Medication adherence suffers because of high drug costs

In a recent study published in Circulation, researchers found that one in eight patients with atherosclerotic cardiovascular disease (ASCVD) in the United States did not adhere to their medications because of cost.

Of the 14,279 individuals surveyed by Khera and colleagues, 1,774 reported not taking their medications as prescribed to save money. This translates to 12.6% of adult patients with ASCVD nationally.

Among the nonadherent patients, 8.6% skipped doses, 8.8% took a lower dose than prescribed, and 10.5% delayed filling their prescriptions. Patients younger than 65 years were three times more likely than those 65 and older to not adhere to their medications because of cost. Among the younger individuals, women, patients from low-income families, and patients without health insurance were most at risk of cost-related nonadherence. Race and level of education did not seem to influence the results.

But even for Americans with insurance, affording medications can be a struggle. In a January 2020 survey by NPR, the Harvard T.H. Chan School of Public Health, and the Robert Wood Johnson Foundation, many patients reported that their insurance plans sometimes don’t cover their medication or may only cover generic versions. In these cases, nearly half of these patients simply don’t fill their prescription.

“The out-of-pocket cost of medications is a huge issue for millions of high-risk patients with cardiovascular diseases, such as heart attacks, stroke, angina, and other conditions,” said senior author of the Circulation study Khurram Nasir, MD, MPH, MSc, chief of the division of cardiovascular prevention and wellness and codirector of the Center for Outcomes Research at Houston Methodist DeBakey Heart & Vascular Center in Texas, in a statement.

This is especially true for younger patients who may not have access to public insurance. Access to Medicare likely contributed to the lower rates of cost-related nonadherence in patients 65 years and older in the study. This suggests that the issue requires grander action on a policy level, including potentially expanding insurance protection offered to the Medicare population to those younger than 65 years, the authors wrote.

Community pharmacists should know what resources are available for patients who can’t afford their medications. Looking into patient assistance programs, checking cash prices of medications, and using discount cards are a few ways to help these patients.

It’s also important to educate patients on other community resources beyond those for medications and prescriptions. Many low-income or underserved patients who are unable to afford their medications are probably struggling to pay for other things, too, such as rent, utilities, transportation, and food.