The Price of Non-Optimized Medication Therapy


Pharmacists can help optimize medication regimens to produce the best patient outcomes at the lowest cost.

Although rising prescription drug prices cause a financial burden, the cost often extends beyond the number that patients see on their bill, according to a recent analysis published in the Annals of Pharmacotherapy. When medication regimens are not appropriately optimized for the patient, the consequences can carry a hefty price tag.

According to the analysis, death and illness resulting from non-optimized medication therapy costs $528.4 billion annually, which is equivalent to 16% of total US health care expenditures in 2016. As the most readily available access point for most patients, pharmacists can play a key role in ensuring that medication therapies are optimized to help produce the best outcomes at the lowest cost.

The study was led by Jonathan Watanabe, PharmD, PhD, associate professor of clinical pharmacy in the Skaggs School of Pharmacy, with Jan Hirsch, PhD, professor of clinical pharmacy and chair of the Division of Clinical Pharmacy at Skaggs School of Pharmacy, and Terry McInnis, MD, of Laboratory Corporation of America and the Get the Medications Right Institute.

A decade ago, data indicated that non-optimized medication therapy was estimated to cost $290 billion annually, or approximately 13% of US health care spending at that time, the researchers noted.

“We’ve experienced increased medical costs and we now have the Affordable Care Act, which gave 20 million more people access to prescription drugs and, as a result, more changes for nonadherence and medication-related health issues,” Dr Watanabe said in a press release.

For the study, the researchers created decision analytic models of many health outcomes that could occur due to a treatment failure or a medical problem caused by a new treatment, such as emergency department visits, hospitalization, long-term care, medical appointments, and additional medications. Based on data from several sources, including the federal government and the National Nursing Home Survey, the researchers estimated the total annual costs of outcomes resulting from non-optimized medication therapy.

Overall, the estimated total annual cost of illness and death resulting from non-optimized medication therapy was $528.4 billion, with a plausible range of $495.3 billion to $672.7 billion, according to the findings. Average medical-related costs associated with non-optimization was approximately $2500, and did not include non-medical costs, such as transportation, caregiving, or indirect costs related to lost productivity.

Related Coverage: 5 Easy Ways Pharmacists Can Improve Medication Adherence

Dr Hirsh noted that the estimate factors in more than just nonadherence to medication regimens, and includes any situation in which the medication regimen is not optimized correctly and safely to treat something treatable.

The researchers acknowledged potential uncertainty in the probabilities of predicted outcomes, but said that better coding and tracking systems will improve monitoring of medical outcomes related to medication therapy, allowing for more effective methods to improve medication-related care.

There are several ways health care providers can improve the optimization of medication regimens, such as improving prescriber-pharmacist communication and expanding comprehensive medication management programs. Allowing clinical pharmacists access to complete medical records and integrating collaboration between members of a patient’s health care team can be efficient ways to better optimize medication management and cut down on unnecessary costs, the researchers indicated.

“Non-optimized medication therapy is a massive avoidable cost,” Dr Watanabe said in the press release. “If medications were prescribed, monitored and taken properly, we wouldn’t face this cost, and patients would be healthier.”


Watanabe JH, McInnis T, Hirsch JD. Cost of prescription drug-related morbidity and mortality. Annals of Pharmacotherapy. Published March 26, 2018.

When Drugs are Wrong, Skipped or Make You Sick: The Cost of Non-optimized Medications [news release]. UC San Diego’s website. Accessed April 3, 2018.

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