Cost-Related Medication Nonadherence Among Elderly and Disabled Medicare Beneficiaries

Soumerai, Stephen B.; Pierre-Jacques, Marsha; Zhang, Fang; Ross‐Degnan, Dennis; Adams, Alyce S.; Gurwitz, Jerry H.; Adler, Gerald; Safran, Dana Gelb

doi:10.1001/archinte.166.17.1829

Cited by 228 publications

(232 citation statements)

References 26 publications

Supporting

Mentioning

215

Contrasting

Unclassified

Order By: Relevance

“…Questions about cost-related underuse were based on validated measures. 8,9 Specifically, we asked whether in the past year patients had: (1) not filled a prescription because it was too expensive, (2) skipped doses to make medicines last longer, (3) took less medicine than prescribed to make the medicine last longer, or (4) split pills to make the medication last longer.…”

Section: Inpatient Surveymentioning

confidence: 99%

Cost‐related medication underuse: Prevalence among hospitalized managed care patients

Choudhry

Saya

Shrank

et al. 2011

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:The affordability of prescription medications continues to be a major public health issue in the United States. Estimates of cost‐related medication underuse come largely from surveys of ambulatory patients. Hospitalized patients may be vulnerable to cost‐related underuse and its consequences, but have been subject to little investigation.OBJECTIVE:To determine impact of medication costs in a cohort of hospitalized managed care beneficiaries.METHODS:We surveyed consecutive patients admitted to medical services at an academic medical center. Questions about cost‐related underuse were based on validated measures; predictors were assessed with multivariable models. Participants were asked about strategies to improve medication affordability, and were contacted after discharge to determine if they had filled newly prescribed medications.RESULTS:One‐hundred thirty (41%) of 316 potentially eligible patients participated; 93 (75%) of these completed postdischarge surveys. Thirty patients (23%) reported cost‐related underuse in the year prior to admission. In adjusted analyses, patients of black race were 3.39 times (95% confidence interval [CI], 1.05 to 11.02) more likely to report cost‐related underuse than non‐Hispanic white patients. Virtually all respondents (n = 123; 95%) endorsed at least 1 strategy to make medications more affordable. Few (16%) patients, prescribed medications at discharge, knew how much they would pay at the pharmacy. Almost none had spoken to their inpatient (4%) or outpatient (2%) providers about the cost of newly prescribed drugs.CONCLUSIONS:Cost‐related underuse is common among hospitalized patients. Individuals of black race appear to be particularly at risk. Strategies should be developed to address this issue around the time of hospital discharge. Journal of Hospital Medicine 2012. © 2011 Society of Hospital Medicine

show abstract

Section: Inpatient Surveymentioning

confidence: 99%

Cost‐related medication underuse: Prevalence among hospitalized managed care patients

Choudhry

Saya

Shrank

et al. 2011

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…These behaviors have been described as cost-related medication underuse. 13,14 Studies have demonstrated the relationship between cost-related medication underuse and poor health outcomes, 15---19 but, to our knowledge, only 1 study has examined the relationship between food insecurity and cost-related medication underuse in the United States in a nationally representative sample. 13 This study, which was restricted to individuals with chronic diseases, found that those living in food-insecure households were more likely to report cost-related medication underuse.…”

mentioning

confidence: 99%

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

et al. 2015

View full text Add to dashboard Cite

Objectives. We investigated whether nonelderly US adults (aged 18–64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. Methods. We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ2 test and multivariate logistic regression with interaction terms. Results. Bivariate and multivariate analyses showed a dose–response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. Conclusions. Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households.

show abstract

“…1 It is therefore not surprising that our study and other investigations have found that physicians often provide samples to patients burdened by prescription costs. 2,3 Important questions remain: 1) what is the effect of policies restricting free samples on patient's prescription drug utilization, expenditures, and health outcomes; and 2) are samples a cost-driver or safety net?…”

mentioning

confidence: 66%

Medicare Beneficiaries and Free Prescription Drug Samples: A National Survey

et al. 2008

Self Cite

View full text Add to dashboard Cite

T he authors reply: We agree with Zipkin that free prescription drug samples will not solve the problem of cost-related medication nonadherence (CRN). However, we argue that use of free prescription drug samples is widespread and indicative of physician attempts to increase economic access to medications.Our previous study demonstrated that 29% of disabled and 13% of elderly Medicare beneficiaries reported CRN. 1 It is therefore not surprising that our study and other investigations have found that physicians often provide samples to patients burdened by prescription costs. 2,3 Important questions remain: 1) what is the effect of policies restricting free samples on patient's prescription drug utilization, expenditures, and health outcomes; and 2) are samples a cost-driver or safety net? We acknowledge our inability in this study to discern the mechanism explaining the strong association between CRN and free sample use because of the cross-sectional design of the study. Some argue that samples lead to overuse of expensive, brandname, medications in lieu of less expensive, evidence-based, treatments. 4 Despite these limitations, we found that 78% of elderly Medicare beneficiaries with CRN accessed free samples. We argue that the needs of these patients should be considered when adopting policies limiting free sample distribution.Physicians need to recognize that requests for free samples are a marker of possible CRN that requires further investigation. Indeed, Piette et al. found that most patients are reluctant to report CRN and most physicians do not ask about affordability. 5 Rather than offering free samples, physicians can switch patients to generic drugs, discontinue nonessential medicines, or refer patients to programs providing financial assistance.For physicians who continue to distribute free samples, we recommend training on the influence of samples and other marketing devices. 6 Many physicians do not believe free samples influence prescribing. We recommend that medical licensing boards adopt policies requiring at least 1 hour of continuing medical education on the marketing of medications as a condition of license renewal for all prescribers. In this way, we might be able to effectively disseminate the message to all physicians that a "free sample" is not necessarily free.

show abstract

Cost-Related Medication Nonadherence Among Elderly and Disabled Medicare Beneficiaries

Cited by 228 publications

References 26 publications

Cost‐related medication underuse: Prevalence among hospitalized managed care patients

Cost‐related medication underuse: Prevalence among hospitalized managed care patients

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

Medicare Beneficiaries and Free Prescription Drug Samples: A National Survey

Contact Info

Product

Resources

About