Study Finds Patients Often Skip Medication To Save Money

by Nicole Fawcett / University of Michigan

In a recent nationwide survey, University of Michigan Health System researchers found diabetes patients' prescription drugs costs -- which frequently mounted above $100 a month -- created a financial burden that led to increasing credit card debt, borrowing money from family or friends and even cutting back on basic needs such as food or heat.

Nearly one in five older adults with diabetes in the survey reported cutting back on prescription medication in the prior year because of costs, and 15 percent used less of their medication at least once per month because of the cost.

By not taking their medications as prescribed, patients had poorer diabetes control, more symptoms and worse physical and mental functioning, researchers found.

"We're really just beginning to appreciate how common it is that people with chronic illnesses are cutting back on prescription medication use because of the cost. We have not yet fully estimated the impact that these costs have on other aspects of patients' lives. We may already be seeing the fallout in terms of poorer health status. While prescription drug coverage may seem expensive, a good plan may save Medicare and other health insurance companies in the long run by preventing serious health problems," says John Piette, Ph.D., a career scientist at the Ann Arbor VA Healthcare System and an associate professor of general medicine at U-M Medical School.

As people reported using more drugs each month, it was more likely that they skipped doses to save money. People who used seven or more drugs were four times more likely than those with one or two prescriptions to cut back on their medications at least once per month. Cost-related medication adherence problems were especially common among patients without prescription drug coverage, and those who were younger than 65 (and therefore not eligible to benefit from planned Medicare drug benefit reforms).

The researchers found many doctors may be in the dark about patients' problems due to medication costs. More than one-third of patients who reported cutting back on their medication use never talked to their doctor or nurse about it. These patients often said they were never asked about possible problems paying for their prescriptions or they did not think their doctor could help with medication costs. Patients also reported feeling embarrassed or rushed for time.

"Especially when a patient is not responding to medication therapy, doctors should raise the issue of prescription drug costs. Common clinician responses, such as changing drugs or adding an additional prescription may actually make the problem worse," Piette says.

VA medical centers cover 100 percent of drug costs for people with low incomes or service-connected disabilities. Other VA patients pay $7 co-pays for 30-day supplies of prescription medications, with no cap on total costs or number of prescriptions. Costs above $840 in a year are waived.

Although many Medicaid and uninsured patients in the study were eligible for low-cost or free prescription drug programs, more of them reported cost-related medication problems than their VA counterparts. The researchers concluded that many of these patients may not be aware of assistance programs available to them. The study authors suggest the VA drug coverage policy may provide a model for other government prescription drug coverage programs.