Bad Economy Adds to Longstanding Cost, Medication Adherence Problems

The economic downturn is hitting healthcare hard, with new reports showing that medication adherence is taking a hit while consumers find themselves strapped for cash.

In a recent survey of over 1,000 US healthcare consumers conducted by Propeller Insights on behalf of iPrescribe, a DrFirst company, more than a third of patients said they are rationing medications or skipping filling prescriptions altogether.

Cost has long been the biggest barrier to medication adherence. Most experts agree that patients want to feel better, but when they cannot afford their prescriptions, they have to go without. In September 2021, patients reported that high costs, plus limited communication about that cost and navigation from their prescribing providers, got in the way of medication adherence.

Poor medication adherence is a key patient safety issue. Patients who can’t take their medicines as prescribed run the risk of seeing their conditions deteriorate, prompting a high-cost, acute care episode.

Centers for Disease Control and Prevention (CDC) numbers show that poor medication adherence causes between 30 and 50 percent of chronic disease treatment failures and 125,000 deaths each year. Meanwhile, poor medication adherence has been the source of one in four hospital readmissions, according to seminal data in the International Journal of Internal Medicine.

This latest survey showed that today’s economic climate has exacerbated things, leaving 35 percent of patients rationing their medications or choosing not to fill a prescription.

One in five patients said in the iPrescribe survey that they are taking their medications at a lower dose than prescribed to make the medication last longer. Meanwhile, 15 percent said they have stopped taking the medication altogether and 14 percent are getting their medications filled at a larger dose so they can split their pills in half, also intended to prolong their prescriptions.

But it’s not just the actual cost of the pills that hurts patient health, the survey added. Even the cost of gas, a social determinants of health signifier, is making it hard for patients to access healthcare. About a quarter of patients said the cost of gas makes it hard to get to appointments (27 percent) and to the pharmacy to pick up prescriptions (23 percent).

Another quarter is putting off their medical visits (27 percent) and said that it’s harder to afford their prescriptions (25 percent), although that affordability hasn’t impacted medication adherence for those patients yet. One in five (18 percent) of respondents said they are struggling to afford their healthcare co-pays.

Most of the strategies patients are using to navigate the high cost of healthcare and medication require at least a moderate level of health literacy. A quarter of patients said they are comparing the cost of medications at different pharmacies, and 21 percent are looking for and using coupons and discount codes to pay for their medications.

Meanwhile, 18 percent of patients are joining patient assistance programs to help afford their drugs and 15 percent are traveling to another country to get their medications at a lower cost.

The survey indicated that there is more room for providers to guide patients. Half of patients said their doctor has never discussed the cost of medication with them. For the half who have had this conversation, patients reported that the conversation was fruitful, with 83 percent confirming it helped them find a lower-cost alternative.

Healthcare providers might feel uncomfortable broaching the topic of cost with their patients, some experts have acknowledged. Rather, research has shown that medication management is a far more common patient-provider topic when discussing prescriptions. In 2021, researchers from Health Union reported that most clinicians focus on how to take a medication, like frequency of dosage and why the medication is important for good outcomes.

While discussing medication management is important, there is no medication to manage if a patient can’t afford a prescription. Healthcare providers might consider using price transparency tools to help guide conversations around cost. Asking patients where they get their medications from can also open the door to cost conversations.