Cost-related Nonadherence Research Articles

Cancer history, insurance coverage, and cost-related medication nonadherence in Medicare beneficiaries, 2013-2018.

BACKGROUND: Cancer survivors are at risk of financial hardships and cost-related medication nonadherence, particularly among those without adequate insurance coverage. OBJECTIVE: To examine the association between cancer history and cost-related medication nonadherence, as well as the association between insurance coverage and nonadherence among Medicare beneficiaries. METHODS: We used the 2013-2018 Medicare Current Beneficiary Survey Public Use File, a survey on the health, health service utilization, access to care, and satisfaction among a nationally representative sample of Medicare beneficiaries. Cost-related medication nonadherence was defined as often or sometimes reporting any of the following: (1) took smaller dose of medication, (2) skipped doses to make medication last, (3) delayed medication because of cost, and (4) not get medication because of cost. Logistic regression was used to estimate the odds ratio of cost-related nonadherence associated with cancer history, adjusting for survey year and sociodemographic characteristics of the respondents, including age, sex, race and ethnicity, highest grade completed, income level, marital status, and number of chronic conditions. We also included Medicare Part D, an interaction between Part D and the low-income subsidy, and Medicare Advantage in the model to examine the effect of insurance coverage on cost-related nonadherence. RESULTS: From 2013 to 2018, there were 12,492 cancer survivors and 53,262 respondents without a history of cancer in our sample, and 16.5% reported cost-related medication nonadherence. After adjusting for characteristics of the respondents, cancer survivors were more likely than those without a history of cancer to report cost-related medication nonadherence (adjusted OR = 1.10; 95% CI = 1.02-1.19). Having unsubsidized Part D-Part D without the low-income subsidy-was associated with a greater likelihood of reporting cost-related medication nonadherence (adjusted OR = 1.63, 95% CI = 1.49-1.78), while having subsidized Part D was not (adjusted OR = 0.96; 95% CI = 0.85-1.08). Finally, being on Medicare Advantage was associated with lower likelihood of reporting cost-related nonadherence compared with traditional fee-for-service Medicare (adjusted OR = 0.86; 95% CI = 0.80-0.92). CONCLUSIONS: Expanding the low-income subsidy and capping out-of-pocket drug expenditure can be effective policy options to reduce cost-sharing burden and cost-related nonadherence. DISCLOSURES: For this study, Li was partially supported by a research grant from the National Cancer Institute (R01CA225647). The sponsor had no role in the design or implementation of the study, analysis or interpretation of the data, or drafting or approval the manuscript. The authors report no conflicts of interest.

Abstract 11520: Cost-Related Medication Nonadherence in Adults with Diabetes Mellitus in the United States

Background: Health-related expenditures due to diabetes mellitus (DM) are rising in the US. Medication nonadherence is associated with worse health outcomes, particularly among individuals with DM who require uninterrupted treatment. We sought to determine whether patients with DM in the US report cost-related nonadherence (CRN), a potential consequence of rising drug costs. Methods: We used the National Health Interview Survey (2013-18), a nationally representative study, to identify participants with and without self-reported DM. Participants were considered to have experienced CRN if during the preceding year they reported skipping doses, taking less medication, or delaying filling a prescription to save money. Results: Of the 20,326 participants with DM, a weighted 14% (or 3 million annually) experienced CRN, including 9.5% skipping doses, 9.9% taking less medicine, and 11.8% delaying prescription filling to save money. Compared to those without DM (N=145,186), participants with DM reported a higher prevalence of CRN, with the largest differences being observed among non-elderly adults (Figure). Among non-elderly adults with DM, a weighted 19.4% (or 2.3 million annually) reported CRN. In multivariable logistic regression models, the main drivers of CRN among participants with DM were lack of insurance (OR 4.34, 95% CI 3.49, 5.39), younger age (OR 3.43, 95% CI 2.65, 4.44), low income (OR 1.82, 95% CI 1.58, 2.09), use of insulin (OR 1.19, 95% CI 1.04, 1.35), and unfavorable risk factor profile (OR 1.53, 95% CI 1.21, 1.93) (Table). Conclusion: In the US, 1 in 7 adults with DM reported CRN, and the burden was highest among non-elderly adults. Cost represents a serious barrier for therapy adherence among individuals with DM in the US, particularly among the most vulnerable. Removing financial barriers to accessing medications may improve adherence to essential therapies among individuals with DM, and ultimately improving outcomes.

