Prevalence of Unclaimed Prescriptions at Military Pharmacies

Abstract

BACKGROUND: Prescriptions that are ordered by physicians but not picked up by patients represent a potential quality improvement opportunity in health systems. Previous research has demonstrated that anywhere from as little as 0.28% to as much as 30.0% of prescriptions are unclaimed, and that 0.45% to 22.0% of patients fail to claim prescriptions. In the Military Health System (MHS), prescriptions filled at military pharmacies are dispensed with no copayment, providing an opportunity to examine the factors that contribute to unclaimed prescriptions other than out-of-pocket cost.OBJECTIVES: To estimate the prevalence of unclaimed prescriptions in the MHS, investigate reasons for unclaimed prescriptions, and compare self-reported noncompliance, defined as the failure to pick up at least 1 prescription in a 12-month period, with evidence from an administrative database of prescription orders and dispensings.METHODS: Research methods included pharmacy staff interviews at 6 military pharmacies, a telephone survey of beneficiaries who filled prescriptions at these pharmacies, descriptive analysis of survey data, and comparison of administrative pharmacy data with self-reported survey data. Beneficiary interviews, conducted from May through July 2004, covered background characteristics, medical conditions, and unclaimed prescriptions, relying on 12 months of recall regarding noncompliance. Interviews with pharmacy staff covered day-to-day operations, factors that alleviate or exacerbate noncompliance, and the burden that noncompliance places on pharmacies. Administrative data from the Pharmacy Data Transaction Service (pharmacy claims) and Composite Health Care System (CHCS: prescription orders and dispensings) databases were used to select a random sample for the beneficiary survey. Survey respondents' CHCS data were matched to their responses to determine the degree of agreement between self-reports and administrative data.RESULTS: Pharmacy interviews were completed with 30 staff members at 6 military pharmacies, and telephone interviews were completed with 1,214 beneficiaries (60.6% response rate). Beneficiary respondents filled an average of 7 prescriptions in the 5 months approximately surrounding the survey administration time frame (from March to July 2004). More than half (56.8%) of respondents were female, and nearly 60.6% were retired military or their dependents. Among all respondents at all study pharmacies, 8.0% reported failing to claim at least 1 prescription during the prior 12 months. Among survey respondents deemed compliant by CHCS data, 93.8% correctly identified themselves as compliant. However, among patients identified as noncompliant using CHCS data, only 16.0% selfidentified as noncompliant. The administrative data were not concordant with self-report data: of 105 survey respondents identifying themselves as noncompliant in the prior year and matched to administrative data (CHCS), only 58.1% were noncompliant per administrative data, and of 1,065 selfidentifying as compliant, only 61.1%...

Oral Contraceptive Use Among Women in the Military and the General U.S. Population

“…35,36 A recent survey also estimated that 8% of Military Health System beneficiaries had at least one unclaimed prescription at military pharmacies during a 12-month period. 37 The most common reason for failing to claim a prescription was no perceived need for the prescription. Therefore, it is likely that unclaimed OC prescriptions are less common.…”

Frequency of and reasons for medication non-fulfillment and non-persistence among American adults with chronic disease in 2008

“…What has been gleaned from this research to date? The following factors have been reported to influence medication non‐fulfillment: lack of perceived need for the medication, 4–17 concerns about side effects, 6,10,12,16,18,19 poor expectations for drug efficacy, 9,10,12–14,16,18 medication costs, 4,5,7,9,11–14,16–21 ,S15 poor understanding of the illness, 20 perceived polypharmacy (i.e. taking too many drugs), 13 general aversion to medications, 16 unaware a prescription was written, 4–6,8,9,18,19 forgot to pick up the prescription, 5,6,8,11,13–15,18 too busy to pick up the prescription, 6,7,10,14,15 transportation issues/inconvenient pharmacy location, 6,11,12,16,18,19,21 and long waits at the pharmacy 6,15,18,21 .…”

“…What has been gleaned from this research to date? The following factors have been reported to influence medication non-fulfillment: lack of perceived need for the medication, [4][5][6][7][8][9][10][11][12][13][14][15][16][17] concerns about side effects, 6,10,12,16,18,19 poor expectations for drug efficacy, 9,10,[12][13][14]16,18 medication costs, 4,5,7,9,[11][12][13][14][16][17][18][19][20][21],S15 poor understanding of the illness, 20 perceived polypharmacy (i.e. taking too many drugs), 13 general aversion to medications, 16 unaware a prescription was written, [4][5][6]8,9,…”

“…taking too many drugs), 13 general aversion to medications, 16 unaware a prescription was written, [4][5][6]8,9,18,19 forgot to pick up the prescription, 5,6,8,11,[13][14][15]18 too busy to pick up the prescription, 6,7,10,14,15 transportation issues ⁄ inconvenient pharmacy location, 6,11,12,16,18,19,21 and long waits at the pharmacy. 6,15,18,21 A similar inventory of reasons has been reported to influence non-persistence given the initial prescription was filled: unconvinced of the need for the medication, [22][23][24][25][26][27][28][29][30][31][32][33] experience of side effects, 12,[22][23]…”

Misclassification in Administrative Claims Data: Quantifying the Impact on Treatment Effect Estimates

“…These data are generally superior to self-reported medication use (which is susceptible to recall bias) [9, 10]. In some cases, these data are also more accurate than records of physician-ordered prescriptions (which may include medications that are never obtained by the patient) [11, 12]. Nonetheless, there are a variety of circumstances in which these pharmacy claims may not reflect the actual medication exposure of patients.…”