Sixty
percent of adult patients received a prescription in 2017, but due to high
prescription drug costs nearly 11 percent didn't take their medications.
By Sara Heath
April
03, 2019 - Although the number of patients with poor medication
adherence has begun to taper off, cost still serves as a factor when patients
do not take their medications, according to a March data set from the Centers for Disease
Control and Prevention (CDC).
A
total of 60 percent of all adult patients received a medication prescription in
2017, the most recent year for which CDC has complete data. And with 70 percent
of all prescriptions carrying with them an out-of-pocket patient cost, understanding
how patients manage those costs is crucial.
Specifically,
CDC investigated the number of patients using one of three cost-cutting
strategies: asking a clinician for a lower cost alternative prescription, not
taking the drug as prescribed, or accessing alternative treatment that did not
include a prescription drug.
Not
taking medication as prescribed meant the patient skipped doses, took less of a
medication, or delayed filling a prescription to save money.
The
CDC data brief asserted that the number of patients using strategies to cut
their out-of-pocket medication spending went down between 2013 and 2015, and
remained stagnant between 2015 and 2017.
Between
2013 and 2015, the number of patients asking for a low-cost alternative
prescription fell from about 26 percent of patients to 19 percent in 2015.
After that, the number of patients requesting a lower-cost prescription
remained relatively the same.
CDC
observed similar trends among patients who did not take a medication as
prescribed. The number of patients doing so fell from 15 percent in 2013 to 11
percent in 2015, and remained there until 2017.
Finally,
the number of patients seeking alternative therapies went down from 6 percent
to just under 5 percent between 2013 and 2015. That number leveled off after
2015.
Certain
demographics were more likely than others to engage in cost-cutting activities,
the researchers noted. For example, more female patients than male engaged in
any of these strategies. Twenty-two percent of women asked for a lower-cost
prescription, 12 percent did not take medications as prescribed,
and just under 7 percent sought alternative therapies.
Additionally,
uninsured patients were more likely to seek cost-cutting solutions than
patients with insurance, likely because these patients did not receive any cost
coverage from an insurer.
Nearly
40 percent of uninsured patients asked their doctors for a less expensive
medication, while 33 percent said they did not take their medications as
prescribed. Nearly 14 percent of uninsured patients used alternative therapies
instead of prescription medication.
Although
the number of patients seeking solutions to their high-cost medications is
going down, these figures still underscore the threat that out-of-pocket
patient costs pose to medication adherence.
Separate data has revealed that high drug
costs limit patient access to medications. A 2017 analysis from the Cleveland
Clinic noted that physicians are reluctant to prescribe drugs with notoriously
high patient financial responsibility. When they do prescribe these drugs,
patients are less likely to fill them.
The
medications in question were nitroprusside and isoproterenol, two key medications
in managing heart disease that do not have a readily-accessible low-cost
alternative.
“In
our study, we identified large decreases in the utilization of nitroprusside
and isoproterenol in response to very large price increases, changes that were
not seen in the use of similar intravenous cardiovascular drugs with stable
prices,” wrote Umesh N. Khot, MD, Eric D. Vogan, MSPH, and Michael A.
Militello, PharmD, a trio of researchers from Cleveland Clinic.
“These
findings refute the claim that price increases do not reduce patients’
access to these medications,” the three said.
Healthcare
policymakers are also beginning to see the link between medication costs and
medication adherence, as lawmakers take on the pharmaceutical industry.
In
a hearing last month, healthcare
lawmakers addressed high list prices for prescription drugs. To be clear, the
list price is the price of a medication before insurance, rebates, and
other subsidies kick in. While some
patients may incur the full list price of a drug, it is more common for
patients to face a smaller price tag through cost-sharing arrangements.
Nonetheless,
the list price influences that final, shared cost, contended Iowa Senator Chuck
Grassley, who is the chairman of the Senate Finance Committee. And when
cost-sharing is too high, the patient loses out, he said.
“Whether
it’s about the EpiPen, insulin, or other prescriptions, in the thousands of
letters I’ve received, Iowans have made clear that high drug prices are hurting
them,” Grassley stated. “I’ve heard about people skipping doses of their
prescription drugs to make them last until the next paycheck. I’m not a doctor,
but rationing one’s medicine doesn’t sound like a safe prescription for health
and wellness. Others have told me about leaving their prescription on the
pharmacy counter because it cost too much.”
As
the healthcare industry continues to focus on patient wellness, medication
adherence will be essential. Strong medication adherence helps manage patient
illness and can prevent patients from falling seriously ill and incurring
exceptional medical costs. Ensuring that medications are not cost-prohibitive
will be a key part of that effort.
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