Medication nonadherence and patient cost responsibility for rural and urban cancer survivors.

4 Background: Little is known about the specific out-of-pocket costs which may lead to prescription nonadherence in older cancer survivors, and how patterns may differ for those living in rural areas. This study quantified patient costs overall and by residence for older cancer survivors who did and did not report cost-related prescription nonadherence. Methods: This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource (SEER-CAHPS) from 2007-2015. Older cancer survivors self-reported cost-related prescription nonadherence in the prior six months. Patient cost responsibility (deductibles, coinsurance, copayments) was summed for all medical care received in the year prior to survey. Differences in patient cost responsibility by cost-related adherence was estimated using gamma generalized linear models adjusted for patient age, race, sex, education, dual Medicaid enrollment status, residence, comorbidity count, cancer type, stage, and phase of care. Models stratified by urban/rural residence as designated by Rural-Urban continuum codes assessed effect modification. Results: Of 11,829 older adult survivors of prostate (37%), breast (32%), colorectal (14%), gynecologic (10%), or lung (6%) cancer, 12% reported any cost-related prescription nonadherence in the prior year. Median age of survivors was 76 (interquartile range [IQR] 71-82), 15% had less than a high school degree, 59% had at least one non-cancer comorbidity, and 16% had ever been dual eligible. Prevalence of cost-related nonadherence was similar by patient characteristics. Median cost responsibility in the year prior to survey was $1,529 (IQR $744-$2,959) for patients reporting nonadherence and $1,123 (IQR $572-$2,362) for those reporting adherence. In adjusted models, patients reporting nonadherence had $656 higher patient cost responsibility in the year prior (95% CI $564-$760) compared to those reporting adherence. Approximately half of the difference in cost was outpatient spending (β = $277, 95% CI $210-$359). Differences in cost responsibility for patients reporting nonadherence compared to adherence were smaller for patients residing in rural areas (18% of respondents; β = $341, 95% CI $177-$564) compared to those residing in urban areas (82% of respondents; β = $715, 95% CI $613-$830). Conclusions: Compared to those reporting adherence, cost-related prescription nonadherence was associated with higher health care cost responsibility in cancer survivors. Furthermore, prescription adherence decisions may be more cost-sensitive for patients living in rural compared to urban areas. Interventions to address out-of-pocket health care costs, particularly for rural cancer survivors, could aid in increased prescription adherence and subsequent health outcomes.

Access and Cost-Related Nonadherence to Prescription Medications Among Lupus Patients and Controls: The Michigan Lupus Epidemiology and Surveillance Program.

Medication access and adherence are important determinants of health outcomes. We investigated factors associated with access and cost-related nonadherence to prescriptions in a population-based cohort of systemic lupus erythematosus (SLE) patients and controls. Detailed sociodemographic and prescription data were collected by structured interview in 2014-2015 from participants in the Michigan Lupus Epidemiology and Surveillance (MILES) cohort. We compared access between cases and frequency-matched controls and examined associated factors in separate multivariable logistic regression models. A total of 654 participants (462 SLE patients, 192 controls) completed the baseline visit; 584 (89%) were female, 285 (44%) were Black, and the mean age was 53 years. SLE patients and controls reported similar frequencies of being unable to access prescribed medications (12.1% versus 9.4%, respectively; P was not significant). SLE patients were twice as likely as controls to report cost-related prescription nonadherence in the preceding 12 months to save money (21.7% versus 10.4%; P = 0.001) but were also more likely to ask their doctor for lower cost alternatives (23.8% versus 15.6%; P = 0.02). Disparities were found in association with income, race, and health insurance status, but the main findings persisted after adjusting for these and other variables in multivariable models. SLE patients were more likely than controls from the general population to report cost-related prescription nonadherence, including skipping doses, taking less medicine, and delaying filling prescriptions; yet, <1 in 4 patients asked providers for lower cost medications. Consideration of medication costs in patient decision-making could provide a meaningful avenue for improving access and adherence to medications.

Association Between the Modalities of Complementary and Alternative Medicine Use and Cost-Related Nonadherence to Medical Care Among Older Americans: A Cohort Study.

