November 25, 2019
By Linda Carroll
(Reuters Health) - One in eight adults with heart disease delays filling prescriptions. takes less of the medication than prescribed, or skips medications altogether because of high out-of-pocket costs, a new study suggests.
Compared to seniors with Medicare insurance, the effect was more pronounced - one in three - among people under 65, according to the report published November 25 online in Circulation.
While medication non-compliance isn't anything new, "in recent years the rising share of health care cost paid directly by patients has become a concern," said study coauthor Dr. Khurram Nasir, chief of the division of cardiovascular prevention and wellness at the Houston Methodist Heart and Vascular Center.
"In a nationally representative sample, almost 2.2 million patients reported either skipping pills, taking a lower dose than prescribed or intentionally delaying filling (prescriptions) to save costs," Nasir said in an email. "More than one in three of those who were noncompliant actively requested their physicians to help them find cheaper alternatives. More importantly, the rate of medical non-adherence was three fold higher among the younger population as compared to elderly individuals covered by Medicare."
The good news, Nasir said, was that seniors who were covered by Medicare but who were also less likely to be actively employed were less likely to cut back on medications.
Nasir and his colleagues analyzed data collected between 2013 and 2017 by the National Health Interview Survey (NHIS), a nationwide survey of non-institutionalized individuals conducted annually by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention.
The researchers focused on 14,279 adults with a self-reported history of cardiovascular disease who answered these three questions pertaining to the last 12 months: (1) Have you skipped medication doses to save money? (2) Have you taken less medication to save money? and (3) Have you delayed filling a prescription to save money?
Participants were asked about strategies used in the past 12 months to save money on prescription medications: (1) Have you asked your doctor for a lower cost medication to save money? (2) Have you bought prescription drugs from another country to save money? and (3) Have you used alternative therapies to save money?
Nasir's team determined that 12.6% of the survey participants had cut back on their medications due to cost. For the nation a whole, that would translate to 2.2 million people. Younger heart disease patients were three times more likely than those over age 65 to report cutting back on medications to save money.
Participants were also more likely to cut back on medications if they were women, low-income or uninsured, the researchers reported.
Overall, 25.7% of heart disease patients reported asking their doctors for a lower cost medication and 4% reported turning to alternative therapies.
The new findings are important because heart disease medications "are proven to improve clinical outcomes, such as reducing the risk of a subsequent heart attack, stroke or cardiac death," said Dr. Jing Luo, an assistant professor of medicine at the University of Pittsburgh.
"Despite decades of evidence showing the effectiveness of medications like blood pressure lowering drugs and cholesterol lowering statins, none of these drugs can have an opportunity to work unless the patient can afford them," Luo said in an email.
The new study may help by underscoring the importance of cost as being "a key mechanism leading to non-compliance," said Dr. Prashant Vaishnava, a cardiologist at The Mount Sinai Hospital in New York.
"It will be important to continue to develop and implement strategies that assuage the burden of cost and lessen its impact on non-adherence," Vaishnava said in an email. Such strategies can include "substitution with generic alternatives and using combination or 'poly pills' as appropriate."
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