A pharmacy employee looks for medication as she works to fill a prescription while working at a pharmacy in New York December 23, 2009. Credit: Reuters/Lucas Jackson

Pharmacy benefits manager Express Scripts Inc identified various behaviors including brand loyalty, procrastinating on refills and occasional forgetfulness, that increase treatment costs.

This is the first time we've looked at the behavioral factors that are driving spending, chief scientist Bob Nease commented about Express Scripts' annual drug trends report.

The cost of these behaviors is a staggering $1 out of every $5 spent on prescription drugs, which account for 10 percent of the $2.3 trillion Americans spend on healthcare each year.

When you slice it that way, you get this eye-popping figure of $163 billion, Nease said in a telephone interview.

The report outlines ways for companies and patients to make people aware of the common habits that can increase the cost of healthcare in the United States as the nation looks for ways to pay for its newly passed healthcare reform legislation.

U.S. prescription drug sales climbed 5.1 percent to $300.3 billion in 2009, outpacing the 1.8 percent growth rate seen in 2008, according to data collected by IMS Health.

Failing to take drugs as directed had the biggest impact, accounting for $106 billion spent yearly to treat people for complications from chronic diseases like diabetes or high blood pressure, he said. People who miss doses can find their condition worsens and requires more costly treatment.


The group has identified three common misbehaviors: the refill procrastinator who takes drugs faithfully until the pill bottle is empty, then delays getting a refill; the sporadic forgetter who stays on track during the week but gets thrown off on weekends; and the active decliner who doesn't think the drug is working.

Loyalty to brand-name drugs over lower-cost generics, often because the former was prescribed first, constitutes $51 billion in missed savings, he said.

Even something as simple as changing the way people fill their prescriptions such as shifting to home delivery from the local drug store could save $6 billion annually, according to the report.

Overall, total drug spending by the Express Scripts' clients who participated in its behavior-changing programs fell by 2.3 percent as they used lower-cost drugs to treat common conditions such as diabetes and high blood pressure.

Changing behaviors by charging a higher co-payment for branded drugs only goes so far, as money is not the sole motivator, Nease said.

The behaviors we are talking about are not that difficult to change, and amount to changing habits, Nease said.

When Express Scripts asked customers last year to volunteer if they wanted their prescriptions refilled by home delivery instead of a trip to the store, home delivery usage doubled and saved clients $40 million, Nease said.