Introduction: Complementary and alternative medicine (CAM) use has been increasingly prevalent among Americans, whereas its relationship with medical nonadherence is unknown. Methods: Using the National Health Interview Survey, we evaluated the use of CAM modalities and their association with cost-related nonadherence to medical care (CRN) among older Americans by gender strata. Results: Men and women were, in general, in the same pattern of higher likelihood of reporting CRN if they utilized herbal supplements, meditation, and chiropractic or osteopathic manipulations (p < 0.05, respectively). Conclusion: Both men and women are more likely to report financial distress while using various CAM modalities.

Easing the Financial Burden of Diabetes Management: A Guide for Patients and Primary Care Clinicians.

More than one in 10 Americans today are living with diabetes (1). To prevent acute and chronic complications of diabetes, including death, patients with diabetes often require multiple medications and medication management supplies to enable effective, safe, and evidence-based control of hyperglycemia. These include insulin and noninsulin medications, technologies for glucose monitoring, and equipment for administration of injectable medications (both insulin and noninsulin injectables). Management of hyperglycemia is increasingly expensive for patients and the health care system, having increased 240% from the period 2005–2007 to 2015–2017, from $16.9 billion to $57.6 billion annually (2). Although the majority of these costs are borne by public and private payers (2), patients and caregivers increasingly report cost-related distress, nonadherence, and adverse health outcomes stemming from the costs of managing their disease (3–5). It is therefore vital for primary care clinicians, who care for the majority of people with diabetes (6), to be cognizant of the financial impact of diabetes management on their patients and to reduce it as much as possible. Insulin is just one component of comprehensive diabetes care, but it is the most critical for people who require it to live (i.e., people with type 1 diabetes and some with longstanding type 2 diabetes). In 2018, 18.6% of U.S. adults with diabetes were treated with insulin alone, and an additional 15.1% were treated with insulin and noninsulin glucose-lowering medications (7). The average list price of insulin in the United States rose by 15–17% each year between 2012 and 2016 (8). The greatest increase in insulin-related costs stems from greater use, and higher per-unit costs, of analog insulins (2). New insulin products such as ultra-long-acting or ultra-rapid-acting insulins offer important clinical and safety advantages to certain patients; however, these formulations are among the most expensive to obtain. Between the …

Association Between High Deductible Health Plans and Cost-Related Non-adherence to Medications Among Americans with Diabetes: an Observational Study.

For people with diabetes, adherence to prescribed medications is essential. However, the rising prevalence of high-deductible health plans (HDHPs), and prices of diabetes medications such as insulin, could deter adherence. To assess the impact of HDHP on cost-related medication non-adherence (CRN) among non-elderly adults with diabetes in the US. Repeated cross-sectional survey. National Health Interview Survey, 2011-2018. A total of 7469 privately insured adults ages 18-64 with diabetes who were prescribed medications and enrolled in a HDHP or a traditional commercial health plan (TCP). Self-reported measures of CRN were compared between enrollees in HDHPs and TCPs overall and among the subset using insulin. Analyses were adjusted for demographic and clinical characteristics using multivariable linear regression models. HDHP enrollees were more likely than TCP enrollees to not fill a prescription (13.4% vs 9.9%; adjusted percentage point difference (AD) 3.4 [95% CI 1.5 to 5.4]); skip medication doses (11.4% vs 8.5%; AD 2.8 [CI 1.0 to 4.7]); take less medication (11.1% vs 8.8%; AD 2.3 [CI 0.5 to 4.0]); delay filling a prescription to save money (14.4% vs 10.8%; AD 3.0 [CI 1.1 to 4.9]); and to have any form of CRN (20.4% vs 15.5%; AD 4.4 [CI 2.2 to 6.7]). Among those taking insulin, HDHP enrollees were more likely to have any CRN (25.1% vs 18.9%; AD 5.9 [CI 1.1 to 10.8]). HDHPs are associated with greater CRN among people with diabetes, particularly those prescribed insulin. For people with diabetes, enrollment in non-HDHPs might reduce CRN to prescribed medications.

