Cost-related Medication Nonadherence Research Articles

Cost-related medication nonadherence in adults with COPD in the United States 2013-2020.

Cost-related medication nonadherence (CRN) is associated with poor prognosis among patients with chronic obstructive pulmonary disease (COPD), a population that requires long-term treatment for secondary prevention. In this study, we aimed to estimate the prevalence and sociodemographic characteristics of CRN in individuals with COPD in the US. In a nationally representative survey of US adults in the National Health Interview Survey (2013-2020), we identified individuals aged ≥18 years with a self-reported history of COPD. Cross-sectional study. Of the 15,928 surveyed individuals, a weighted 18.56% (2.39 million) reported experiencing CRN, including 12.50% (1.61 million) missing doses, 13.30% (1.72 million) taking lower than prescribed doses, and 15.74% (2.03 million) delaying filling prescriptions to save costs. Factors including age < 65 years, female sex, low family income, lack of health insurance, and multimorbidity were associated with CRN. In the US, one in six adults with COPD reported CRN. The influencing factors of CRN are multifaceted and necessitating more rigorous research. Targeted interventions based on the identified influencing factors in this study are recommended to enhance medication adherence among COPD patients.

Association of Supplemental Nutrition Assistance Program participation duration with cost-related medication non-adherence and emergency department visits.

Administrative requirements could disrupt sustained Supplemental Nutrition Assistance Program (SNAP) participation among income-eligible individuals. To meet their food needs, low-income individuals without consistent SNAP benefits may compromise on medication use, posing a risk to their health. The objective of this study is to examine the association of SNAP participation duration in a given year with cost-related medication nonadherence (CRN) and emergency department (ED) use in income-eligible individuals. Cross-sectional. Non-elderly and elderly adults who used prescription medications and participated in SNAP the previous year in 2016-2018 National Health Interview Survey. Subsamples included individuals with specific chronic conditions. CRN and ED usage. SNAP participation for<12 months in the previous year was related to increased CRN and ED use in nonelderly adults taking prescription medication, as well as in those with hypertension, cardiovascular disease and asthma. Further, <12-month SNAP participation was associated with greater odds of having at least one ED visit in nonelderly and elderly adults. Sustained SNAP participation could help income-eligible individuals better adhere to their prescribed medications and reduce health complications requiring ED visits. Findings suggest the importance of addressing SNAP participation gaps among income-eligible individuals in health care settings.

Developing an Integrated Longitudinal Dataset for Patient-Centered Outcome Measures in Cost-Related Medication Nonadherence.

Cost-related medication nonadherence (CRN) is an important patient-centered outcome measure. Longitudinal follow-up of CRN is rare. We propose to develop a novel integrated dataset to study CRN longitudinally. A dataset of 2000 Medicare beneficiaries at high risk of hospitalization surveyed quarterly on CRN and followed up individually for 8 quarters between 2013 and 2018 was linked to Medicare files. A metric of CRN categorizing persistent, intermittent, and transient CRN during the 8 quarters was developed. An ordered logit model and a logit model were developed to assess the factors influencing CRN overall and persistent CRN, respectively. A total of 1761 patients were included in the analysis, among whom 869 (49.3%) reported CRN at least once in the 8-quarter study period, 178 (10%) reported persistent CRN, 395 (22.4%) reported intermittent CRN, and 296 (16.8%) reported transient CRN. The conditional effect in the logit model for persistent CRN revealed that baseline dual eligibility was negatively associated (adjusted odds ratio = 0.45, P < 0.01) and depression positively associated (adjusted odds ratio = 1.55, P = 0.01) with persistent CRN. The marginal analysis in the ordered logit model revealed a clear pattern of higher probabilities of persistent and intermittent CRN at younger ages while transient CRN was flat. Among the 252 subjects who were deceased, 31 (12.3%) reported persistent CRN, compared with 147 (9.74%) who were alive (P = 0.21 by χ2 test). A significant number of patients reported persistent CRN, including those who were at the end of life. Research is critically needed to understand behavioral patterns among the younger Medicare population.

