Cost a Barrier to Medication Adherence, But Price Estimates May Help

One in five patients experience some cost-related barrier to medication adherence, a new JAMA Network Open report showed, meaning their drugs are too expensive for them to take as prescribed.

That’s dismal news, considering the age-old discussion around prescription drug costs and medication adherence that’s taken place for the past few years. Cost has long been seen as the biggest barrier to medication adherence, a behavior that is critical to effective chronic disease management.

Prescription drug affordability is a pressing issue, the researchers concluded, and it is essential for the healthcare industry to utilize price transparency tools to address it.

The study focused on a national panel survey of 2,005 patients over age 65 that was conducted in 2022. The researchers asked patients about how cost impacts their medication adherence—their ability to take their drugs as prescribed—as well as how they cope with those costs and whether they, as patients, think a real-time benefits checker could improve the situation.

Overall, the researchers found that prescription drug costs are seriously impeding patients’ care management and daily life. One in five (20.2 percent) patients reported cost-related medication non-adherence, which means they did not take their medications as prescribed because the prescription was too expensive. For some patients, this means rationing pills to make them last longer. For others, it means not filling the prescription at all.

Some patients took drastic measures to manage their finances and medication adherence; 8.5 percent of patients said they went without basic needs to pay their medication costs, while 4.8 percent said they’d gone into debt to afford their medications.

This isn’t exactly new information; numerous studies have shown that patients forego their medications when the cost is too high.

But this study also shows that patients themselves have an appetite for patient-provider communication about medication costs. Particularly, patients signaled that they are open to providers using real-time prescription benefits checkers to facilitate those conversations.

A vast majority (89 percent) of patients said they are open to or at least neutral about being screened before a provider visit for wanting to have a conversation about medication costs. A similar number of patients (89.5 percent) said they wanted their clinicians to use a real-time benefit tool.

These types of technologies give providers insights into how much a prescription would cost a patient after the patient’s health payer kicked in. In theory, a provider could offer the patient that information, and, through shared decision-making, the two could decide whether that prescription is feasible. After all, the best medication a patient can take is the one she can afford.

Although patients are receptive to using these price transparency technologies at the point of care, they did have some slight reservations. Around half of those already experiencing cost barriers to medication adherence said they were worried a benefits checker would provide an inaccurate estimate. Around four in ten (39.3 percent) said they’d be extremely upset if their actual medication price exceeded the price in the estimate.

What’s more, 80 percent of those already facing cost barriers said if the actual price significantly exceeded the estimated price, they would reconsider even filling the prescription.

Still, it’s a notable share of patients who are open to using these drug price transparency technologies at the point of care, although patients did note some minor caveats. For one thing, providers shouldn’t gatekeep the information produced by the real-time benefits checker; they need to use it to facilitate patient-provider communication. Around half of those experiencing cost barriers and 30 percent of those not experiencing cost barriers said as much.

“These findings highlight a risk that real-time benefit tools, if used by clinicians but not discussed with patients, could drive prescribing decisions that are not patient-centered but rather reflect prescribers’ assumptions about their patient’s needs,” the researchers wrote in the study’s discussion section.

Instead, clinicians can use drug price transparency for shared decision-making. By outlining the costs of a certain medication, plus the benefits of using that medication or a lower-cost alternative, the patient and provider can make a decision that will most benefit the patient’s well-being.

The researchers said clinicians can mitigate the risk of a discrepancy in estimated and actual drug price by leaning deeper into patient communication. This could mean reminding patients that the real-time benefits checker is only an estimate and equipping them with language for addressing a discrepancy.

“For example, telling patients to have the pharmacist contact the physician if the price is too high would be one way to highlight and prepare the patient for the potential for a price discrepancy and what to do if this occurs,” the team recommended.

Clinicians may also communicate with the pharmacy after the appointment to discuss lower-cost alternatives should that issue arise, the researchers added.

“This proactive approach also reduces the burden on patients and caregivers, reduces trips to the pharmacy, and could ultimately prevent cost-related nonadherence,” they concluded.