Cost-Related Nonadherence to Medications Among US Adults With Chronic Liver Diseases

ObjectiveTo estimate the prevalence, risk factors, and consequences of cost-related medication nonadherence (CRN) in individuals with chronic liver diseases (CLDs) in the United States. Patients and MethodsUsing the National Health Interview Survey from January 1, 2014, to December 31, 2018, we identified individuals with CLDs. Using complex weighted survey analysis, we obtained national estimates and risk factors for CRN and its association with cost-reducing behaviors and measures of financial toxicity. We evaluated the association of CRN with unplanned health care use, adjusting for age, sex, race/ethnicity, insurance, income, education, and comorbid conditions. ResultsOf 3237 respondents (representing 4.6 million) US adults with CLDs, 813 (representing 1.2 million adults, or 25%; 95% CI, 23% to 27%) reported CRN, of whom 68% (n=554/813) reported maladaptive cost-reducing behaviors. Younger age, female sex, low income, and multimorbidity were associated with a higher prevalence of CRN. Compared with patients without CRN, patients experiencing CRN had 5.1 times higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 5.05; 95% CI, 3.73 to 6.83) and 2.9 times higher odds of food insecurity (aOR, 2.85; 95% CI, 2.02 to 4.01). The CRN was also associated with 1.5 times higher odds of emergency department visits (aOR, 1.46; 95% CI, 1.11 to 1.94). ConclusionWe observed a high prevalence of CRN and associated consequences such as high financial distress, financial hardship from medical bills, food insecurity, engagement in maladaptive cost-reducing strategies, increased health care use, and work absenteeism among patients with CLD. These financial determinants of health have important implications in the context of value-based care.

Longitudinal changes of financial hardship in patients with multiple sclerosis

Objective: To measure the longitudinal changes in three domains of financial hardship (i.e., financial worry, cost-related care non-adherence, material hardship) in patients with MS. Methods: A convenience sample of 559 adult patients with a known diagnosis of MS visiting a single outpatient neurology clinic between July 2018 to February 2020 were approached. Patients completed surveys at baseline and 3, 6, 9, and 12 months post-enrollment. Outcomes included financial worry (using Comprehensive Score for Financial Toxicity Patient-Reported Outcome (COST)), cumulative cost-related care non-adherence, and cumulative financial hardship as adopted by Medical Expenditure Panel Survey (MEPS). Associations of financial worry with care non-adherence and material hardship were assessed using ANOVA. Results: A total of 242 (43.3%) participated at baseline. Mean age was 43.6 ± 13.6 years (76.9% female; 46.4% White); median months from diagnosis was 63 (IQR, 28–120). The mean COST score at enrollment was 17.43 (± 10.15) and increased to 19.41 (± 11.12) at 12 months (p = 0.09). Cumulative cost-related MS care non-adherence increased from 32.6% at baseline to 53.3% at 12 months (20.7% increase; p <0.001). Cumulative material hardship increased from 61.6% at baseline to 76.0% at 12 months (14.4% increase; p<0.001). Changes in COST score from baseline to 12 months were significantly associated with changes in non-adherence and material hardship (p<0.01). Conclusion and relevance: Cost-related care non-adherence and material hardship accumulate progressively over time and correlates with financial worry. Clinical practices should focus on screening those at risk and intervene with the goal of mitigating costs of care and improving patient outcomes.

Cost-related nonadherence for prescription medications: a cross-sectional study in Jordan

ABSTRACT Background Cost-related nonadherence to medications is a commonly encountered problem posed by many patients, and specifically among elderly patients who use multiple chronic medications. This study aims to explore the prevalence of medication cost-related nonadherence and its predictors in Jordan. Method A cross-sectional study was conducted between February 2019 and May 2019 in Jordan. The CRN questionnaire was used as a measure to assess the prevalence of cost-related nonadherence. Logistic regression was used to determine predictors of medication cost-related nonadherence. Results The prevalence rate of CRN was 29.6% (95% CI: 27.0–32.3). Participants who are married or widowed were found to have higher odds of being non-adherent due to medication costs, with an odds ratio of 1.55 (95%CI: 1.19–2.00) and 1.95 (95%CI: 1.20–3.15), respectively. Lower educational level was associated with higher odds of being non-adherent 1.95 (95%CI: 1.25–3.05). Being retired was associated with higher odds of being non-adherent (2.20 (95%CI: 1.49–3.27)). Conclusion Cost-related nonadherence is a common problem in Jordan and was most prevalent among those with hypertension and diabetes mellitus, low-income, and low levels of education. Our findings could help in developing interventions to improve cost-related medication nonadherence in developing countries.

