William Borden, M.D., FAHA, Associate Professor of Medicine and Health Policy, George Washington University; Chief Quality and Population Health Officer, GW Medical Faculty Associates; Chair, American Heart Association Council on Quality of Care and Outcomes Research
Cost-related issues deter nearly 13 percent of patients with heart disease from taking medications as prescribed, according to new research in the American Heart Association journal Circulation.
Researchers reviewed National Health Interview Survey (2013-17) data of adults 18 years and older with atherosclerotic cardiovascular disease (ASCVD). They found that one in eight patients (2.2 million people in the United States) reported one or more cost-reducing behaviors within the preceding 12 months: skipping doses of medication, taking less medication, or delaying filling a prescription.
- About one in five patients younger than age 65 reported one or more of the behaviors, compared with 6.2% of patients 65 and older. Among patients under 65, 25% of women, 30% of those from low-income families, and 53% of those without health insurance reported at least one of the behaviors.
- People who reported one or more of the behaviors were nearly 11 times more likely to request low-cost medication and nearly nine times more likely to use alternative, non-prescription therapies, compared with people who didn’t report any of the behaviors.
Drivers and consequences of poor medication adherence
Poor medication adherence is common, with studies indicating that 20% to 30% of medication prescriptions are never filled and that about 50% of medications for chronic disease are not taken as prescribed. The results of poor medication adherence include unfavorable health effects: about 125,000 deaths, at least 10% of hospitalizations, and a substantial increase in morbidity and mortality.
Researchers didn’t have information on patient health outcomes in the survey. But future research should explore the direct effect of drug costs and cost-related medication non-adherence as factors influencing health outcomes.
The reasons for not taking medication as directed are varied and complex. But when the reason is cost, health policy interventions that remove financial barriers to medication access may help improve adherence to essential therapy and improve patient health outcomes. This could involve broadening health insurance coverage and/or targeting drug costs; the latter strategy was explored in a 2017 American Heart Association Presidential Advisory on the Accessibility and Affordability of Drugs and Biologics.
The study helps identify the characteristics of patients who may benefit from interventions to improve medication access and affordability. These include patients younger than 65 years old, particularly females, people with low family income, or people without health insurance. (This age demarcation is likely because nearly all people 65 years and older can access health insurance with Medicare.)
Interestingly, there were no significant differences in cost-related medication adherence by race/ethnicity or education. This suggests that focusing efforts on low-income groups and increasing access to insurance, which cut across large groups of patient populations, might be highly beneficial.
As we pursue health equity for all, it’s imperative that individuals and communities have access to care and resources — including medications to manage heart disease.