion. Express Scripts forecasts that pharmacy-related waste will exceed $1.2 trillion between 2010 and 2014, equal to $3,722 per capita in the U.S. This is ‘waste’ because that spending doesn’t result in any marginal health benefit for each U.S. health citizen. Overall, $1 in every $3 of traditional pharmacy spend is waste.

Express Scripts asserts that, “Consumer behavior stands between the doctor and optimal outcomes.” Regardless of health providers’ appropriate prescriptions for their patients, there are three opportunities for re-shaping consumer behavior that achieves optimal outcomes and reduces pharmacy-related waste:

  1. Optimizing the sales/retail channel, equivalent to $88 billion of waste.
  2. Optimizing drug mix, equal to $57 billion of wasteful health spending.
  3. Maximizing adherence, an opportunity of $258 billion.

The chart above identifies the key metrics for the top 10 prescribed therapy class of drugs in 2010, showing the percentage of “behavioral waste.” The top categories in waste were Rx drugs for treating cholesterol, ulcers, pain, depression and diabetes.

Health Populi’s Hot Points:  Express Scripts asked Harris Interactive to poll U.S. health consumers about their use of and interest in pharmacies and personal health behaviors. 71% of retail pharmacy consumers said they’d use home delivery of Rx drugs instead of a “bricks” retail pharmacy. 82% of people said they’d switch to generic drugs instead of brands. And, 58% of patients who are non-adherent with prescribed drug regimens think they’re already taking their meds as prescribed.

As I was filling my gas tank yesterday, I noted the sign pictured on the right: an attestation from a consumer saying, “I know more about how my car works than how my body works.” The same can be said, based on the Harris Poll data for Express Scripts, that people know more about regularly changing their car’s oil than they do about sticking to prescription drug instructions given by their doctors and pharmacists.

What to do? Express Scripts’ own prescription for addressing waste is three-fold: switch patients to generics whenever possible, move consumer to buy drugs for home delivery, and get patients to take drugs as prescribed. The third challenge is the heaviest lifting, and requires major and complex behavior change. Health plans have begun to adopt value-based designs that artfully and fiscally nudge patients toward better health behaviors, including medication adherence. The more these plans can influence consumers on a 24×7 basis at peoples’ daily touchpoints — especially utilizing mobile platforms like smartphones and PDAs — the more patients will become more conscious, and conscientious, about their micro-health decisions. Perhaps then, one day, CITGO will be able to revise its Fueling Good campaign slogan.

3 Comments on The intent-behavior gap is what stands between the doctor and optimal health outcomes

Ian Shendale said : Guest Report 10 years ago

There are thousands upon thousands of studies from the FDA, the American Pharmacists Association, the National Community Pharmacists Association, Frost and Sullivan, Modern Medicine, the Institute of Medicine, CBS, Medco, and more. A major complication is that most patients and caregivers think that they are good medicine takers. However, a National Community Pharmacists Association survey from October 2006 found that while people answered ‘yes' when asked if they are good medicine takers, 57% also answered ‘yes' to the next question, which asked if they ever forget to take medication. So people believe they're good and want to be good at taking their medicines, but they're not. Considering that forgetfulness is the major cause of non-adherence, let's then think about the fact that there are currently 5,000,000 people with Alzheimer's disease. Now how many people are turning 65 over the next decade, and how many of them will suffer from Alzheimer's or early dementia? When we look at healthcare costs in America and we look at the numbers of people who are accidentally underdosing and overdosing and being taken to hospitals or nursing homes, that number is going to grow exponentially. Early onset Alzheimer's in an aging population means that there are going to be so many people who don't know if they've taken their medications or not. When I look at the campaigns to increase disease screening, adherence programs, efforts by insurers and drug companies, pill boxes, efforts by conscientious individual clinicians, medication regimen manipulation, and patient empowerment efforts, all of which are done in the name of compliance improvement, and when you consider all the money spent in the same pursuit since 1995, and I ask what have we gotten, the answer is we've gotten nothing. No improvement whatsoever. The cost of healthcarre has grown from $77 billion in early 2000 to $290 billion. 2010. attributed to preventable medication-related problems. The problem is people are most dangerous when they don't know what they don't know. The other problem is that very few professionals are taking the time to give proper advice. In the U.S. we live in a big box, supermarket, give em what they want, fast and furious and send them out the door. I remember hearing the President of Amgen say that he thought he was doing God's work creating a new Heart Medication. 1,000,000 pages to the FDA, 10 years to create the new miracle medication and 1 minute for a patient to forget. Why? Responsibility by necessity falls upon the shoulders of the individual least capable of following a strict dosage interval.

A Los Angeles Cardiologist said : Guest Report 10 years ago

Your post makes a very important point about the magnitude of the problem of non-compliance to the contribution of healthcare waste. The figures actually may be an underestimation because if there is non-compliance there is probably also treatment failure and resultant long-term increased medical costs. I think it is very hard for patients if they are taking numerous medications to adhere to the prescriptions. Unfortunately, it is sometimes very hard to figure out if a patient is adhering to their medication regimen.

Thom de Bruijn said : Guest Report 10 years ago

The start was good, the race is bad. Yes there is a gap and yes it's about compliance. But why do people know more about their cars than bodis; because the behaviour of cars you can easely adapt to the result and the behaviour of men not. Change of behaviour is the worst solution healthcare can think of and typical for healthcare; thy consider bodies as cars. Everyone knows that the challenge to adapt a machine to serve a man, makes the man the director of the machine and with that he changes from the driver of a car ( the server) into the user of a car and with that the owner of the mobility and the way mobility can be used to comfort, serve or satisfy the rest of life.. Do the same in compliance and use a machine to take care of, make the user the owner and director of this server ( modern digital assistant) and by that the director of compliance and the way it has to be managed to be comfortable, to serve health and satisfy everything besides health. My Pillkey is designed for that and yes the gap will never be bridged if healthcare needs to arrange dailt compliance. I can win 285 billion and healthcare will upgrade the costs above this number.

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