Cost-related nonadherence with glaucoma medications in Ontario

ObjectiveTo determine the proportion of glaucoma patients in Ontario aged 25–64 who lack insurance coverage for glaucoma medications and to assess the frequency of cost-related nonadherence to glaucoma medications. DesignCross-sectional study. ParticipantsGlaucoma patients on medication from 2 glaucoma clinics in Toronto, Ontario. Methods100 consecutive glaucoma patients aged 25–64 (not entitled to provincial drug benefit) and 100 consecutive glaucoma patients aged 65+ (entitled to provincial drug benefit), all on topical glaucoma therapy, completed a standardized questionnaire. Questions included insurance coverage for glaucoma medications, cost concerns when paying for glaucoma medications, cost-related nonadherence, and sociodemographics. Results25.8% of those aged 25–64 express concerns about the cost of their glaucoma medications compared to 7.1% of those aged 65+ (p < 0.001). Patients aged 25–64 were also significantly more likely to report at least one form of cost-related nonadherence (15.5% vs 2.0%, p = 0.001) and significantly more likely to report missing eye drops in a given week than patients aged 65+ (32.0% vs 16.7%, p = 0.01). 17% (95% confidence interval 11%–26%) of patients aged 25–64 self-reported having no insurance coverage for their glaucoma medications. Of those with coverage, the most common source of insurance was employer-sponsored (68.6%) with 44% requiring a copayment. The average copayment was $18 (range $2–$250) for those aged 25–64 compared with $5 in the 65+ group (range $0.62–$100). Conclusions17% of glaucoma patients aged 25–64 do not have coverage for their drops. One in four expressed concerns about the cost of their glaucoma medications, and 15.5% reported cost-related nonadherence.

Cost-related Medication Nonadherence and Its Risk Factors Among Medicare Beneficiaries.

Unaffordability of medications is a barrier to effective treatment. Cost-related nonadherence (CRN) is a crucial, widely used measure of medications access. Our study examines the current national prevalence of and risk factors for CRN (eg, not filling, skipping or reducing doses) and companion measures in the US Medicare population. Survey-weighted analyses included logistic regression and trends 2006-2016. Main analyses used the 2016 Medicare Current Beneficiary Survey. Our study sample of 12,625 represented 56 million community-dwelling beneficiaries. Additional outcome measures were spending less on other necessities in order to pay for medicines and use of drug cost reduction strategies such as requesting generics. In 2016, 34.5% of enrollees under 65 years with disability and 14.4% of those 65 years and older did not take their medications as prescribed due to high costs; 19.4% and 4.7%, respectively, experienced going without other essentials to pay for medicines. Near-poor older beneficiaries with incomes $15-25K had 50% higher odds of CRN (vs. >$50K), but beneficiaries with incomes <$15K, more likely to be eligible for the Part D Low-Income Subsidy, did not have significantly higher risk. Three indicators of worse health (general health status, functional limits, and count of conditions) were all independently associated with higher risk of CRN. Changes in the risk profile for CRN since Part D reflect the effectiveness of targeted policies. The persistent prevalence of CRN and associated risks for sicker people in Medicare demonstrate the consequences of high cost-sharing for prescription fills.

Cost-Related Nonadherence and Mortality in Patients With Chronic Disease: A Multiyear Investigation, National Health Interview Survey, 2000-2014.

IntroductionPrescription costs are rising, and many patients with chronic illnesses have difficulty paying for prescriptions. Missing or delaying medication because of financial concerns is common; however, the effects of cost-related nonadherence (CRN) on patient outcomes have not been described. Our objective was to determine if CRN is associated with higher all-cause and disease-specific mortality among patients living with diabetes and cardiovascular disease in a representative sample of US adults.MethodsWe ascertained CRN, vital status, and cause of death for 39,571 patients with diabetes, 61,968 patients with cardiovascular disease, and 124,899 patients with hypertension in the 2000 through 2014 releases of the National Health Interview Survey. We used adjusted Cox proportional hazards models to estimate associations between CRN and all-cause mortality and CRN and disease-specific mortality.ResultsOn average, 15% of the sample reported CRN in the year before interview. After adjusting for confounders, CRN was associated with 15% to 22% higher all-cause mortality rates for all conditions (diabetes hazard ratio [HR] = 1.18; 95% CI, 1.1–1.3; cardiovascular disease [CVD] HR = 1.15; 95% CI, 1.1–1.2; hypertension HR = 1.22; 95% CI, 1.2–1.3). Relative to no CRN, CRN was associated with 8% to 18% higher disease-specific mortality rates (diabetes HR = 1.18; 95% CI, 1.0–1.4; CVD HR = 1.09; 95% CI, 1.0–1.2; hypertension HR = 1.08; 95% CI, 0.9–1.3).ConclusionRelative to full adherence, CRN is associated with higher mortality rates for patients with diabetes, cardiovascular disease, and hypertension, although associations may have weakened since 2011. Policies that increase prescription affordability may decrease mortality for patients experiencing CRN.

