Abstract
Little is known about the current use of imported drugs and the factors associated with individual purchase of medications outside the US. To evaluate the proportion of the US adult population that purchases medications in other countries and the patient factors associated with the behavior. This retrospective cross-sectional study used data from the 2015-2017 National Health Interview Survey. The study sample included 61 238 individuals 18 years or older who reported use of prescribed medication by a physician or other practitioner. Data analysis was performed in November 2019. Self-reported experience of purchasing prescription drugs from countries outside the US in the past 12 months. Internet use behaviors for health care included searches for health information and filling of a prescription online. Medication-taking behaviors included skipping or delaying filling a prescription and using alternative therapies to save money. Survey design-adjusted analysis was used to estimate and compare characteristics between those who purchased medications outside the US and those did not. Multivariable logistic regression was fitted to examine the association of medication purchases with internet use and medication-taking behavior factors. Among 61 238 US adults taking prescription medications (mean [SD] age, 50.5 [18.5] years; 56.5% female; 70.8% white), the estimated prevalence of purchasing of medication outside the US was 1.5% (95% CI, 1.4%-1.7%; 2.3 million US individuals). Those who purchased medications outside the US were more likely to be older (age >64 years; adjusted odds ratio [aOR], 1.68; 95% CI, 1.24-2.29), to be from Hispanic (aOR, 1.70; 95% CI, 1.23-2.35) or immigrant populations (aOR, 3.20; 95% CI, 2.44-4.20), and to have higher educational attainment (bachelor's degree; aOR, 1.79; 95% CI, 1.27-2.54), lower family income (low income; aOR, 1.41; 95% CI, 1.06-1.87), and lack of insurance (aOR, 3.14; 95% CI, 2.33-4.21). Data analyses indicated that online health information-seeking behavior (aOR, 1.62; 95% CI, 1.33-1.98) or use of an online pharmacy (aOR, 2.30; 95% CI, 1.83-2.90) was associated with a greater likelihood of medication purchases outside the US. Individuals who skipped medications (aOR, 3.86; 95% CI, 3.05-4.88) or delayed filling a prescription (aOR, 4.04, 95% CI, 3.23-5.06) also had higher odds of purchasing medication outside the US. The findings suggest that patients are not using prescription purchases outside the US to meet their medication needs. However, monitoring to promote safe administration of medications imported into the US should be continued.
Highlights
Health care spending in the US is substantially higher than in other high-income nations and has outpaced overall national economic growth for several decades.[1]
Data analyses indicated that online health information–seeking behavior or use of an online pharmacy was associated with a greater likelihood of medication purchases outside the US
After controlling for socioeconomic and health characteristics, those 65 years or older were 1.68 times more likely to have purchased medication outside the US compared with those aged 18-44 years
Summary
Health care spending in the US is substantially higher than in other high-income nations and has outpaced overall national economic growth for several decades.[1]. When devising policies to address drug importation successfully, policy makers should understand the factors associated with recent individual purchase of medications outside the US. Previous work[10] has suggested that financial difficulties associated with being uninsured or underinsured are the main factors associated with this pattern; little is known about the characteristics and behavioral patterns (eg, internet use and medication-taking behaviors) of individuals who purchased their medications outside the US. To address these research gaps, this study aimed to use nationally representative survey data (1) to evaluate the proportion of the US adult population who recently purchased prescription medications outside the US to save money, (2) to identify the key socioeconomic and patient factors associated with purchasing medications outside the US, and (3) to assess the associations between internet use and medication-taking behaviors and medication purchases outside the US
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