Self-restriction of Medications Due to Cost in Seniors without Prescription Coverage: A National Survey

Abstract

Prescription drug costs are growing faster than any other segment of health care.1 In turn, many anecdotal reports have surfaced of elderly patients forced to skip doses of their medications, or avoid these medications altogether, because they lack adequate prescription drug coverage and cannot afford the high cost of modern pharmaceuticals.2–4 These stories, and the media interest they have generated, have stimulated calls for a prescription drug benefit for Medicare.4 However, the extent to which different groups of elderly patients skip, avoid, or otherwise restrict their use of prescription medications because of cost is largely unknown. Recent studies show that patients who lack prescription coverage receive fewer prescription medications than those with coverage.5–8 However, it remains unclear to what extent these disparities reflect differential prescribing by physicians, preferential enrollment of sicker patients into plans that provide coverage, or patients restricting their own use of medications because of cost.9 Moreover, little is known about which groups of underinsured patients are at the greatest risk of restricting their use of medications because of cost, and how prescription coverage may attenuate that risk. We studied these questions in a large, nationally representative cohort of older Americans. First, we compared the rate of medication restriction in patients with different levels of prescription insurance. Next, we determined which seniors who lacked prescription coverage were at highest risk of restricting their use of medications because of cost. Finally, to examine how prescription coverage modified the risk of medication restriction among these vulnerable groups, we compared rates of medication restriction in high-risk seniors who had no, partial, or full coverage.