1 in
6 chronically ill adults
Skip Rx drugs due to cost
A recent nationally
representative survey of older adults finds that 18 percent of those
with chronic conditions such as heart disease and depression skip some
of their prescription medicines because of out-of-pocket cost pressures,
and 14 percent do so at least every month.
Based on the study’s findings, the authors
estimate that every month, this cost-related medication skimping leads
more than a million Americans with diabetes to use less medication for
that illness than was prescribed to them, and causes more than 1.6
million people with asthma to miss some of their doses of medication.
The findings, from a nationally
representative survey of 4,055 adults over the age of 50, are published
in the October issue of the American Journal of Public Health by
a team from the University of Michigan Health System, the Veterans
Affairs Ann Arbor Healthcare System and Stanford University. The study
was funded by the VA.
Not surprisingly, the study finds that
seniors whose out-of-pocket prescription costs are more than $100 a
month, and those with low incomes or no prescription drug coverage, are
at the greatest risk for skimping on their medications.
Other results of the survey indicate
that people with chronic illnesses were more likely to cut back on
certain kinds of medications over others, suggesting that patients are
selective about which drugs they go without.
“We found that many patients go
without drugs that relieve serious symptomatic conditions such as back
pain or ulcers, while others skipped drugs that are life-sustaining,
such as blood pressure and cholesterol drugs, but that might not cause
any noticeable difference in day-to-day functioning,” says lead author
John D. Piette, a VA Career Scientist and associate professor of
internal medicine at the U-M Medical School.
More patients regularly cut back on
costs by forgoing their medicines for depression, asthma, ulcers,
arthritis, migraines and back pain, for example, than went without
medicines for high blood pressure, high cholesterol or diabetes. Piette
and his colleagues say their findings suggest that changes in
prescription drug benefit policites will affect patients differently
depending on their particular medical problems and possibly their
demographic characteristics as well.
The data add to a growing list of
findings on cost-related prescription drug skimping that have been
published by the same group of researchers in the last few months.
In September, the group reported in
the Archives of Internal Medicine that most chronically ill patients who
cut back on prescription drugs due to cost don’t tell their doctors
they’re doing so. And in June, they released the first long-term
evidence that skimping on medications due to cost can lead to adverse
health outcomes for chronically ill patients. In February, they reported
that diabetes patients who forgo medication due to cost pressures have
worse blood sugar control, symptoms and physical functioning.
“We’re getting a clearer picture of
how chronic illness, out-of-pocket cost, insurance and patient
characteristics combine to create a pattern of non-adherence among older
Americans,” says Piette. “This is an issue that affects millions of
Americans, and will influence their health for years to come.”
No matter which drugs they cut back
on, those patients who reported at least some cost-related adherence
problems were describing a relatively frequent problem. In fact, 78
percent of those who reported ever having cut back on any medication due
to cost in the last year also said they were forgoing treatment at least
once a month.
Having insurance to cover drug costs
didn’t always mean patients were always able to stay on their
medications, the researchers found. That’s because cash co-payments and
deductibles required by some insurance plans can add up to hundreds of
dollars a month, especially for the large number of older adults with
multiple chronic illnesses.
When the sample of surveyed adults was
weighted to reflect national population characteristics, the researchers
found that half of all respondents had monthly prescription-related
costs of $50 or more, and 25 percent had monthly costs of $100 or more.
Eighty-three percent of respondents had some form of prescription drug
coverage, but even so, many of these patients reported that their
monthly medication costs topped $100.
Those who didn’t have insurance were
the least likely to be able to afford out-of-pocket payments for drugs:
Respondents who had incomes under $20,000 a year were more than twice as
likely to be without drug coverage than those making more than $60,000 a
year.
In general, there were no notable
differences in cost-related medication under-use across groups defined
by race, gender or educational attainment. However, the researchers
found that patients over the age of 65 were substantially less likely to
cut back on medications due to cost than those in their 50s. As a
result, Piette says, planned Medicare reforms will not address the
problems of medication cost pressures for those chronically ill patients
who may need assistance the most: those under age 65.
In the study, the researchers examined
risk factors for cost-related medication under-use separately for
patients with the 10 most common chronic health problems. For example,
people who had been prescribed drugs to control their blood pressure
were more than four times as likely to skimp on their medicines if they
paid more than $100 a month for all their medications than if they paid
less than $100. Overall, about 7 percent of people with high blood
pressure said they had cut back on their blood pressure medication due
to cost at least once per month.
Similarly, people who had been
prescribed drugs to treat depression were more than four times as likely
to say they had cut back on a medication due to cost if they paid more
than $100 a month for all their medications. And 14 percent of those
patients who had prescriptions for antidepressants cut back on those
depression medications each month due to cost.
In addition to Piette, the study’s
authors include Michele Heisler, M.D., M.P.A., also of the VA Ann Arbor
Healthcare System and the U-M Medical School, and Todd H. Wagner, Ph.D.,
of the VA Health Economics Resource Center and Stanford University.
Reference: AJPH: Oct. 2004, Vol. 94, No. 10, pp 1782-1787.