Non-adherence to WC Specialty Drug Regimen Costs Employers a Bundle, Study Finds

Nancy Grover

Sarasota, FL ( – Specialty drugs represent just a tiny fraction of medication spend in the worker’s compensation system. However, they come with an exorbitantly high pricetag. And what’s the costliest specialty drug?

“The most expensive specialty drug is the one not taken,” said Phil Walls, chief Clinical Officer for myMatrixx, an Express Scripts Company. “Meaning that if the doctor, pharmacist AND patient don’t all do their part to ensure the patient takes the medication as prescribed it is not going to be effective, and the money not well spent.”

In a new study researchers looked at patient compliance with one particular medication over a two-year period. They found those who did not adhere to the prescription regimen incurred more than $10,000 in costs compared with those who took the medication as prescribed. Their findings were published in the Journal of Occupational and Environmental Medicine.


Adalimumab, which is sold under the brand names Humira, Amjevita, and adalimumab-atto is approved to treat a variety of autoimmune conditions, including rheumatoid arthritis. While not related to workplace events, the drug is occasionally prescribed for injured workers.

“Almost universally claims professionals will tell me that they approve rheumatoid arthritis drugs because an injury has exacerbated the condition,” Walls explained. “It’s not used a lot – < 0.1% of our book of business by Rx count – but it drives considerable expense – about $500,000 … even though specialty drugs only account for 0.7% of all retail prescriptions for workers’ compensation, they drove 9.5% of costs [in our latest Drug Trend Report]. And Humira is definitely in the specialty drug class.”

The drug is a tumor necrosis factor-alpha (TNF) inhibitor agent. These TNF agents have improved patient outcomes among those who take them as prescribed, improving their quality of life, productivity and ability to work. However, one-third of patients – especially young adults, do not adhere to these prescriptions.

Prior research has shown that about 50% of prescriptions overall are not taken, “resulting in a substantial burden to patients and to society as a whole,” the researchers wrote. “Hundreds of billions of dollars in costs are attributed to medication non-adherence in the United States.”

For their study, the researchers compared a group of adherent and non-adherent patients prescribed Adalimumab in terms of their:

  • Healthcare resource utilization
  • Work loss, including leaves of absence, short-term disability and absenteeism days
  • Direct medical costs
  • Indirect costs

Medical, pharmacy, and work loss data from the OptumHealth Reporting and Insights database, covering the first quarter (Q1) of 2007 to Q1 2017 was used. The sample included 2,159 employed people, with roughly half in each of the adherent and non-adherent categories.


“Over two years, adherent patients had $10,214 lower per patient medical and indirect costs compared to non-adherent patients, resulting from lower health resource utilization, fewer days of absenteeism, and lower rates of work loss events,” the authors wrote. “Our results also highlight the importance of policies and interventions that aim to improve medication adherence, thereby reducing burden on patients and employers alike.”

One option noted is the idea of patient support programs (PSPs). These have emerged over the past couple of decades as insurers, health systems and drug manufacturers try to improve engagement in health regimens and self-management of medications among patients.

“These programs provide patients with face-to-face interactions with medical professionals, training programs, support in navigating the insurance and financial assistance processes, provision of materials to keep medications at required temperatures for travel, or reminders to take medications through phone, text, or e-mail,” they wrote. “Participation in PSPs has been shown to be successful in improving medication adherence to treatment while also lowering the economic burden to patients, health systems, and society.”

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