Pharmacy World & Science

, 29:19 | Cite as

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

  • Kristin Krigsman
  • Arne Melander
  • Anders Carlsten
  • Anders Ekedahl
  • J. Lars G. NilssonEmail author
Research Article


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.

Key words

Costs Exemption from charges Oversupply Refill adherence Repeat prescriptions Treatment gaps Undersupply 


  1. 1.
    World Health Organization. (2003). Adherence to long-term therapies. Evidence for action. World Health Organization, Geneva. ISBN 924 154599 2Google Scholar
  2. 2.
    Andersson K, Melander A, Svensson C, Lind O, Nilsson JLG Repeat prescriptions — refill adherence in relation to patient and prescriber characteristics, reimbursement level and type of medication. Eur J Public Health 2005 Dec; 15(6):621–626Google Scholar
  3. 3.
    Steiner JF and Prochazka AV (1997). The assessment of refill compliance using pharmacy records: methods, validity and applications. J Clin Epidemiol 50: 105–116CrossRefPubMedGoogle Scholar
  4. 4.
    Jackevicius CA, Mamdani M and Tu JV (2002). Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 288(4): 462–467CrossRefPubMedGoogle Scholar
  5. 5.
    Wei L, Wang J, Thompson P, Wong S, Struthers AD and MacDonald TM (2002). Adherence to statin treatment and readmission of patients after myocardial infarction: a six year follow-up study. Heart 88: 229–233CrossRefPubMedGoogle Scholar
  6. 6.
    Morningstar BA, Sketris IS, Kephart GC and Sclar DA (2002). Variation in pharmacy prescription refill adherence measures by type of oral antihyperglycaemic drug therapy in seniors in Nova Scotia, Canada. J Clin Pharm Ther 27: 213–220CrossRefPubMedGoogle Scholar
  7. 7.
    Mojtabai R, Lavelle J, Gibson PJ, Sohler NL, Craig TJ and Carlson GA (2002). Gaps in use of antipsychotics after discharge by first-admission patients with schizophrenia, 1989 to 1996. Psychiatr Serv 53: 337–339CrossRefPubMedGoogle Scholar
  8. 8.
    Hylan TR, Dunn RL, Tepner RG and Meurgey F (1998). Gaps in antidepressant prescribing in primary care in the United Kingdom. Int Clin Psychopharmacol 13(6): 235–243CrossRefPubMedGoogle Scholar
  9. 9.
    Rudd P, Ramesh J, Bryant-Kosling C and Guerrero D (1993). Gaps in cardiovascular medication taking: the tip of the iceberg. J Gen Intern Med 8(12): 659–666CrossRefPubMedGoogle Scholar
  10. 10.
    Haynes RB, Montague P, Oliver T, McKibbon KA, Brouwers MC, Kanani R (2001) Interventions for helping patients to follow prescriptions for medications. (Cochrane Review). In: The Cochrane Library, Issue 3, Oxford: Update SoftwareGoogle Scholar
  11. 11.
    Heaton PC, Cluxton RJ and Moomaw CJ (2003). Acetaminophen oversupply in the Ohio medicaid population. J Am Pharm Assoc 43: 680–684CrossRefGoogle Scholar
  12. 12.
    Frediani F, Cannata AP, Magnoni A, Peccarisi C and Bussone G (2003). The patients with medication oversupply: clinical management problems. Neurol Sci 24(Suppl 2): 108–111Google Scholar
  13. 13.
    Noyce PR, Huttin C, Atella V, Brenner G, Haaijer-Ruskamp FM and Hedvall M-B (2000). The cost of prescription medicines to patients. Health Policy 52: 129–145CrossRefPubMedGoogle Scholar
  14. 14.
    LIF (Läkemedelsindustriföreningen), Fakta (2004) Pharmaceutical market and healthcare. LIF, StockholmGoogle Scholar
  15. 15.
    Schafheutle EI, Hassell K, Noyce PR and Weiss MC (2002). Access to medicines: cost as an influence on the views and behaviour of patients. Health Soc Care Commun 10: 187–195CrossRefGoogle Scholar
  16. 16.
    O’Brien B (1989). The effect of patient charges on the utilisation of prescription medicines. J Health Econ 8(1): 109–132CrossRefPubMedGoogle Scholar
  17. 17.
    Lundberg L, Johannesson M, Isacson D and Borgquist L (1998). Effect of user charges on the use of prescription medicines in different socio-economic groups. Health Policy 44: 123–134CrossRefPubMedGoogle Scholar
  18. 18.
    Westerlund T, Almarsdóttir AB and Melander A (1999). Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract 7: 40–50Google Scholar
  19. 19.
    (1997) Medical products agency, Vol. 10, §37–38. Sweden LVFS, Uppsala. ISSN 1101–5225Google Scholar
  20. 20.
    Al-Saffar N, Deshmukh A, Eid S and Carter P (2003). Health beliefs and drug compliance of depressed patients in Kuwait. J Soc Adm Pharm 20: 142–150Google Scholar
  21. 21.
    Apoteket AB (2002) Annual report, p. 42. Apoteket AB, StockholmGoogle Scholar
  22. 22.
    Morris LS and Schulz RM (1992). Patient compliance — an overview. J Clin Pharm Therap 17: 283–295Google Scholar
  23. 23.
    George CF, Peveler RC, Heiliger S and Thompson C (2000). Compliance with tricyclic antidepressants: the value of four different methods of assessment. Br J Clin Pharm 50: 166–171CrossRefGoogle Scholar
  24. 24.
    Casado JL, Sabido R, Perez-Elias MJ, Antela A, Oliva J and Dronda F (1999). Percentage of adherence correlates with the risk of protease inhibitor (PI) treatment failure in HIV-infected patients. Antivir Ther 4(3): 157–161PubMedGoogle Scholar
  25. 25.
    Information obtained from the drug statistics database of Apoteket AB, StockholmGoogle Scholar
  26. 26.
    Isacson D and Olofsson C (1999). Drugs up in smoke: a study of caseated drugs in Sweden. Pharm World Sci 21(2): 96–99CrossRefPubMedGoogle Scholar
  27. 27.
    Ekedahl A, Wergeman L and Rydberg T (2003). Unused drugs in Sweden measured by returns to pharmacies. J Soc Adm Pharm 20: 26–31Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Kristin Krigsman
    • 1
  • Arne Melander
    • 1
    • 2
  • Anders Carlsten
    • 3
  • Anders Ekedahl
    • 3
  • J. Lars G. Nilsson
    • 1
    Email author
  1. 1.NEPI FoundationStockholmSweden
  2. 2.Department of Community MedicineMalmö University HospitalMalmöSweden
  3. 3.National Corporation of Swedish Pharmacies (Apoteket AB)GöteborgSweden

Personalised recommendations