Pharmacy Subscription Program and Medication Refills, Days' Supply, and Out-of-Pocket Costs.

Area of Science:

• Health Economics
• Pharmaceutical Policy
• Medication Adherence Research

Background:

• Medication nonadherence leads to significant morbidity, mortality, and healthcare costs.
• Subscription models are emerging as a strategy to promote healthy behaviors and improve medication access.
• Amazon Pharmacy introduced RxPass, a flat-fee subscription for 60 common generic medications, to address these challenges.

Purpose of the Study:

• To evaluate the impact of the RxPass subscription program on medication refills.
• To assess changes in medication days' supply among program enrollees.
• To determine the effect of the subscription program on out-of-pocket medication costs.

Main Methods:

• A retrospective, population-based cohort study design was employed.
• A difference-in-differences approach with doubly robust estimation compared outcomes before and after enrollment.
• The study included adults under 65, excluding Medicare/Medicaid enrollees, comparing program users with a matched control group.

Main Results:

• Program enrollment was associated with a 10.39-day increase in medication days' supply per person per month (PPPM), a 27% rise.
• A 0.19 increase in prescription refills PPPM (29% increase) was observed.
• Out-of-pocket spending decreased by $2.35 PPPM (30% reduction), including subscription fees.

Conclusions:

• Enrollment in the RxPass subscription program significantly increased medication refills and total days' supply.
• The program demonstrated a notable reduction in out-of-pocket medication expenses for members.
• Further research is recommended to explore the underlying mechanisms and generalizability of these findings.