Every prescription experiences some lag between the moment the prescription is issued and the moment the medication lands in a patient’s hands. During this time, several events might cause delays, expanding the total length of the time between a prescription being written and a paid filling of that prescription.
Patients can often tolerate delays of one or more days. The more days that pass between prescription and filling, however, the more likely it is that the prescription won’t ever reach the point of a first paid fill. As time to paid fill increases, the paid fill rate drops.
Understanding the relationship between time to fill and paid fill rates can help pharmaceutical companies, pharmacies, payers and physicians identify why prescriptions go unfilled. This information can help these participants work together to reduce the number of patients who never receive a paid fill.
How Time to Paid Fill Affects Overall Fill Rates
The connection between time to paid fill and overall fill rate varies by the type of pharmaceuticals involved, their use in treatment, patient access to financial support and other factors. Overall, there is an inverse correlation between the time it takes to fill a prescription the first time and the likelihood that the prescription will be filled rather than canceled. The reasons patients fail to fill a prescription vary, and many can be addressed before patients give up.
Our research indicates that while no prescription has a 100 percent fill rate, fill rates above 80 percent disappear after 40 days between prescribing and first paid fill. In only two cases, fill rates above 60 percent extended into the 50-60 day window; for most prescriptions, manufacturers and pharmacies can expect a 60 percent fill rate or less after only 30 days. No fill rate of 90 percent or above persisted beyond the 30-day mark.
Patients are most likely to receive a first paid fill between 5 and 30 days after a prescription is written. Filled prescriptions are rarer after 40 days and nearly unheard of by 70 days after a prescription is written. Manufacturers who wish to ensure that patients receive the medication they are prescribed simply do not have time to waste when it comes to helping patients reach their first paid fill.
Connecting Payment and Fulfillment
Cost can affect whether prescriptions are filled or abandoned — and factors like the need for payer pre-authorization can increase the time to first paid fill. In a 2017 study, Ann Marie Navar, Benjamin Taylor and Hillary Mulder, et al. found that even among patients who received pre-authorization approval for PSCK9 inhibitors, 34.7 percent — more than one in three — never filled their prescription. The researchers noted that “prescription abandonment was largely explained by out-of-pocket cost.”
The longer patients are forced to wait for their medications to be covered and prescriptions filled, the more likely it is that a written prescription will be abandoned, even in the case of life-saving medications. Instead, patients turn to other treatment options. In some cases, patients may even forego treatment, instead enduring the complications and decreased health outcomes that accompany such a decision.
Several factors influence the time to paid fill and overall fill rates. In one study, Nirav R. Shah and fellow researchers examined 1,132 patients with diabetes as the patients filled diabetes medication prescriptions for the first time. The researchers found that low copays and high A1C [blood sugar] levels predicted higher fill rates.
The researchers also found that certain diabetes medications were filled more often than others. For instance, “biguanides and sulfonylureas had higher first-fill rates than second-line oral agents or insulin.” Sex, age and comorbidity did not demonstrate a relationship to fill rates. Patients who filled their first prescription also demonstrated better A1C reductions than patients who didn’t fill the first prescription.
In another study of patients with hypertension, however, Shah and the research team found that sex, age and comorbidity were connected to first-fill rates. Older patients, female patients and those with several comorbid conditions were less likely to fill a first prescription than other patients.
The granular, condition- and medication-specific nature of the factors that affect first paid fill rates calls for keen attention to data. It also requires a comprehensive platform that allows this data to be gathered and analyzed on the individual patient level when needed.
A comprehensive platform connecting manufacturers, distributors, payers, providers and patients can help reduce time to fill, boost overall fill rates and improve health outcomes.
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