What do you do if you can’t get your prescriptions filled after you leave the hospital?

Health care systems perpetuate barriers to medication adherence by using restricted formularies and pharmacies, and allowing high costs for drugs, copayments, or both.²  While reasons for medication non-adherence are complex, such systemic barriers are important for patients to know about.  Several studies report that non-adherence with medications prescribed at discharge are as high as 27-28% at seven days after discharge.^3,4  Cost of medications is certainly a contributor to non-adherence. One study evaluating over 10,000,000 prescriptions found that patients were three to five times more likely to not pick up medications if the cost was $40-50 compared to having no copay.⁵  Patients who are readmitted to the hospital have reported difficulty accessing their discharge medications as one of the reasons they come back.¹ A recent study of medical inpatients discharged at New York Presbyterian-Weill Cornell Medical Center found that 38% of patients were facing at least one of the following barriers to filling their prescriptions at discharge: high co-pay, non-formulary status, need for prior authorization, or unavailability of medication at preferred pharmacy.  (Patel et al, IN press) The medical team may not realize that such barriers exist either, therefore, it is crucial for both patient and care team to be have open dialog about the availability of all medications before the patients leaves the hospital.

^References

1. Kangovi S, Grande D, Meehan P, Mitra N, Shannon R, Long JA. Perceptions of readmitted patients on the transition from hospital to home. J Hosp Med. 2012;7(9):709-12.
2. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97.
3. Fallis BA, Dhalla IA, Klemensberg J, Bell CM. Primary Medication Non-Adherence after Discharge from a General Internal Medicine Service. PLoS One. 82013.
4. Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008;117(8):1028-36.
5. Shrank WH, Choudhry NK, Fischer MA, Avorn J, Powell M, Schneeweiss S, et al. The epidemiology of prescriptions abandoned at the pharmacy. Ann Intern Med. 2010;153(10):633-40.