Quality of Medication Cost Conversations and Interest in Future Cost Conversations Among Older Adults.

Medication cost conversations occur less frequently than patients prefer, and it is unclear whether patients have positive experiences with them when they do occur. To describe patients' experiences discussing their medication costs with their health care team. Cross-sectional survey. Nationally representative survey fielded in the United States in 2022 (response rate = 48.5%). 1020 adults over age 65. Primary measures were adapted from Clinician and Group Consumer Assessment of Healthcare Providers Survey visit survey v4.0 and captured patients' experiences of medication cost conversations. Additional measures captured patients' interest in future cost conversations, the type of clinicians with whom they would be comfortable discussing costs, and sociodemographic characteristics. Among 1020 respondents who discussed medication prices with their health care team, 39.3% were 75 or older and 78.6% were non-Hispanic White. Forty-three percent of respondents indicated that their prior medication cost conversation was not easy to understand; 3% indicated their health care team was not respectful and 26% indicated their health care team was somewhat respectful during their last conversation; 48% indicated that there was not enough time. Those reporting that their prior discussion was not easy to understand or that their clinician was not definitely respectful were less likely to be interested in future discussions. Only 6% and 10% of respondents indicated being comfortable discussing medication prices with financial counselors or social workers, respectively. Few differences in responses were observed by survey participant characteristics. This cross-sectional survey of prior experiences may be subject to recall bias. Among older adults who engaged in prior medication cost conversations, many report that these conversations are not easy to understand and that almost one-third of clinicians were somewhat or not respectful. Efforts to increase the frequency of medication cost conversations should consider parallel interventions to ensure the discussions are effective at informing prescribing decisions and reducing cost-related medication nonadherence.

Abstract P115: Cost-related Medication Non-adherence Among Non-elderly Hypertensive Adults In The United States.

Background: In the US, approximately 20% of prescriptions are never filled, and 50% of filled prescriptions are non-compliant with provider’s recommendations. The affordability of prescribed medicines could be a barrier for hypertensive patients leading to cost-related medication non-adherence (CRN). Methods: We used the National Health Interview Survey 2019 adult dataset to study predictors of CRN among non-elderly hypertensive adults aged 18-64. We defined CRN dichotomously based on four yes or no questions: delayed, skipped, took less medicine, and didn’t get medicine due to cost or to save money. We report descriptive statistics for the entire sample (n=5695) and a multivariable logistic regression model for the lower-income sub-sample with ≤138 federal poverty levels (FPL) (n=845). Results: Around 16% of respondents reported CRN. Females experienced CRN at a higher proportion (19.9%) than men (12.7%). Those uninsured, below 200% of the FPL, with less than a high school education, unemployed last week, had additional co-morbidities, and identified as non-Hispanic Black, more commonly experienced CRN compared to their counterparts. The subgroup analysis among lower-income (≤138 FPL) revealed an even higher rate of CRN (25.1%). Gender-based differences still existed in this sub-group, with higher CRN among women (27.6%) than men (22.5%). However, in the regression model with gender, insurance, age, education, race, co-morbidity, rural/urban geography, and having a usual source of care as covariates, only co-morbidities and insurance status had statistically significant associations. Those with one additional co-morbidity had 1.98 times the odds, and those with four or more additional co-morbidities had 3.88 times the odds of CRN compared to those with hypertension only. Medicaid enrollees had significantly lower odds of reporting CRN (OR = 0.28, p-value &lt;0.001) than those uninsured. Conclusion: Our study provides evidence of an overall high prevalence (16%) of cost-related medication adherence in non-elderly hypertensive Americans and an even higher rate (25%) among those with lower income. As non-adherence to medication could lead to poor hypertension control, removing financial barriers to access medicines is imperative.

Prevalence and persistence of cost-related medication non-adherence before and during the COVID-19 pandemic among medicare patients at high risk of hospitalization.