When universal health care isn’t truly universal: Beyond filling gaps in access to medicines

Abstract Issue The Canadian healthcare system is defined by universality, but unfortunately that does not extend to drugs outside of hospitals. Access to medication remains an area of inequity, fragmentation and system failure, with millions struggling with cost related non-adherence. This has created major implications for public health, limiting the health status of populations. Canada's inequitable system and the recent pursuit to fix it, provides an opportunity to examine ways of balancing public health goals and health systems reform in a country with established public and private care services. Background The government mandated the creation of a plan to improve access to medications. Stakeholder consultations ran from June -September 2018 and the Heart &amp; Stroke Foundation (H&amp;S) aimed to create policy recommendations that would improve population health outcomes and inequities. Research review and analysis determined the scope of the problem and viable solutions. Questions arose around whether a solution could improve equity and lower health care costs without dismantling the existing private system. Results Visionary principles led to the recommendation of a universal pharmacare program, designed to improve access to cost-effective medicines for all people in Canada regardless of geography, age, or ability to pay. A hybrid -program would include a robust common formulary for which the public payer is the first payer creating cost efficiencies. Top-up private insurance would result in less strain on the public system and maintain the presence of the existing private industry. Lessons Health charities have a unique role to play in creating innovative policy solutions that also serve patient interests. In order to advance public health, health charities need to maintain focus on equity and avoid policy development that is biased with conflict of interest. Key messages Canada is primed to implement a unique universal pharmacare program that addresses healthy inequities. Varied stakeholder interests can block public health goals.

Cost-Related Medication Nonadherence in a Nationally Representative US Population with Self-Reported Glaucoma

To determine the rates of cost-related nonadherence to medications among US adults with glaucoma and to determine if participants with glaucoma have more cost-related medication nonadherence than those without glaucoma. Cross-sectional study. Participants in the 2016-2017 National Health Interview Survey (NHIS), a cross-sectional survey regarding health topics that is administered annually to a nationally representative sample of noninstitutionalized adults in the United States. We calculated proportions of NHIS participants with and without self-reported glaucoma who reported cost-related nonadherence over the previous 12 months. We analyzed responses to 7 survey items that dealt with medication cost-related issues to any/all of a participants' medication: couldn't afford a prescribed medication; skipped medication doses to save money; took less medicine to save money; delayed filling a prescription to save money; asked doctor for lower cost medication to save money; bought prescription drugs from another country to save money; used alternative therapies to save money. We performed univariable and multivariable logistic regression to evaluate the association between self-reported glaucoma diagnosis and responses to these selected questions. Proportion of participants with and without self-reported glaucoma who reported cost-related nonadherence. Participants with glaucoma reported they could not afford prescribed medication more frequently than participants without glaucoma (8.2% vs. 6.4% P= 0.024). Adjusted predicted proportions from a multivariable model demonstrated that participants with glaucoma responded that they had greater cost-related barriers to medication access. In this nationally representative sample of the US population, after adjustment for confounding variables, participants with glaucoma more frequently reported cost-related nonadherence to medications compared with participants without glaucoma. Providers prescribing medication to patients with glaucoma should be aware of these findings and consider the impact of medication cost on their patients' ability to adhere to therapy.

Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States.

The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18-1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05-1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16-1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30-1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20-1.40]). Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.

Adherence to Adjuvant Aromatase Inhibitor Therapy Among Postmenopausal Hispanic/Latino Women With Breast Cancer.

