Unpacking the Barriers to Medication Adherence May Move Us Closer to Eye Health Equity

Factors Affecting Glaucoma Medication Adherence and Interventions to Improve Adherence: A Narrative Review

“…Since the implementation of Medicare Part D in 2006, most adults with glaucoma over the age of 65 have experienced increased rates of prescription drug coverage and thus lower out-of-pocket costs [ 4 ]; however, Medicare Part D does not cover adults under 65. Ross and Higginbotham noted that non-Hispanic white patients with glaucoma are more likely to be older than 65 and qualify for Medicare and separately qualify for Medicaid compared with African American and Hispanic patients with glaucoma [ 28 ]. Thus, African American and Hispanic patients, who are more likely to get glaucoma at a younger age, are more likely to be impacted by limited prescription drug coverage and high cost of their glaucoma medications [ 28 ].…”

“…Ross and Higginbotham noted that non-Hispanic white patients with glaucoma are more likely to be older than 65 and qualify for Medicare and separately qualify for Medicaid compared with African American and Hispanic patients with glaucoma [ 28 ]. Thus, African American and Hispanic patients, who are more likely to get glaucoma at a younger age, are more likely to be impacted by limited prescription drug coverage and high cost of their glaucoma medications [ 28 ].…”

“…In review of the Delavar et al. study, other researchers assert that confounding variables need to be considered when discussing cost, such as severity of disease, since patients with severe disease consider cost more as they are likely taking multiple medications, patients greater than 65 in the USA have Medicare to lower cost, and new treatment modalities to decrease IOP such as laser and minimally invasive surgery are more widely available [ 28 ].…”

“…Cost is a major factor affecting patient adherence to glaucoma medication therapy. To address this barrier, ophthalmologists and their staff should proactively mention medication costs, ask about financial obligations, and tailor prescribed medications (generic versus brand name) based on these discussions [ 5 , 28 , 36 ]. If cost is identified as a significant barrier or concern, physicians may be more inclined to offer non-medical intervention such as selective laser trabeculoplasty (SLT) [ 28 ].…”

“…To address this barrier, ophthalmologists and their staff should proactively mention medication costs, ask about financial obligations, and tailor prescribed medications (generic versus brand name) based on these discussions [ 5 , 28 , 36 ]. If cost is identified as a significant barrier or concern, physicians may be more inclined to offer non-medical intervention such as selective laser trabeculoplasty (SLT) [ 28 ]. Additional studies, including in the USA, should explore if glaucoma medication adherence can be increased by implementing an adherence-contingent rebate system similar to the Bilger and colleagues and/or government subsidies according to Gupta and colleagues [ 33 , 34 ].…”