Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs

Objective: To determine the nature and extent of undersupply and the economic consequences of oversupply of medication among non-adherent patients. Methods: This study used copies of repeat prescriptions (=multiple dispensations), collected during 1 week in 2002 at 16 Swedish community pharmacies. For patients with a refill adherence below 80%, treatment gaps were defined as the number of days they had no drug available. The cost of drug oversupply (i.e., refill adherence >120%) was calculated from the prices of the drug packages dispensed. Results: The number of collected repeat prescriptions was 3,636. The median of treatment gaps among patients with a refill adherence below 80% was 53 days per 90–100 days treatment period and the corresponding median for oversupply was 40 days. The cost of oversupply for exempt patients (i.e., patients who have paid 1,800 SEK (€ 196; US$ 243) per year for medicines) was 32,000 SEK (€ 3,500; US$ 4,300) higher than for non-exempt patients. An extrapolation to all Sweden indicates that exemption from charges leads to an additional oversupply of about 142 million SEK (€15 million; US$ 19 million) per year above that of non-exempt patients. Conclusion: Both undersupply and oversupply of prescribed medicines are common in Sweden. Patients with a refill adherence below 80% seem to have less than half of the prescribed treatment available. Oversupply or drug stockpiling occurs more frequently among exempt than among non-exempt patients, and this oversupply leads to high unnecessary costs.