The good news from IMS Institute for Healthcare Informatics: Using prescription medicines properly could save $200 billion in annual U.S. healthcare costs. More good news, at least for the pharma business: The institute's ideas for saving money don't all translate to less spending on drugs, branded or otherwise.
Sure, broader use of generic drugs can save the healthcare system money. But a lot of that savings has already been realized. There's still an $11.9 billion savings opportunity in that sphere. Meanwhile, reserving antibiotics for cases when they're actually necessary and useful could save another $35 billion.
But responsible use of prescription meds sometimes means taking more of them, generics or not. The biggest cost-cutting "lever" identified in the IMS report was a familiar one: medication adherence. When patients don't take their drugs as directed, the drugs don't work as expected. Think heart attacks for people who don't take their cholesterol fighters or blood pressure pills.
The IMS Institute figures fixing the adherence problem could save $105 billion per year on avoidable hospitalizations, ER visits and more. And that's just for the 6 chronic health problems IMS assessed, with high cholesterol and Type 2 diabetes accounting for the biggest share of avoidable costs.
And then there are the delays in diagnosing and treating patients, when early treatment could make a big difference in the course of an illness. The right drugs at the right time can prevent costly complications down the road--about $39.5 billion worth per year, the IMS report says, looking at four common diseases, including diabetes and hepatitis C. Prompt diagnosis and treatment of diabetes alone could save $34 billion per year by preventing unnecessary outpatient care and hospitalizations, the report says.
A big chunk of patients with each of these four diseases aren't receiving treatments proven to work. Only one-fifth of hepatitis C patients are treated, mostly because infection often goes undiagnosed. Just 24% of patients with heart disease take aspirin as a preventive measure. Up to two-thirds of atrial fibrillation patients who've already had strokes don't get the blood-thinning meds that can prevent a repeat. And only about half of diabetics who already have kidney problems are being treated properly, the report says.
Adherence is improving already, and drugmakers are focusing on it more than ever, using technologies like text messaging, email and mobile apps to spur patients to keep with the program. Upping treatment rates in key diseases could be an even tougher nut to crack, though. Some of the adherence gap is due to patients who aren't covered by insurance.
Murray Aitken, executive director of the IMS Institute, says the Affordable Care Act's focus on coordinating care and performance-based payments could promote "positive forces in addressing the avoidable costs" described in the new report. "Performance-based payment systems and the introduction of accountable care organizations are enabling Medicare to really put a focus on improving these areas," Aitken said during a conference call with journalists. In fact, keeping patients on their meds will be a Medicare-reimbursement metric. "Payment will be higher if adherence rates improve," Aitken said.
- read the IMS Institute release
- and IMS' infographic