Abstract
The United States spends more per capita on prescription drugs than do other high-income countries (1). In 2017, patients paid 14% of this cost out of pocket (2). Prescription drug cost-saving strategies, including nonadherence to medications due to cost concerns, have been documented among U.S. adults (3) and can negatively affect morbidity and, in the case of persons with human immunodeficiency virus (HIV) infection, can increase transmission risk (4,5). However, population-based data on prescription drug cost-saving strategies among U.S. persons with HIV are lacking. CDC's Medical Monitoring Project* analyzed cross-sectional, nationally representative, surveillance data on behaviors, medical care, and clinical outcomes among adults with HIV infection. During 2016-2017, 14% of persons with HIV infection used a prescription drug cost-saving strategy for any prescribed medication, and 7% had cost saving-related nonadherence. Nonadherence due to prescription drug costs was associated with reporting an unmet need for medications from the Ryan White AIDS Drug Assistance Program (ADAP), not having Medicaid coverage, and having private insurance. Persons who were nonadherent because of cost concerns were more likely to have visited an emergency department, have been hospitalized, and not be virally suppressed. Reducing barriers to ADAP and Medicaid coverage, in addition to reducing medication costs for persons with private insurance, might help to decrease nonadherence due to cost concerns and, thus contribute to improved viral suppression rates and other health outcomes among persons with HIV infection.
Highlights
Because of the strong relationship between human immunodeficiency virus (HIV) infection and unsuppressed viral load, nonadherence among persons with HIV infection leads to increased morbidity, mortality, and risk for HIV transmission [4,5]
Among all persons taking prescription drugs in this study, 97% were taking ART, these results are likely reflective of cost savings–related ART nonadherence
Removing barriers to ADAP and Medicaid coverage, in addition to reducing medication costs for persons with private insurance, could help to decrease nonadherence related to cost concerns, which will contribute to improved health outcomes among persons with HIV infection and decrease HIV transmission
Summary
Persons taking prescription drugs were asked about their use of six cost-saving strategies over the past 12 months: 1) asking a doctor for a lower-cost medication, 2) buying prescription drugs from another country, 3) using alternative therapies, 4) skipping doses, 5) taking less medicine, and 6) delaying filling a prescription because of cost. Approximately 14% (95% CI = 12–15) of U.S adults with HIV used any medication cost-saving strategy, including 7% (95% CI = 6–8) who reported cost saving– related nonadherence; among this group, 4% (95% CI = 3–5) skipped doses, 4% (95% CI = 3–5) took less medicine, and 6% (95% CI = 5–7) delayed a prescription. Nonadherence due to prescription drug costs was associated with lower likelihood of HIV care engagement and higher numbers of emergency department visits and hospitalizations
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