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Report

The impact of medication adherence on total healthcare costs for commercially insured patients

13 May 2025

Milliman's report analyzed 2.5 million commercially insured patients aged 18 to 64 with diabetes, hypertension, or hyperlipidemia and found that patients with high risk scores showed a strong correlation between medication adherence and lower healthcare costs.

Key takeaways include:

  • Employers and healthcare providers may benefit from stratifying patients by imputing health risk scores into their claims data.
  • This process will improve insights into the relationship between adherence interventions and overall healthcare costs.
  • In the study of more than 2.5 million commercially insured patients, 64.1% were adherent.
  • For diabetes and hyperlipidemia, we observed that adherent patients had higher healthcare costs if their risk score was under 10.
  • Adherent patients had significantly lower total healthcare costs when risk scores were above 10.
  • Differences in healthcare costs for adherent patients did not follow a meaningful pattern until the population was divided into groups based on age and risk score.
  • From a health plan’s perspective, stratifying the patient population by health risk and age may assist in decision making when reviewing the benefits of medication adherence-based programs, especially programs that have guarantees or pricing based on return on investment.

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