title: Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs.
abstract: 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 (Euro 196; US$ 243) per year for medicines) was 32,000 SEK (Euro 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 (Euro 15 million; US$ 19 million) per year above that of non-exempt patients.
  
  
  CONCLUSIONS
  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.
authors.affiliation: NEPI Foundation, S-11881 Stockholm, Sweden.
authors.forename: Kristin
authors.initials: K
authors.lastname: Krigsman
authors.forename: Arne
authors.initials: A
authors.lastname: Melander
authors.forename: Anders
authors.initials: A
authors.lastname: Carlsten
authors.forename: Anders
authors.initials: A
authors.lastname: Ekedahl
authors.forename: J Lars
authors.initials: JL
authors.lastname: Nilsson
mesh_terms: D000553:Ambulatory Care; D003365:Costs and Cost Analysis; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D010349:Patient Compliance / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations / Q000191:economics / Q000600:supply & distribution*; D010594:Pharmacies / Q000191:economics* / Q000706:statistics & numerical data; D013548:Sweden; D016312:Treatment Refusal / Q000706:statistics & numerical data*
chemical_list: D004364:Pharmaceutical Preparations