Express Scripts Research Shows Significant Benefit of Adherence to Diabetes Medications

New research released by Express Scripts reveals that commercially insured people who were adherent to their oral diabetes medications experienced significantly fewer emergency room visits and inpatient hospitalizations, and spent nearly $500 less on total healthcare costs compared to nonadherent patients, potentially avoiding more than $210 million in healthcare spending in 2016.

According to the report, Diabetes Dilemma: U.S. Trends in Diabetes Medication Use, people with diabetes who were nonadherent to their oral diabetes drugs had 1.3 times higher medical costs and 4 percent higher total healthcare costs compared to those who were adherent, spending an average of $11,176 vs. $10,683 in 2016. Those who were adherent to their medications experienced 235 fewer ER visits and 50 fewer inpatient hospitalizations per 1000 patients.

While not all diabetes-related complications are avoidable, among people with diabetes who had diabetes-related complications, such as blindness, diabetic foot pain or chronic kidney disease, healthcare costs for adherent patients with diabetes-related complications were 9.4 percent lower than for those who were not adherent to their oral diabetes drugs in 2016.

"Medication adherence pays off in a meaningful way for patients, in both better health and lower total healthcare costs," said Glen Stettin, M.D., senior vice president, clinical, research and new solutions at Express Scripts. "Continued efforts to improve medication adherence, particularly for diabetes, should be a priority for employers seeking to lower cost and improve care."

Employers spent more than $9,000 in total medical expenses per person with diabetes, nearly three times more than for individuals without diabetes, last year.

People with diabetes experienced three times greater inpatient hospitalizations and nearly twice as many ER visits than those without diabetes in 2016. Inpatient hospitalizations and ER visits cost four times more and two times more, respectively, for people with diabetes than those without the chronic illness. Those costs are amplified for patients who are nonadherent to their medications:  ER visit costs were 1.5 times more, and inpatient hospitalizations were 1.6 times more for nonadherent patients compared to adherent patients.

In 2016, nearly 85 percent of people treating diabetes used oral diabetes medications, such as metformin and Januvia (sitagliptin), with 69 percent of people using only these medications to treat their condition.  A separate analysis shows adherence to oral diabetes medications increased 3.6 percent between 2014 and 2016.

Age, gender and pharmacy channel all were factors for adherence to oral diabetes medications:

In 2016, our research found medication adherence to oral diabetes medications was greatest among commercially insured people age 65 and older at nearly 75 percent, followed by people aged 45-64 at nearly 65 percent, yet there is still room for improvement.

People aged 20-44 have the greatest opportunity to improve adherence, with just under half of that population being adherent to their oral diabetes medications in 2016.

90-day supplies of medication are associated with greater adherence: 81 percent of people who received a 90-day supply of oral diabetes medication through Express Scripts PharmacySM home delivery, and nearly 68 percent of people who received a 90-day supply at retail, were adherent.

More than five percent of the commercially insured Americans, nearly 12 million people, used medication to treat type 1 or type 2 diabetes in 2016, when Express Scripts' prevalence data is extrapolated for the U.S. population.

Despite American Diabetes Association guidelines recommending metformin as first-line treatment for newly diagnosed people with type 2 diabetes, only about 82 percent of newly diagnosed patients received metformin in 2016.

Overall use of antidiabetic medications was greater among older adults: 10.5 percent of commercially insured people aged 45 to 64 years, and 15.2 percent of commercially insured people aged 65 or older, used a diabetes medication in 2016.

Adjusted for age and gender, use of diabetes medications was higher in Southern states: 6.5 percent of the Southern U.S. commercially insured residents used a diabetes medication in 2016; commercially insured residents in the Western part of the U.S. had the lowest utilization at 4.3 percent. At 7.7 percent, Alabama had the highest proportion of commercially insured residents in the country on an antidiabetic medication; Colorado had the lowest proportion among all 50 states with 4.2 percent.