To study cost-related medication non-adherence (CRN) for a 30-month period before and during the COVID-19 pandemic using a sample of Medicare patients at high risk of hospitalization. A novel data set of quarterly surveys of CRN was used to evaluate CRN before and during the COVID-19 pandemic. Generalized Estimating Equation (GEE) analyses were conducted to evaluate the adjusted coefficients of change in CRN behaviors controlling for socio-demographic and health characteristics. Six hundred seventy-seven Medicare beneficiaries at high risk of hospitalization who were alive on January 1, 2020 and followed up through quarterly surveys on CRN for 30 months before and during the COVID-19 pandemic. Two metrics of prevalence and persistence of CRN and their adjusted coefficients in GEE with binomial family distribution and log link function controlling for socio-demographic and health characteristics. A total of 5,990 quarterly surveys were completed by the 677 patients during the 30-month study period. Among the 677 patients, 250 (37%) were men, 591 (87%) were African American, and 288 (42%) were Medicare-Medicaid dual eligible. The unadjusted prevalence of CRN before and during the COVID-19 pandemic was 31.1% and 25.7% respectively (p = 0.02 by Chi-squared test), and persistent CRN rates were 12.1% and 9.7% respectively (p = 0.17 by Chi-squared test). The adjusted odds ratio of CRN prevalence during the pandemic compared to the pre-pandemic level was 0.75 (p<0.01), and 0.74 (p = 0.03) for persistent CRN in GEE estimations. There are coherent evidence of a reversal of CRN rates during the COVID-19 pandemic among this high-need, high-cost resource utilization Medicare population. Patients' CRN behaviors may be responsive to exogenous impacts, and the behaviors changed in the same direction with similar magnitude in terms of prevalence (the extensive margin) and persistence (the intensive margin). More research is needed to advance the understanding of the driving forces behind patients' behavioral changes and to identify factors that may be informative for reducing CRN in the long run.

Cost–related medication nonadherence in US adults with asthma: The National Health Interview Survey, 2013-2020

BackgroundAsthma is a chronic disease that needs long-term control for secondary prevention. Health-related expenditures resulting from asthma are rising in the United States, and medication nonadherence is associated with adverse health outcomes in patients with asthma. ObjectiveTo estimate the prevalence and risk factors of cost–related medication nonadherence (CRN) in individuals with asthma in the United States. MethodsWe identified patients aged above or equal to 18 years with a history of asthma in nationally representative cross-sectional data, the National Health Interview Survey 2013 to 2020. Participants were considered to have experienced CRN if at any time in the 12 months they reported skipping doses, taking less medication, or delaying filling a prescription to save money. The weighted prevalence of CRN was estimated overall and by subgroups. Logistic regression was used to identify CRN-related characteristics. ResultsOf the 26,539 National Health Interview Survey participants with a history of asthma, 4360 (15.77%; representing 3.92 million of the US population) reported CRN, with 10.12% (weighted 2.51 million) of patients skipping doses to save money, 10.82% (weighted 2.69 million) taking less medication to save money, and 13.35% (weighted 3.31 million) delaying filling a prescription to save money. The subgroups young, women, low income, no health insurance, currently smoking, and with comorbidities had a higher prevalence of CRN. The results of this sensitivity analysis did not differ from the overall results. ConclusionIn the United States, 1 in 6 adults with a history of asthma is nonadherence with medications due to costs. Removing financial barriers to accessing medication can improve medication adherence in patients with asthma.

Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022

Rising prescription drug costs and increasing prices for consumer goods may increase cost-related medication nonadherence. Cost-conscious prescribing can be supported by real-time benefit tools, but patient views on real-time benefit tool use and their potential benefits and harms are largely unexplored. To assess older adults' cost-related medication nonadherence, cost-coping strategies, and views on the use of real-time benefit tools in clinical practice. A weighted, nationally representative survey of adults aged 65 years and older administered via the internet and telephone from June 2022 to September 2022. Cost-related medication nonadherence; cost coping strategies; desire for cost conversations; potential benefits and harms from real-time benefit tool use. Among 2005 respondents, most were female (54.7%) and partnered (59.7%); 40.4% were 75 years or older. Cost-related medication nonadherence was reported by 20.2% of participants. Some respondents used extreme forms of cost-coping, including foregoing basic needs (8.5%) or going into debt (4.8%) to afford medications. Of respondents, 89.0% reported being comfortable or neutral about being screened before a physician's visit for wanting to have medication cost conversations and 89.5% indicated a desire for their physician to use a real-time benefit tool. Respondents expressed concern if prices were inaccurate, with 49.9% of those with cost-related nonadherence and 39.3% of those without reporting they would be extremely upset if their actual medication price was more than what their physician estimated with a real-time benefit tool. If the actual price was much more than the estimated real-time benefit tool price, nearly 80% of respondents with cost-related nonadherence reported that it would affect their decision to start or keep taking a medication. Furthermore, 54.2% of those with any cost-related nonadherence and 30% of those without reported they would be moderately or extremely upset if their physicians used a medication price tool but chose not to discuss prices with them. In 2022, approximately 1 in 5 older adults reported cost-related nonadherence. Real-time benefit tools may support medication cost conversations and cost-conscious prescribing, and patients are enthusiastic about their use. However, if disclosed prices are inaccurate, there is potential for harm through loss of confidence in the physician and nonadherence to prescribed medications.

Food Insecurity and Perceived Financial Stress are Associated with Cost-related Medication Non-adherence in Stroke.

To determine whether food insecurity and perceived financial stress contribute to cost-related medication non-adherence (CRN) in stroke. We conducted a retrospective study of adult stroke survivors in the National Health Interview Survey (2014-2018). Weighted prevalence of food insecurity, perceived financial stress, and CRN by age was calculated. Multiple logistic regression was conducted between food insecurity or perceived financial stress and CRN, adjusting for demographic and clinical variables. Prevalence of food insecurity, perceived financial stress, and CRN respectively were 38%, 75%, and 26% (age 18-44), 38%, 76%, and 21% (age 45-64) and 17%, 43%, and 6% (age≥ 65). Food insecurity and perceived financial stress respectively were associated with CRN in stroke survivors aged 45-64 [odds ratio (95% CI) 1.35 (1.18-1.54) and 1.44 (1.29-1.61)] and age ≥ 65 [1.77 (1.52-2.06) and 1.51 (1.37-1.67)]. Food insecurity and perceived financial stress are prevalent in stroke survivors and associated with CRN.

An adapted model of cost-related medication nonadherence among older adult patients with chronic diseases: an Iranian qualitative study

BackgroundFollowing the rapid aging of population, some concerns have emerged regarding increasing demand for health care services and the consequent increase in health costs. Besides, older adult patients with chronic disease are more prone to show cost-related medication non-adherence (CRN) to cope with their medication costs. The objective of this qualitative study was to develop an adopted conceptual framework on the contextual determinants that affect the CRN in older adult patients with chronic diseases.MethodsProblem-centered, semi-structured, in-depth, and face-to-face interviews, were conducted with healthcare informants in Iran, from Sep. 2021 to Feb. 2022. Collected data were analyzed using deductive and inductive analytic approaches and content analysis methodology was used to develop the model. This study applies to the COREQ checklist.ResultsFifteen informants, including 8 (60%) males, with mean ± SD age of 44.4 ± 9.7 years, entered into the study. Based on the data analysis performed on the information obtained from the interview with 3 subgroups of geriatricians, health policymakers, and pharmacists, six major themes identified as determinants: 1) socio-economic factors, 2) health system-related factors, 3) healthcare provider-related factors, 4) medication-related factors, 5) disease-related factors, and 6) patient-related factors. There were also 23 minor themes which were matched with the aforementioned six major themes.ConclusionThe final framework obtained in this qualitative study depicts CRN as an issue that is highly likely affected by six main determinants among older patients with chronic disease. Our findings emphasize that policymakers would focus on certain major themes and allocate resources to programs to improve medication therapy management in older adult patients.

Patterns of Cost-related Medication Non-Adherence among Children with Atopic Dermatitis

Consistent medication use and follow-up are mainstays of atopic dermatitis (AD) management. Previous studies suggest variable medication adherence among children with AD. Data are limited regarding cost-related barriers to medication adherence among children with AD.

