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

Abstract

ImportanceRising 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.ObjectiveTo assess older adults’ cost-related medication nonadherence, cost-coping strategies, and views on the use of real-time benefit tools in clinical practice.Design, Setting, and ParticipantsA weighted, nationally representative survey of adults aged 65 years and older administered via the internet and telephone from June 2022 to September 2022.Main Outcomes and MeasuresCost-related medication nonadherence; cost coping strategies; desire for cost conversations; potential benefits and harms from real-time benefit tool use.ResultsAmong 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.Conclusions and RelevanceIn 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.

Dapagliflozin versus sacubitril–valsartan for heart failure with mildly reduced or preserved ejection fraction

“…Although a growing body of evidence supports the role of SGLT2Is and ARNI in reducing HF hospitalization and CVD among HF patients, their use is still limited in clinical practice partially due to their cost. The unaffordability of pharmacotherapy due to high cost is a major reason for nonadherence to prescribed medications ( De Avila et al, 2021 ; Simon et al, 2021 ; Dusetzina et al, 2023 ). Our analysis attempts to provide some cost-per-outcome insight when prescribing dapagliflozin and sacubitril–valsartan.…”

Overactive Bladder Medication Access

“…Twenty percent of nonadherence to medication has been attributed to cost in the United States, and cost-coping strategies have demonstrated success at improving adherence. 9 The price range, insurance coverage, and adverse effect burden of overactive bladder medications are broad and varied. Increasing awareness of adverse effects has resulted in more prescriptions for beta agonist and selective antimuscarinic medications, despite cost and potential lack of insurance coverage.…”

“…Twenty percent of nonadherence to medication has been attributed to cost in the United States, and cost-coping strategies have demonstrated success at improving adherence 9 . The price range, insurance coverage, and adverse effect burden of overactive bladder medications are broad and varied.…”

Why Some Patients Overpay for Specialty Generic Drugs

“…Imatinib, the original tyrosine kinase inhibitor drug for the treatment of chronic myelogenous leukemia, was first approved by the US Food and Drug Administration in 1999. By the time the first generic version of imatinib reached the market in February 2016, the average monthly price for the brand-name version exceeded $10 000, which was a major contributor to nonadherence among patients with cancer …”