State-by-State Medication Adherence

The annual excess of health care costs as a result of medication nonadherence is roughly $290 billion in the U.S., according to a new report, with large variations across the nation.

CVS Caremark’s The State of the States: Adherence Report provides a snapshot of medication adherence across all 50 states. The report found that patients with depression generally had the lowest adherence rates, while those with hypertension were the most adherent. Medicare beneficiaries were more adherent than patients in health plans or employer insurance.

Regional variations were apparent and depended on conditions and population groups (Medicare, health plan, employer). For instance, in the Midwest, the adherence rates for diabetes and depression were the lowest. Adherence rates for employers and Medicare were lowest in the South.

The report also calculated potential cost savings by improving adherence and reducing unnecessary health care interventions. The report also calculated the maximum potential savings by converting all brand prescriptions to generics when available.

To determine the states with the best adherence rates, CVS considered various measures, including the medication possession ratio (MPR), which is the percentage of time a patient has access to medication. The optimal MPR is 80%.

These states had the best medication adherence for four conditions: diabetes, hypertension, high cholesterol and depression.

10. Vermont

Adherence: 65%

Savings by achieving optimal MPR: $7 million

Savings by converting to generics: $15 million

Burlington. Wikipedia.org

While MPR for health plan members was above average for high cholesterol, they were lower than average for diabetes, hypertension and depression. Adherence was higher than average among Medicare beneficiaries.

9. New Jersey

Adherence: 66.4%

Savings by achieving optimal MPR: $265 million

Savings by converting to generics: $837 million

Spring Lake. Photo by Nick Harris.

Medicare beneficiaries had average MPRs, but the percentage of optimally adherent beneficiaries was above average. Health plan members had slightly better than average MPRs for diabetes, hypertension and depression.

8. Virginia

Adherence: 66.6%

Savings by achieving optimal MPR: $113 million

Savings by converting to generics: $256 million

A.D. Williams Clinic and West Hospital at the Virginia Commonwealth University Medical Center. Photo by Taber Andrew Bain.

The percent of optimally adherent health plan members was higher than average, although adherence for all four conditions was below average among Medicare beneficiaries.

7. New York

Adherence: 66.9%

Savings by achieving optimal MPR: $276 million

Savings by converting to generics: $716 million

Rochester

Health plan members had higher than average adherence for all four conditions and the percent of optimally adherent Medicare beneficiaries was above average as well.

6. Massachusetts

Adherence: 68.2%

Savings by achieving optimal MPR: $310 million

Savings by converting to generics: $529 million

Harvard Square in Cambridge. Photo by chensiyuan.

A high percent of health plan members and Medicare beneficiaries were optimally adherent for all conditions. Adherence was especially high among health plan members for diabetes and hypertension.

5. West Virginia

Adherence: 68.5%

Savings by achieving optimal MPR: $44 million

Savings by converting to generics: $109 million

Wheeling. Photo by Tim Kiser.

The MPRs for health plans were below average for all four conditions, adherence among Medicare beneficiaries was also below average. However, for certain medications the percent of optimally adherent was above average.

4. New Hampshire

Adherence: 75.2%

Savings by achieving optimal MPR: $38 million

Savings by converting to generics: $109 million

Concord

Adherence was higher than average across the board, especially for diabetes. While MPRs among employers were slightly below average, the percent of members that were optimal was much higher for each condition.

3. Maryland

Adherence: 75.3%

Savings by achieving optimal MPR: $114 million

Savings by converting to generics: $312 million

Inner Harbor, Baltimore. Photo by G. Edward Johnson.

Adherence for all conditions was higher than average, but especially for diabetes. However, adherence among Medicare beneficiaries was below average.

2. Pennsylvania

Adherence: 76.6%

Savings by achieving optimal MPR: $281 million

Savings by converting to generics: $734 million

Pennsylvania Hospital in Philadelphia. Photo by Bruce Andersen.

Pennsylvania health plan members had above average adherence for all four conditions, but especially for diabetes.

1. Maine

Adherence: 78%

Savings by achieving optimal MPR: $34 million

Savings by converting to generics: $51 million

Old Port in Portland.

Adherence for all conditions was higher than average in Maine, but particularly so for diabetes and high cholesterol. Adherence among Medicare beneficiaries was also above average.