Adherence to Diabetes Rx
Diabetes is one of the most costly and concerning conditions for employers and plan sponsors. The CDC estimates that more than 30 million Americans have diabetes, with another 84 million having elevated blood sugar, putting them on the cusp of type 2 diabetes. All told, roughly one out of every three people in the U.S. has the potential to need treatment for diabetes.
In Diabetes Dilemma: U.S. Trends in Diabetes Medication Use, we examined diabetes medication use among 1.4 million commercially insured members to identify what’s working, and where there might be room for improvement in outcomes and in reducing costs.
Good News for Patients and Plan Sponsors
Our most significant observation concerns adherence: people who were adherent to their oral diabetes medications experienced 235 fewer ER visits and 50 fewer inpatient hospitalizations per 1000 patients, and they spent nearly $500 less on total healthcare costs compared to nonadherent patients, potentially avoiding more than $210 million in healthcare spending in 2016.
People with diabetes who were nonadherent to their oral diabetes drugs had 1.3 times higher medical costs and 4% higher total healthcare costs compared to those who were adherent, spending an average of $11,176 vs. $10,683 in 2016.
While not all diabetes-related complications are avoidable, among people with diabetes who had diabetes-related complications, such as blindness, diabetic foot pain or chronic kidney disease, healthcare costs for adherent patients with diabetes-related complications were 9.4% lower than for those who were not adherent to their oral diabetes drugs in 2016.
Nonadherence Amplifies Costs
Employers spent more than $9,000 in total medical expenses per person with diabetes, nearly three times more than for individuals without diabetes, last year.
Overall, people with diabetes experienced three times greater inpatient hospitalizations and nearly twice as many ER visits than those without diabetes in 2016. Inpatient hospitalizations and ER visits cost four times more and two times more, respectively, for people with diabetes than those without the chronic illness.
However, those costs are greater for patients who are nonadherent to their medications: ER visits costs were 1.5 times more, and inpatient hospitalizations were 1.6 times more for nonadherent patients compared to adherent patients.
Adherence is Increasing
In 2016, nearly 85% of people treated for diabetes used oral diabetes medications, such as metformin and Januvia™ (sitagliptin), with 69% of people using only these medications to treat their condition. A separate analysis shows adherence to oral diabetes medications increased 3.6% between 2014 and 2016.
Age, gender and pharmacy channel all were factors for adherence to oral diabetes medications:
- In 2016, our research found medication adherence to oral diabetes medications was greatest among commercially insured people age 65 and older at nearly 75%, followed by people aged 45-64 at nearly 65%, yet there is still room for improvement.
- People aged 20-44 have the greatest opportunity to improve adherence, with just under half of that population being adherent to their oral diabetes medications in 2016.
- 90-day supplies of medication are associated with greater adherence: 81% of people who received a 90-day supply of oral diabetes medication through Express Scripts PharmacySM home delivery, and nearly 68% of people who received a 90-day supply at retail, were adherent.
Room for Improvement
Medication adherence pays off in a meaningful way for patients and plan sponsors, in both better health and lower total healthcare costs. Yet, there is substantial opportunity to continue reducing costs and improving outcomes by applying an increased focus on the prevention of type 2 diabetes, sustainable lifestyle modifications and greater adherence to diabetes medications.
Our study of behavioral science tells us patient behavior – forgetfulness and procrastination – are significant barriers to achieving optimal health and medication adherence.
At the Express Scripts Lab, we’re partnering with more than 300 plans to test new solutions and address important issues in diabetes care, including the use of new technologies like connected glucometers, counseling by diabetes pharmacists, and our collaboration with Mango Health, whose mobile health platform is designed to unlock our members’ good intentions and help them achieve better diabetes outcomes.
In addition, our Diabetes Care Value ProgramSM provides payers with condition-specific cost management and a quality pharmacy network – supported by the Express Scripts Diabetes Therapeutic Resource Center (TRC) – that can boost the average medication adherence rate for enrolled patients by 5%.