Prompt Filling of Heart Failure Prescriptions Improved Outcomes and Reduced Costs in Humana Healthcare Research Study

When Humana Medicare Advantage member Helen was experiencing difficulty exercising, shortness of breath and swelling in the legs, she talked to her doctor who conducted tests which came back abnormal. Helen’s doctor diagnosed her with heart failure, a condition where the heart muscle can’t pump enough blood to meet the body’s needs.

The body tries to compensate in a variety of ways, some of which can make heart failure worse over time. Fortunately, Helen’s doctor started her on medications right away and treatment was effective, helping to improve her quality of life.

Cost of heart failure and hospitalization
The American Heart Association predicts heart failure will affect more than 8 million Americans by 2030. The estimated direct cost in the United States related to all forms of cardiovascular disease, including heart failure, was $226.2 billion in 2017 to 2018 with hospital inpatient stays accounting for $99.6 billion of that cost.

Staying out of the hospital is good for the patient and for the healthcare system. Some hospital admissions are unavoidable, perhaps due to injury caused by a serious accident, but others might be avoided. If you’ve been hospitalized, it’s equally important to avoid needing to be readmitted.

The Agency of Healthcare Research and Quality (AHRQ) identifies heart failure-related hospitalization as avoidable if the condition might have been managed successfully in an outpatient setting. According to the AHRQ’s Healthcare Cost and Utilization Project, the most common and expensive reason for avoidable hospitalizations is heart failure, which accounted for 1,112,600 stays at a cost of roughly $11.2 billion in 2017.

Medication adherence and heart failure
Medication adherence is defined as the extent to which patients take their medications as prescribed. Three easy ways for a patient to stay adherent would be to fill prescriptions within a month of a doctor’s visit, refill medications on time (so you don’t run out) and take medications as prescribed at least 80% of the time (don’t miss or skip meds more than 6 days in a month).

The clock for measuring medication adherence begins with the date a medication is prescribed. According to a recent Humana Healthcare Research study published in the Journal of Managed Care & Specialty Pharmacy, heart failure patients who delayed filling new prescriptions by more than 30 days after hospital discharge had a 65% increased risk of rehospitalization within 6 months.

Study results also showed that delayed filling of heart failure medication after hospital discharge was associated with 49.5% increase in average all-cause medical costs.

New target to improve patient care
Current programs to reduce the risk of heart failure-related readmissions commonly focus on medication reconciliation after discharge and improvement of medication adherence. This study suggests that the rapid filling of new heart failure prescriptions may be another targeted area of focus to improve heart failure patient care.

Key takeaway
Study results showed that heart failure patients who delayed filing newly prescribed heart failure medications by more than 30 days after hospital discharge experienced an increased risk of rehospitalization within 6 months.

Clinical programs and policies that focus on increasing access to and filling medications more quickly after discharge may offer an added tool for reducing avoidable readmission rates and lead to improved health outcomes and reduced costs after heart failure-related hospitalization.

Future research to understand the characteristics that increase the likelihood of delayed prescription filling may be valuable to health systems and health plans. This information could be used to implement interventions in small but high-risk populations.

The HHR study reference above: Poonawalla IB, Sutherland A, Chung L, Dixon SW, Ellis JJ. Early vs late filling of new heart failure prescription and its association with avoidable hospital admissions. Journal of Managed Care & Specialty Pharmacy, 2023;29:350-356. https://doi.org/10.18553/jmcp.2023.29.4.350

To explore more studies conducted by Humana Healthcare Research, visit research.humana.com.