The Underestimated Cost of Prescription Abandonment

Leveraging technology to address financial barriers to medication adherence and improve outcomes

By Chris Kepinski and Gia Seymour

It’s a scene that plays out in pharmacies across the country each day—with implications that echo across healthcare organizations, life science companies, and the lives of patients and their families:

The pharmacy receives a script and fills it, but no one ever comes to pick it up. After multiple attempts to reach the patient, the prescription is ultimately cancelled, the medication restocked, and the patient’s health hangs in the balance as they go without their prescribed treatment.

Prescription abandonment—the term for a prescription order sent by a physician’s office to the pharmacy but never picked up by the patient—is a complex and highly under-studied phenomenon. While data on the subject are limited in recent years, a 2020 report by IQVIA found that 9% of all prescriptions are abandoned.¹ For medications that were free to the patient, the abandonment rate fell to 5%; however, for medications with an out-of-pocket cost to the patient of $500 or more, the abandonment rate rose to a staggering 60%.¹

The IQVIA data suggests that cost is a major, though not the only, factor contributing to prescription abandonment, making abandonment a particular concern for specialty medications—those used to treat rare, chronic, and/or complex medical conditions such as cancer and immune disorders. For these medications, astronomically high prices are the rule rather than the exception²: a report by the AARP Public Policy Institute found that the average cost of therapy for widely used specialty drugs was $84,442 per year.³

Specialty medications are not typically dispensed through the retail pharmacies that carry over-the-counter medications and fill prescriptions for infections and other common illnesses and conditions; instead, patients can get these prescriptions filled at specialty pharmacies. Specialty medications may also be filled via mail order pharmacies, at medically integrated pharmacies, or through in-office dispensing, in which the patient is given their medication directly by their healthcare provider.

Abandonment is a significant issue in and of itself, but it’s also just the tip of the prescription non-adherence iceberg: while 21% of adults in a 2023 KFF survey reported not filling a prescription at all because of the cost, 31% reported not taking their medications as prescribed because of the cost.⁴ Those not taking medicines as prescribed said they cut pills in half, skipped doses, or took over-the-counter drugs instead of their prescribed medicine.⁴

Impact on health and financial outcomes

A frequently-cited statistic attributes 125,000 avoidable deaths in the United States each year to medication non-adherence.⁵ In fact, that statistic dates back to 1998, yet virtually every article written on the subject since has referenced it. Why? Because there’s no more recent statistic available.

It goes without saying that a lot can change in 25 years. The figure we have doesn’t reflect recent innovations in medicine and healthcare technology, rising drug costs, economic or socioeconomic trends, changes to the health insurance landscape, nor any interventions that may have been aimed at reducing prescription non-adherence and abandonment over the past two and a half decades.

The data are similarly limited for other measures of the impact of non-adherence. For example, research published in 2018 estimated the annual cost of prescription drug-related morbidity and mortality due to non optimized medication therapy to be $528.4 billion in 2016.⁶ In addition to being nearly a decade old, it’s important to note that number is also not specific to non-adherence, encompassing other types of “non optimized” medication use as well. More recent, more specific data has yet to be published.

In short, we know frustratingly little about the true impact of prescription non-adherence and abandonment today, but that shouldn’t stop us from taking steps to minimize them.

The reasons patients abandon their prescriptions

To combat prescription non-adherence and abandonment, we need to understand the causes. Factors that may keep patients from picking up their prescriptions and/or taking their medications as prescribed include^{4, 7-13}:

• Financial hardship – Many patients struggle to afford their prescribed treatment, leading them to cut pills, skip doses, or abandon treatment altogether
• Intolerable side effects – When patients experience side effects that are severe, uncomfortable, or disruptive to their daily lives, especially without assistance in managing these side effects, they may decide that the negatives outweigh the benefits of treatment
• Lack of patient education – Without a clear understanding of the purpose of the medication, correct usage, and potential risks of not adhering to their prescribed treatment, patients may not follow through with treatment
• Complex medication regimens – Patients prescribed multiple medications or complicated dosing schedules may struggle to manage their treatment, leading to confusion, missed doses, or eventual abandonment of the medication
• Medically underserved areas – People in communities with limited access to healthcare providers or pharmacies often encounter barriers to getting prescriptions filled or obtaining follow up care, which can result in non-adherence
• Transportation issues – Patients lacking reliable transportation may find it difficult to attend necessary medical appointments or to visit the pharmacy, which can lead to missed medications or abandonment of their treatment regimen
• Medical anxiety – Some patients may abandon treatment due to fear, doubt, or overwhelming worry regarding medication use, potential side effects, or the treatment process itself
• Misinformation – Incorrect or misleading information about a medication—whether from the internet, friends, or other sources—can cause patients to doubt the necessity or safety of their prescribed treatment, resulting in non-adherence or abandonment

While all of these factors, and others, can influence whether or not a patient will follow their prescribed treatment plan, financial hardship plays an outsized role in the problem, as evidenced by the IQVIA data referenced earlier in this article.¹ Addressing financial hardship, then, can go a long way in reducing non-adherence and abandonment

A closer look at financial hardship

Financial hardship itself is a multifaceted issue, with high medication costs, insurance coverage issues, and socioeconomic status all factoring in.