Clinicians’ contribution to cost-related medication non-adherence: Impact of irrational prescribing and influence of pharmaceutical promotional activities on prescribing behavior of clinicians

Poor training of clinicians on the Rational Use of Medicines (RUMs) and the impact of pharmaceutical promotional activities fuel irrational prescribing behavior, which is a major contributor to cost-related medication non-adherence. The aim of this study was to determine how training on the RUMs and related concepts and the influence of pharmaceutical promotional activities impact on clinicians prescribing behavior, a major cause of cost-related medication non-adherence. This was a cross-sectional descriptive study, conducted among medical practitioners in South-eastern Nigeria using a self-administered questionnaire. The questions were designed to determine the clinicians’ knowledge and practice of the basic concepts of the RUMs, as well as how much pharmaceutical promotional activities (information and incentives) impact on their prescribing behaviors. There were 100 clinicians, 71 (71%) males and 29 (29%) females, with mean years of practice of 8.2±5.8 years. About 66% of the respondents claimed they were trained on the concept of the RUMs, however, only 20% were aware of the Personal Drugs (Pdrugs) concept, and 17% had their own list of P-drugs, which is basic to rational prescribing. Fifty-six percent (56%) agreed that pharmaceutical promotional activities influenced their prescribing habits, while 32% were indifferent. The poor knowledge of the basic concepts of the RUMs as seen in this study makes clinicians vulnerable to irrational prescribing and the negative impact of pharmaceutical promotional activities. In developing nations, where medicines are mostly paid out of pocket by the patient, such prescribing habits fuel cost-related medication non-adherence.

Unfavorable social determinants of health are associated with higher burden of financial toxicity among patients with atherosclerotic cardiovascular disease in the US: findings from the National Health Interview Survey

BackgroundAtherosclerotic cardiovascular disease (ASCVD) is a major cause of financial toxicity, defined as excess financial strain from healthcare, in the US. Identifying factors that put patients at greatest risk can help inform more targeted and cost-effective interventions. Specific social determinants of health (SDOH) such as income are associated with a higher risk of experiencing financial toxicity from healthcare, however, the associations between more comprehensive measures of cumulative social disadvantage and financial toxicity from healthcare are poorly understood.MethodsUsing the National Health Interview Survey (2013–17), we assessed patients with self-reported ASCVD. We identified 34 discrete SDOH items, across 6 domains: economic stability, education, food poverty, neighborhood conditions, social context, and health systems. To capture the cumulative effect of SDOH, an aggregate score was computed as their sum, and divided into quartiles, the highest (quartile 4) containing the most unfavorable scores. Financial toxicity included presence of: difficulty paying medical bills, and/or delayed/foregone care due to cost, and/or cost-related medication non-adherence.ResultsApproximately 37% of study participants reported experiencing financial toxicity from healthcare, with a prevalence of 15% among those in SDOH Q1 vs 68% in SDOH Q4. In fully-adjusted regression analyses, individuals in the 2nd, 3rd and 4th quartiles of the aggregate SDOH score had 1.90 (95% CI 1.60, 2.26), 3.66 (95% CI 3.11, 4.35), and 8.18 (95% CI 6.83, 9.79) higher odds of reporting any financial toxicity from healthcare, when compared with participants in the 1st quartile. The associations were consistent in age-stratified analyses, and were also present in analyses restricted to non-economic SDOH domains and to 7 upstream SDOH features.ConclusionsAn unfavorable SDOH profile was strongly and independently associated with subjective financial toxicity from healthcare. This analysis provides further evidence to support policies and interventions aimed at screening for prevalent financial toxicity and for high financial toxicity risk among socially vulnerable groups.