The purpose of this study was to determine the level of adherence to adjuvant aromatase inhibitor (AI) therapy and factors associated with non-adherence among Hispanic/Latino women with hormonal receptor-positive breast cancer (BC) treated at an academic center at the American-Mexican border city of El Paso, TX. Institutional Review Board approval was obtained in this cross-sectional study using the validated Morisky Medication Adherence Scale to assess patient adherence to AI therapy. Patients diagnosed with stage I-III hormonal receptor-positive, human epidermal growth factor receptor 2-negative BC who were on adjuvant AIs therapy were recruited from the Texas Tech University Health Sciences Center El Paso breast clinic. Between September 2017 and August 2018, 122 consecutive patients were enrolled; 119 were analyzed, three were lost to follow up. The mean age was 61.6±9.4 years, and 109 (91.6%) self-identified as Hispanic/Latino. A total of 58% reported an annual income of $15,000 or less. Overall, 40.3% had completed eighth grade or less education, 31.9% high school, and 12% had obtained a technical degree. The majority of patients (56%) had either a medium (45%) or a low level of adherence (11%). High adherence was noted in 44% of participants. Seven (5.6%) patients scored 2 or below on a 4-point scale for intentional adherence, and 18 (13.5%) scored 2 or below on a 4-point scale for unintentional adherence. These data suggest that the majority of Hispanic/Latino women with breast cancer have medium or low levels of adherence to therapy with AIs. Factors associated with medium and low adherence were unintentional (forgetfulness), but also included intentional factors, such as avoidance of adverse effects and delays with obtaining refills (cost-related nonadherence).

Study protocol: CareAvenue program to improve unmet social risk factors and diabetes outcomes- A randomized controlled trial

Despite the burdens costs can place on adults with diabetes, few evidence-based, scalable interventions have been identified that address prevalent health-related financial burdens and unmet social risk factors that serve as major obstacles to effective diabetes management. In this study, we will test the effectiveness of CareAvenue – an automated e-health tool that screens for unmet social risk factors and informs and activates individuals to take steps to connect to resources and engage in self-care. We will determine the effectiveness of CareAvenue relative to standard care with respect to improving glycemic control and patient-centered outcomes such as cost-related non-adherence (CRN) behaviors and perceived financial burden. We will also examine the role of patient risk factors (moderators) and behavioral factors (mediators) on the effectiveness of CareAvenue in improving outcomes. We will recruit 720 patients in a large health system with uncontrolled Type 1 diabetes mellitus (T1DM) or Type 2 diabetes mellitus (T2DM) who engage in CRN or perceive financial burden. Participants will be randomized to one of two arms: 1) receipt of a 15–20 min web-based program with routine follow-up (CareAvenue); or 2) receipt of contact information for existing health system assistance services. Outcomes will be assessed at baseline and 6- and 12-month follow-up.Clinical Trial Registration: ClinicalTrials.gov ID NCT03950973, May 2019

Prescription medication cost, insurance coverage, and cost-related nonadherence among people with spinal cord injury in Canada.

Observational cross-sectional study. To describe the most common prescription medications used and the extent of out-of-pocket cost, insurance coverage, and cost-related nonadherence (CRNA) for those medications by people with spinal cord injury (SCI) in Canada. Community in Canada. It was an observational study wherein data were collected through a cross-sectional online survey from individuals living with an SCI in Canada. We used descriptive statistics to describe the extent of drug cost, insurance coverage and CRNA among study sample, and analytical statistics to find association of CRNA with sociodemographic, injury-related and medication-related characteristics of the sample. Individuals with an SCI (n = 160) used an average of five medications and spent a median of $49 (interquartile range: $234.75) per month on their medications. More than 90% of participants had some form of drug insurance, though 37% reported CRNA. The most common medications that were forgone due to cost included opioids, antidepressants, and drugs for genitourinary and muscular spasms. Individuals with paraplegia and nontraumatic SCI had higher drug costs, though injury-related characteristics did not influence CRNA. Sex, monthly drug expenditure, and monthly additional healthcare costs were significantly associated with CRNA. People with SCIs are at risk of experiencing CRNA to their prescription medications despite having insurance coverage. Decision makers for the national pharmacare in Canada should account for their concerns judiciously.

Exploring the experiences of people in Ontario, Canada who have trouble affording medicines: a qualitative concept mapping study

ObjectivesThe experiences of people who report cost-related medicine non-adherence are not well documented. We aimed to present experiences relating to accessing medicines reported by the participants in a randomised controlled...