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How Medication Overutilization Drives Out-of-Pocket Healthcare Costs

Medication overutilization can lead to thousands of dollars in out-of-pocket healthcare costs.

medication overutilization

Source: Thinkstock

By Sara Heath

- Medication overutilization is costing patients thousands of dollars in out-of-pocket healthcare costs, according to a recent report from the AARP.

Specifically, unnecessarily prolonged prescription of dementia medications is running up a high bill for patients and their families.

According to the report, half of all adults age 85 or older have dementia. Costs associated with this chronic illness totaled at about $270 billion in 2017 and could reach as high as $1.1 trillion by 2050. These high costs are tied to the overutilization of common dementia drugs cholinesterase inhibitors (ChEI) and memantine.

ChEI and memantine are common medications used to slow down the progress of dementia, a degenerative disease that impacts cognitive abilities. These two treatments can improve some patients’ conditions, but cease to be clinically effective after about one year of use.

In addition to that pitfall, ChEI and memantine have some side effects such as fainting, abnormally slow heart rate, and hip fractures. The two medications also can cost patients about $700 each month.

Despite those issue, ChEI and memantine see high prescription rates even after they lose their clinical effectiveness. In an analysis of claims data for nearly 71,000 Medicare Advantage patients over age 65, AARP found high overutilization rates for these drugs.

About 50 percent of all patients diagnosed with dementia were treated using ChEI or memantine. Of those patients, 70 percent were on the drug for longer than 13 months, or longer than the drug was clinically effective.

Patients taking both ChEI and memantine at the same time incurred about $150 in monthly out-of-pocket healthcare costs. Additionally, about $18,000 of total dementia care spending occurred after the first year of the study, or after the medications ceased being clinically effective.

A small proportion of patients took the medications for the entire ten-year study period, racking up a bill of about $20,000.

Medication overutilization likely occurred because clinicians have limited education about how to taper off medications, AARP said.

“Despite the limited effectiveness of dementia drugs, most clinicians receive little guidance on when and how to de-prescribe them —that is, taper or discontinue the drugs to improve patient outcomes,” the AARP researchers said. “Further, it is common for physicians to continue prescribing these drugs to patients for considerably longer than the duration supported by clinical evidence. The associated costs can be substantial for both patients and health care payers.”

Additionally, medication overutilization may be the outcome of limited knowledge of patient wishes. It is not uncommon for clinicians to overprescribe certain treatments near the end of life, even if those treatments are not likely to be effective. While intentions are surely noble, overutilization of healthcare services can impede patient quality of life and increase healthcare costs.

“Health care providers must regularly assess patients and their prescription drug regimens to ensure regimens remain appropriate given changing health status and needs,” the AARP researchers concluded. “Accessible and up-to-date information on a drug’s effectiveness and side effects is essential to help increase the practice of de-prescribing medications that may no longer be of benefit, or even cause harm.”

Providers are not the only ones who practice healthcare overutilization, however. Patients often overutilize healthcare services, as well, especially when it comes to accessing care at convenient or lower-cost locations.

Data shows that although retail clinics are less costly that other care sites, they are not cutting overall healthcare spending because patients are using them too much and for symptoms that could mitigate on their own. In other words, patients are seeking unnecessarily medical help from low-acuity cases like the common cold.

At 2016 report published in Health Affairs found that 58 percent retail clinic visits were low-acuity, meaning the patient did not need medical attention for her symptoms. This resulted in cost increases of $14 per person.

A separate 2016 report published by the RAND Corporate yielded similar findings. Less than half of all retail clinic visits replaced a primary care provider visit, the report found. And while that 42 percent of retail clinic visits resulted in $22 of per patient cost savings, low-acuity cases cost about $35 per patient.

Overcoming healthcare overutilization will require better education for both patients and providers. Understanding how to de-prescribe or taper a prescription for a patient will be essential to cutting a patient from a medication that has ceased to be clinically effective.

Patient education efforts must also center on helping patients identify which health clinics to visit and for which symptoms. This will ensure patients receive the right level of care at the least possible cost.

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