Abstract 13740: Cumulative Social Disadvantage and Cost-Related Medication Non-Adherence Among US Adults With Hypertension: The National Health Interview Survey 2014-2017

Introduction: Less than 50% adherence is reported 1 year after initiating antihypertensives. We examined social disparities in cost-related medication non-adherence (CRN) by insurance and family income categories in adults with hypertension. Methods: We used National Health Interview Survey 2014-2017 data from adults who reported hypertension and were taking antihypertensive medications. Respondents reported their insurance plan and family income. A cumulative SDoH index was created by aggregating 45 determinants from 6 domains, and respondents were grouped by quartiles (SDoH-Q1 to Q4). Higher SDoH quartiles indicated greater disadvantage. CRN was present if an individual skipped medication to save money, took less medicine to save money, or delayed filling a prescription to save money in the last 12 months. Results: A total of 35,893 adults managed for hypertension were surveyed, with a mean age 62.48 [SD 14.24] years, female 51.3%). The prevalence of CRN was 9.5%. The uninsured (34.6%) and those with low income were most likely to report CRN. Regardless of insurance or income, higher SDoH quartile groups were more likely to report CRN. This trend was accentuated among the uninsured and the middle-income group. Adjusting for demographics and comorbidities, the least increment in the odds of CRN with SDoH quartiles was seen among Medicare beneficiaries and low-income: SDoH-Q4 was associated with OR = 8.47 (95%CI, 2.11, 33.93) for Medicare beneficiaries, and OR = 17.80 (95%CI, 7.91, 40.03) for low-income. The highest increment in the odds of CRN with SDoH quartiles were observed with the uninsured (OR = 22.89; 95%CI [4.91, 106.81]), and the middle-income group (OR = 21.57; 95%CI [13.78, 33.77]). Conclusion: While cumulative social disadvantage was associated with higher cost-related medication non-adherence among adults on medications for hypertension, this association was stronger in the uninsured, Medicaid beneficiaries, and the middle-income group.

Medication cost-reducing behaviors in older adults with atrial fibrillation: The SAGE-AF study

BackgroundAs patient prices for many medications have risen steeply in the United States, patients may engage in cost-reducing behaviors (CRBs) such as asking for generic medications or purchasing medication from the Internet. ObjectiveThe objective of this study is to describe patterns of CRB, cost-related medication nonadherence, and spending less on basic needs to afford medications among older adults with atrial fibrillation (AF) and examine participant characteristics associated with CRB. MethodsData were from a prospective cohort study of older adults at least 65 years with AF and a high stroke risk (CHA2DS2VASc ≥ 2). CRB, cost-related medication nonadherence, and spending less on basic needs to afford medications were evaluated using validated measures. Chi-square and t tests were used to evaluate differences in characteristics across CRB, and statistically significant characteristics (P < 0.05) were entered into a multivariable logistic regression to examine factors associated with CRB. ResultsAmong participants (N = 1224; mean age 76 years; 49% female), 69% reported engaging in CRB, 4% reported cost-related medication nonadherence, and 6% reported spending less on basic needs. Participants who were cognitively impaired (adjusted odds ratio 0.69 [95% CI 0.52–0.91]) and those who did not identify as non-Hispanic white (0.66 [0.46–0.95]) were less likely to engage in CRB. Participants who were married (1.88 [1.30–2.72]), had a household income of $20,000-$49,999 (1.52 [1.02–2.27]), had Medicare insurance (1.38 [1.04–1.83]), and had 4-6 comorbidities (1.43 [1.01–2.01]) had significantly higher odds of engaging in CRB. ConclusionAlthough CRBs were common among older adults with AF, few reported cost-related medication nonadherence and spending less on basic needs. Patients with cognitive impairment may benefit from pharmacist intervention to provide support in CRB and patient assistance programs.

Cost-related medication nonadherence among Medicare beneficiaries with cardiovascular disease risk factors: The role of comprehension of the Medicare programme and its prescription drug benefits.

