The Affordable Care Act and cost-related medication non-compliance in cancer survivors.

Abstract

106 Background: Cost-related medication non-compliance (CRN), which is associated with access-to-care barriers and poorer health outcomes, is more prevalent among cancer survivors than other adults. While CRN in survivors has been decreasing recently, evidence for a change driven by the Affordable Care Act (ACA) is limited. We aimed to quantify the impact of the ACA on CRN in non-elderly cancer survivors using population-based data and a quasi-experimental design. Methods: We utilized 2011-2017 National Health Interview Survey data. CRN was defined as not being able to afford medication or taking less than prescribed, skipping doses, or delaying prescription filling due to cost. Linear probability models applied to difference-in-difference analyses were used to compare CRN changes after the ACA in non-elderly ( < 65 years) cancer survivors relative to control groups expected to be impacted less by ACA provisions--non-elderly adults without a cancer history, elderly survivors, and non-elderly survivors with high income. Results: We identified 6,176 non-elderly and 8,508 elderly cancer survivors and 142,732 other non-elderly adults. Non-elderly cancer survivors had a 6.31 (95% CI = 3.47, 9.15; p < .001) percentage point (PP) decrease in CRN relative to non-elderly adults without a cancer history, particularly for those earning 125-249% of the federal poverty limit (FPL) (8.46 PP; 95% CI = 0.45, 16.46; p = .038) and < 125% FPL (11.8 PP; 95% CI = 4.51 to 19.1; p = .002). Relative to elderly survivors, CRN decreased 6.01 PP (95% CI = 3.12, 8.90; p < .001) in non-elderly survivors after the ACA, especially for individuals earning < 125% FPL (15.7 PP; 95% CI = 7.7, 23.7; p < .001). Relative to non-elderly survivors earning > 400% FPL, those earning < 125% FPL had an 8.36 PP (95% CI = 1.44, 15.3; p = .018) reduction in CRN. Conclusions: CRN decreased in non-elderly cancer survivors after the ACA relative to both elderly survivors and adults without a history of cancer. Furthermore, reductions in CRN were observed in low relative to high income survivors. Thus, the ACA is associated with decreasing CRN in cancer survivors, especially those with low income, and hence may improve health care access and affordability for this vulnerable population.