Do subscription services for drugs actually work?

A study published in JAMA Network Open looked at how one subscription drug program from Amazon affects medication non-adherence, a problem that impacts nearly half of all Americans and contributes to 125,000 deaths and up to $300 billion in additional health care costs each year. Researchers found that Amazon Pharmacy’s RxPass subscription service significantly improves medication adherence while reducing out-of-pocket expenses for patients.

The study, the first to examine the potential of subscription-based pharmacy services, found that RxPass subscribers had 27% more medication on hand compared to non-subscribers, increasing their likelihood of being clinically adherent. Additionally, subscribers were 29% more likely to refill their prescriptions and saw an average decrease of $2.35 per month in out-of-pocket spending, a 30% reduction.

Vin Gupta, M.D., chief medical officer at Amazon Pharmacy, said: “This study suggests RxPass is a promising tool to improve medication management among patients with chronic conditions, especially those who take multiple medications and may have a limited income. RxPass is a simple option for a significant problem in health care. Addressing medication non-adherence can prevent further disease progression and reduce overall costs.”

Launched in January 2023, RxPass offers Prime members access to 60 prescription medications for a flat fee of $5 per month. The service covers widely prescribed medications for chronic conditions, including statins, anti-hypertensives, and antidepressants, benefiting millions of Americans managing high blood pressure, high cholesterol, and anxiety.

Led by Senior Healthcare Research Scientist Kai Yeung, Ph.D., Pharm.D., of Amazon Health Services, the study analyzed data from approximately 5,000 RxPass enrollees and a control group over six months. The findings suggest that subscription models could provide an effective solution to persistent medication adherence challenges.

Non-adherence often stems from multiple factors, including financial constraints, complex medication regimens, and limited access to pharmacies. Conditions like cardiovascular disease require consistent medication to prevent severe health complications, such as heart attack or stroke.

Yeung underscored the importance of simplifying medication access. “Patients face multiple barriers to medication adherence, making it a challenging issue to address across health care. RxPass tackles patient challenges holistically, simplifying medication management by reducing both the financial and administrative burdens. Subscribers know the cost upfront, have medications delivered to their door, and benefit from 24/7 access to a pharmacist. Our early findings indicate a low-cost subscription model can be an effective tool to help patients get and stay on their medications.”

Subscription programs like RxPass leverage behavioral and cognitive factors, including transparent pricing, automatic renewals, bundled services, and enhanced customer support, to encourage medication adherence.

“Improving health is often reliant on a series of small, consistent steps,” said Gupta. “I’m excited by the promise of the subscription medication model for chronic care, and compelled by how it could evolve the way we think about supporting our patients.”

As health care providers and policymakers explore strategies to improve medication adherence, the RxPass model may serve as a blueprint for expanding affordable access to essential medications while enhancing patient outcomes, according to researchers.