This study aims to investigate how reported comprehension of the Medicare programme and its prescription drug benefits is associated with cost-related medication nonadherence (CRN) among Medicare beneficiaries with cardiovascular disease (CVD) risk factors. This cross-sectional study used the 2017 Medicare Current Beneficiary Survey Public Use File data and included Medicare beneficiaries aged ≥65 years who reported having at least one CVD risk factor (i.e., hypertension, hyperlipidemia, diabetes, smokingand obesity) (n = 2821). A survey-weighted logistic model was used to examine associations between perceived difficulty of understanding the Medicare programme and its prescription drug benefits and CRN, controlling for beneficiaries' demographic (e.g., age) and clinical characteristics (e.g, comorbidities). This study further analyzed five subgroups based on the type of CVD risk factors involved. Among Medicare beneficiaries with CVD risk factors, 14.4% reported CRN. Medicare beneficiaries with CVD risk factors who reported difficulty understanding the overall Medicare programme and its prescription drug benefits were more likely to report CRN, compared to those who reported easy understanding of the overall Medicare programme (OR = 1.50; 95% CI = 1.11-2.04; p = 0.009) and its prescription drug benefits (OR = 2.01; 95% CI = 1.52-2.66; p < 0.001). Similar results were obtained for the subgroups with obesity, hypertensionor hyperlipidemia. Perceived difficulty of understanding the Medicare Programme and its prescription drug benefits is associated with CRN among Medicare beneficiaries with CVD risk factors, especially those with obesity, hypertension or hyperlipidemia. Monitoring and enhancing Medicare beneficiaries' overall understanding of the Medicare programme may reduce CRN.

Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors.

The relationship between out-of-pocket spending and cost-related medication nonadherence among older rural- and urban-dwelling cancer survivors is not well understood. This retrospective cohort study used the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource linked data (2007-2015) to investigate the relationship between cancer survivors' cost responsibility in the year before and after report of delaying or not filling a prescription medication because of cost in the past 6 months (cost-related medication nonadherence). Secondary exposures and outcomes included Medicare spending and utilization. Generalized linear models assessed bidirectional relationships between cost-related medication nonadherence, spending, and utilization. Effects of residence were assessed via interaction terms. Of 6,591 older cancer survivors, 13% reported cost-related medication nonadherence. Survivors were a median 8 years (interquartile range, 4.5-12.5 years) from their cancer diagnosis, 15% were dually Medicare/Medicaid-eligible, and prostate (40%) and breast (32%) cancer survivors were most prevalent. With every $500 USD increase in patient cost responsibility, risk of cost-related medication nonadherence increased by 3% (risk ratio, 1.03; 95% CI, 1.02 to 1.04). After report of cost-related medication nonadherence, patient cost responsibility was 22% higher (95% CI, 1.11 to 1.32) compared with those not reporting nonadherence, amounting to $523 USD (95% CI, $430 USD to $630 USD). Medicare spending and utilization were also higher before and after report of cost-related nonadherence versus none. For survivors residing in rural (18%) and urban (82%) areas, residence did not modify adherence or cost outcomes. A bidirectional relationship exists between patient cost responsibility and cost-related medication nonadherence. Interventions reducing urban- and rural-dwelling survivor health care costs and cost-related adherence barriers are needed.

State-Level Social Vulnerability Index and Healthcare Access in Patients With Atherosclerotic Cardiovascular Disease (from the BRFSS Survey)

We analyzed the association between social vulnerability index (SVI) and healthcare access among patients with atherosclerotic cardiovascular disease (ASCVD). Using cross-sectional data from the Behavioral Risk Factor Surveillance System 2016 to 2019, we identified measures related to healthcare access in individuals with ASCVD, which included healthcare coverage, presence of primary care clinician, duration since last routine checkup, delay in access to healthcare, inability to see doctor because of cost, and cost-related medication nonadherence. We analyzed the association of state-level SVI (higher SVI denotes higher social vulnerability) and healthcare access using multivariable-adjusted logistic regression models. The study population comprised 203,347 individuals aged 18 years or older who reported a history of ASCVD. In a multivariable-adjusted analysis, prevalence odds ratios (95% confidence interval) for participants residing in states in the third tertile of SVI compared with those in the first tertile (used as reference) were as follows: absence of healthcare coverage=1.03 (0.85 to 1.24), absence of primary care clinician=1.33 (1.12 to 1.58), &gt;1 year since last routine checkup=1.09 (0.96 to 1.23), delay in access to healthcare=1.39 (1.18, 1.63), inability to see a doctor because of cost=1.21 (1.06 to 1.40), and cost-related medication nonadherence=1.10 (0.83 to 1.47). In conclusion, SVI is associated with healthcare access in those with pre-existing ASCVD. Due to the ability of SVI to simultaneously and holistically capture many of the factors of social determinants of health, SVI can be a useful measure for identifying high-risk populations.

