Financial barriers are a leading reason that many people do not adhere to prescribed medication regimens. In a 2015 survey by the Kaiser Family Foundation, 42% of respondents said they found it difficult to afford health care.2 This percentage outranked those who found it difficult to afford other necessities such as housing, utilities, and food. Medical care has become harder to afford for essentially everyone. Though employee-sponsored health insurance has been the norm since the 1940s in the United States, out-of-pocket costs for even those covered by insurance through their employer have risen substantially.3 Another survey found that the average deductible for those with employer coverage increased from $303 in 2006 to $1505 in 2017, a 397% increase.4
It comes as no surprise, then that as costs for health care and medications rise, consumers often find they need to go without certain things. A 2017 survey by Consumer Reports illustrates how and what consumers decide to go without when faced with rising drug costs.5 The below figures come from that report and show the household and health care changes individuals made to deal with these costs and effects on medication adherence.
Source: Consumer Reports Best Buy Drugs Tracking Poll 7, Conducted March 10-27, 2016.
*Percentages won’t add up to 100 because people were able to report multiple actions taken
Cost-related medication nonadherence is a common problem that leads to more frequent emergency department visits, psychiatric admissions, nursing home placements, as well as decreased overall health status.6-8
More expensive medications often results in lower daily adherence rates (patients take the medication less consistently), which in certain medications results in worse patient outcomes. For example in a study of more than 90,000 people taking statins, those who were prescribed generic statins had a better daily adherence rate, which resulted in an 8% reduction in incidence of death and hospitalization for acute coronary syndrome or stroke in that group.
Conclusion: Patients prescribed a generic statin were more likely to take their pills and had slightly better outcomes than people prescribed brand-name statins
Source: Gagne JJ, Choudhry NK, Kesselheim AS, et al. Comparative Effectiveness of Generic and Brand-Name Statins on Patient Outcomes: A Cohort Study. Comparative Effectiveness of Generic and Brand-Name Statins. Ann Intern Med 2014;161(6):400-407. doi:10.7326/M13-2942.
WebM&M case with commentary by Dr. Chris Moriates: “A Costly Colonoscopy Leads to a Delay in Diagnosis”
ARTICLE
In an era of increasing deductibles and other out-of-pocket costs, physicians should be prepared to engage patients about financial issues.
Zamosky, Lisa, hfma. 2015.
ARTICLE
In an era of rising co-pays, patients with cancer want cost-of-treatment discussions, and these conversations do not lead to negative feelings in the majority of patients
Kelly RJ, et al.
J Onc Pract. 2015;11(4):308-312.
BLOG POST
Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. A new funding opportunity from RWJF seeks to address this challenge by surfacing best practices.
Ganos, Emmy.
Robert Wood Johnson Foundation Culture of Health Blog. 2016.