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 Compared to seniors with Medicare insurance, the effect was more
pronounced - one in three - among people under 65, according to the
report published 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?
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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."
SOURCE: http://bit.ly/34mgFnn Circulation, online November 25, 2019.
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