1212-P: Cost-Related Medication Nonadherence in Alabama's Medicaid Population with Diabetes

Background: Cost-related medication nonadherence (CRMN) occurs when an individual takes less medication than what is prescribed due to difficulty affording their medications. In adults with diabetes, medication nonadherence is associated with worse glycemic control and increased healthcare costs. The goal of this study was to determine what proportion of Alabama’s Medicaid population with diabetes experiences CRMN and to evaluate for potential risk factors for CRMN in this financially-at-risk population. Methods: We conducted a cross-sectional study surveying a population-based sample of adults (ages 19-64) with diabetes covered by Alabama Medicaid. We classified participants as experiencing CRMN if they responded yes to “Not including over the counter medications, was there a time in the past 12 months when you didn't take your medication as prescribed because of cost?” Using multivariable logistic regression, we examined what variables were associated with CRMN adjusting for demographic and clinical factors (insulin use, diabetes duration, receipt of care coordination, and self-rated health) . Results: We included 1893 of 2235 (84.7%) participants who completed the survey and had complete data for the variables of interest in the analysis. This sample was predominantly nonwhite (60.7%) , female (73.9%) with a mean age of 52 ±10.1 years. Overall, 23.7% of participants reported CRMN. In the fully adjusted model, insulin use (OR 1.41, 95% CI 1.11, 1.79) , use of a discount prescription plan (OR 1.55, 95% CI 1.20, 2.00) , and self-report of poor health (OR 1.67, 95% CI 1.33, 2.09) were significantly associated with CRMN. Conclusion: We found that almost a quarter of a population-based sample of adults with diabetes covered by Alabama Medicaid experienced cost-related medication nonadherence. More research is needed to determine how to address this among this vulnerable population. Disclosure E.C.Ness: None. L.Juarez: None. C.R.Howell: None. L.Hohmann: None. A.Cherrington: Consultant; Bayer AG, Other Relationship; Novo Nordisk. C.A.Presley: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK109501) UAB Diabetes Research Center (P30 DK079626)

Cost-related medication nonadherence and cost-saving strategies among Native Hawaiian and Pacific Islander cancer survivors.

e18531 Background: Although cost-related medication nonadherence resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about cost-related medication nonadherence among Native Hawaiian and Pacific Islander cancer survivors. This study compared cost-related medication nonadherence among Native Hawaiian and Pacific Islander adults diagnosed with and without cancer and described the strategies cancer survivors used to offset the costs of medications. Methods: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey, we compared self-reported cost-related medication nonadherence, shifting spending from basic needs to afford medications, and cost reduction strategies among Native Hawaiian and Pacific Islanders diagnosed with and without cancer. Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). Descriptive statistics and logistic regression models were used to characterize (age, sex, sexual orientation, marital status, household income, educational attainment, health insurance status, comorbidities, self-rated health, activity limitation, and cancer type) and compare these populations. Results: Of 2,593 adults were included in the study, 151 (5.8%) reported a history of cancer, and 2,442 (94.2%) did not. Although 13.6% of cancer survivors and 7.7% without cancer reported cost-related medication nonadherence (p = 0.065), about 9.9% and 11.7% of those with and without cancer, respectively, reported delays in filling a prescription to save money. In addition, about 8.0% and 9.9% of those with and without cancer, respectively, reported taking less medication to save money. In weighted adjusted analyses, the rate of cost-related non-adherence among the two groups was similar, but with some subgroup differences noted by sex and household income. The use of cost reduction strategies was mostly similar among cancer survivors and those without cancer. Conclusions: Cost-related medication nonadherence is common among Native Hawaiian and Pacific Islanders, but appears at similar prevalence among those diagnosed with and without cancer.