Patients taking their prescription medicines as directed, and using generics, low-cost brands and home delivery wherever possible could reduce unnecessary spending on health care in the US by up to $403 billion a year, claims a new study.

Moreover, as much as a third of total pharmacy-related waste - $134 billion, or $434 per person per year - could be eliminated by taking steps to make it easier for patients to act on their existing good intentions towards taking their prescription drugs, says pharmacy benefit management (PBM) company Express Scripts, in its latest annual Drug Trend Report.

The study includes results from a Harris Interactive survey which shows that 55%-82% of consumers “want one thing but do another,” says the PBM. This "intent-behaviour" gap is greatest in terms of the use of generic drugs, with 82% of patients who use only brand-name medications stating that they actually prefer generics, while 70% of those using a retail pharmacy to fill their medications for chronic conditions would prefer to use a home delivery pharmacy.

The costs of “such behavioural missteps” are enormous, says Express Scripts, which forecasts that, between 2010 and 2014, the cost of pharmacy-related waste to the nation will top $1.2 trillion. "Equivalent to $3,721.82 for each person in the US, all of it is money spent with no additional health benefit obtained," it adds.

However, the report estimates that $258.3 billion could be saved each year if all patients took their medications as prescribed, while $56.7 billion could be gained through eliminating the waste associated with the use of "higher-cost medications that generate no additional health benefit." Moreover, $88.3 billion a year in annual wasted spending could be avoided by moving all maintenance medication users who now have their prescriptions filled at retail pharmacies to home delivery, dispensing acute medications through "narrow retail network" pharmacies and distributing specialty medications through "optimal channels."

These findings "reframe conventional thinking," commented Bob Nease, chief scientist at Express Scripts. They show that the disparity in health care is not between what payers and patients want, "but between patient wants want and what they actually do. Optimal health care outcomes are possible only with an advanced understanding of behaviour," he added.

James Klein, president of the American Benefits Council, said the report's finding have significant implications for employer-sponsored health care.

"Activating consumer intent is a win-win for employers and employees," he said. "Engaging tools that help people make decisions will lead to more cost-effective quality outcomes, which is essential to health system reform.”