Out-of-Pocket Costs Limit Medication Adherence for 13% of Patients

Medication adherence is still an issue for patients incurring high out-of-pocket costs, although more inquire about low-cost drug alternatives.

By Sara Heath

August 22, 2019 - Medication adherence has fallen by the wayside for patients who are working to mitigate the high out-of-pocket costs associated with managing their diabetes treatments, according to new data from the Centers for Disease Control (CDC).

Insulin, the primary medication used to treat diabetes, is a notoriously expensive drug, running patients upwards of $250 for a monthly supply, according to pharmacy price checker GoodRX. That price can be insurmountable for many patients who must also prioritize costs for housing, groceries, and other living expenses, leaving many to forgo their medications or to take medications less often than their doctors prescribed.

But with nearly 10 percent of all adults having some diabetes diagnosis, there are population health impacts to consider. Lapses in medication adherence can result in poorer health outcomes for diabetic patients or more catastrophic health events, which in the long run could bring about higher healthcare costs for both patient and payer.

Overall, 13.2 percent of patients with diabetes did not take their medications as prescribed, the CDC reported using data from 2018. Women were more likely than men to have limited adherence, with 14.9 percent saying they do not take their medications as prescribed. Just over 11 percent of men said the same.

Additionally, younger patients under age 65 – meaning those who do not yet qualify for Medicare coverage – were also more likely to have poor medication adherence. Just about 18 percent of all patients under age 65 did not take medications as prescribed, compared to only 7.2 percent of patients over age 65.

As suggested, these disparities may have arisen because of differences in insurance type. Patients with Medicare or private insurance may have seen more reasonable copayments or had their own personal means to pay for expensive insulin and other diabetes drugs.

Among patients under 65, only 14 percent with private insurance did not take their medications as prescribed. About 18 percent with Medicaid and 35.7 percent without any insurance had poor adherence.

And for patients over 65, similar trends emerged, although at lower levels.

Far fewer older patients altogether had poor medication adherence, the data showed. Only 6.2 percent of those with private insurance or both Medicare and Medicaid chose not to take their medications as prescribed, while the same could be said of just over 9 percent of those with Medicare Advantage or traditional Medicare.

In addition to rationing prescriptions, patients are also discussing lower-cost drug options with their providers, the CDC report noted. While in some cases patients may have to opt for less-effective medications, most experts agree the tradeoff for better medication adherence is worth it.

In total, about one-quarter (24.4 percent) of patients discussed lower-cost diabetes treatment options with their providers. Twenty-three percent of women had these discussions compared to 25 percent of men.

Again, younger patients under age 65 were more likely to discuss low-cost options with their doctors than older patients, coming in at 26.3 percent and 21.9 percent, respectively.

Patients with private insurance were most likely of any insurance type to have these conversations, with 25.7 percent of younger patients and 26.1 percent of older patients discussing low-cost drug alternatives with their doctors.

Patients with public insurance, including Medicaid and Medicare, were less likely to discuss low-cost options with doctors. Both younger and older patients without insurance also had a high likelihood of asking about low-cost drugs, although it was still lower than for patients with private insurance.

These findings come as considerable attention is paid to the cost of insulin. Drug manufacturers are facing pressure from industry and government leaders to offer insulin at a more reasonable cost and many are responding.

Earlier this year, manufacturer Eli Lilly unveiled its generic version of insulin, Insulin Lispro, which will cost $137.35 per vial or $265.50 for a pack of five KwikPens. Sanofi followed a similar path, announcing it would offer insulin for only $99 for a month’s supply, a far cry from the average $347 patients were previously paying.

Health payer Cigna and Express Scripts likewise announced it would cut the out-of-pocket patient cost for insulin down to a $25 copayment.

While these efforts have been an essential step forward in lowering the cost to everyday, live-saving drugs like insulin, critics say they do not go far enough. Insulin famously patented for only $1, leaving some asking why accessing it can still be financially crippling for patients.

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