When patients face high prescription costs, they may be forced to prioritize other essential needs for their families, such as housing, food, utilities, or child care, over their health care. Those with chronic illnesses or those requiring multiple medications can quickly become overwhelmed by the cumulative cost of care, making it even more likely they will abandon treatment or resort to measures like skipping doses.^1,4

The problem isn’t confined to the uninsured and under-insured. Even those with health insurance often struggle to afford their medications—especially specialty medications—due to high deductibles, copays, prior authorization issues, and coverage limitations and denials.¹⁴

Socioeconomic status, of course, further amplifies these challenges, with patients with lower incomes disproportionately affected by the financial strain of healthcare expenses.¹⁵

Financial assistance and access services make a difference

The primary way in which the healthcare industry has sought to offset high out-of-pocket prescription costs is through financial assistance and access services offered by life science companies and charitable foundations. A 2023 study in patients with rheumatoid arthritis or cancer demonstrated the impact of these resources, specifically copay assistance, in reducing prescription abandonment: copay assistance was associated with 79% lower odds of abandonment in patients prescribed medication for rheumatoid arthritis, and 71% lower odds of abandonment in patients prescribed oral oncolytics.¹⁶

Given the demonstrated success of programs like these in helping patients follow their prescribed treatment regimens, it’s perhaps not surprising that life science companies are spending upwards of $5 billion annually on patient support programs. What is surprising, though, is that only 3% of patients are actually using them.¹⁷

This is due in large part to eligible patients being unaware that assistance exists, or that they qualify for it. In a recent survey of 738 patients diagnosed with cancer, 68% reported that their care team had not provided them with financial assistance despite reporting a high level of financial toxicity, while 58% reported that their care team had not even asked them about financial stressors. An overwhelming 83% of respondents said they wanted their healthcare providers to reach out to them about financial needs, with 82% wanting those financial discussions to take place early in their patient journey.¹⁸

In order to limit treatment non-adherence and abandonment, it’s incumbent upon healthcare providers, pharmacies, life science companies, and foundations to take a proactive role in managing financial assistance to ensure patients are receiving the resources intended to help them afford treatment.

How technology can help

Proactively assessing every patient to determine whether or not they qualify for any available assistance is a step healthcare provider organizations and pharmacies can take as soon as a treatment plan is determined or a script is received to make sure no assistance opportunity is missed.

But with dozens of individual program portals and disease fund websites to check and navigate, the search for patient assistance is time- and labor-intensive, and it can be easy to overlook available resources. Moreover, once a funding opportunity is identified, each program has a unique and elaborate enrollment process requiring manual, often redundant, data entry, which can lead to errors and omissions.

For most healthcare provider organizations and pharmacies, these administrative barriers have historically made it difficult, if not impossible, to secure financial assistance for every eligible patient. In fact, assistance is typically not sought out unless and until a patient states that they cannot afford treatment. But because patients don’t know that assistance opportunities are out there, and that they likely qualify for them, they rarely bring up financial need with their providers, abandoning treatment instead.

Fortunately, digital innovation makes it possible for healthcare organizations and pharmacies—even those with a high patient volume and/or limited human resources—to proactively work up every patient and enroll them in every program they qualify for.

AssistPoint^® is a comprehensive software platform that accelerates the management of financial assistance and access services for healthcare organizations, helping patients get on and stay on their prescribed treatment.

AssistPoint integrates seamlessly with practice management systems, electronic health records, pharmacy management systems, and patient support programs offered by life science companies and charitable foundations. This digital connectivity makes finding and managing patient assistance quick and straightforward, empowering healthcare organizations and pharmacies to:

• Rapidly search a comprehensive library of over 10,000 assistance opportunities at the click of a button
• Digitally enroll patients into individual programs using a standardized form, automatically prepopulated with patient information pulled directly from the practice management or pharmacy management system, saving time and reducing errors by eliminating the need to fill out multiple repetitive forms^*
• Actively monitor award fulfillment to ensure utilization and adherence, and easily provide patients with accurate, up-to-date award balances
• Stay on top of all activities related to patient assistance via a suite of 35 insightful analytics reports for AssistPoint users, management, and the C-suite, available real time

Life science companies and charitable foundations can do their part to reduce prescription non-adherence and abandonment by integrating their patient support programs with AssistPoint via AP Connect^®.

AP Connect optimizes patient support program utilization by creating a two-way, secure information exchange between the program and AssistPoint, accelerating the application, enrollment, and fulfillment processes. Through AP Connect, program communication delays are reduced, award approval notifications are sped up, and more eligible patients are able to afford and access their prescribed treatment.

Minimizing prescription abandonment through innovation

Prescription non-adherence and abandonment remain critical issues with profound implications for patient health and the healthcare system, and financial hardship is a significant contributor to the problem. Addressing this issue requires a collective effort from healthcare provider organizations, pharmacies, life science companies, and charitable foundations. By leveraging innovative solutions like AssistPoint and AP Connect to secure available assistance for eligible patients, the industry can take meaningful steps to reduce prescription abandonment, improve adherence, and ultimately enhance patient outcomes.

Want to see AssistPoint and AP Connect in action? Submit a contact form at annexushealth.com/contact and a member of the Annexus Health team will be in touch to schedule a virtual demo.

*For programs that are not yet digitally integrated with AssistPoint, users can still identify these opportunities using the AssistPoint search wizard and are presented with a link to quickly access the program portal to complete the enrollment process, and can document the enrollment details in AssistPoint for future reference and tracking.

About the contributors

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