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Too costly to use

Patients not using life-saving drugs because of cost


Nearly 8 percent of Americans are not taking their prescription drugs as indicated by a physician because they can’t afford to pay for them.

In a recent study, the Centers for Disease Control and Prevention found Americans are using a number of strategies to manage the high cost of medications. Some methods of saving money are safer and better for people’s health than others.

The study found that 15 percent of U.S. adults have asked their physician for a lower-cost medication as an alternative. However, almost 2 percent have purchased drugs from a foreign country where the medications may or may not be regulated, and an additional 4 percent have used alternative medicines while 7.8 percent just skipped taking the drugs altogether.

Some Americans did take their medications, but not at the frequency or dosage prescribed. The study found this to be true in adults younger than 64 years of age with 5.3 percent admitting they had skipped doses and 5.6 percent taking less medication than recommended to save money.

It’s common knowledge in the medical community that patients are not taking their medications as prescribed, said Dr. David Cook, senior vice president of population health management at Novant Health. Population health is a health care approach that aims to keep people healthy and reduce inequities in access to health care provided to different populations.

“In some cases, doctors will write a prescription for a certain drug, but the patient’s insurance policy will offer different coverage,” Cook said. “The physician will have no idea that the cost of the drug has changed.”

Sometimes it’s the expense of the drug that causes patients not to use it, but other times patients just don’t understand why they need a medication, Cook said.

Cook said that disparities in health care can also contribute to patients not taking required medications. “Doctors will prescribe medicines asking patients if they understand why,” he said. “Patients will nod ‘yes’ when they really don’t understand why they need the drug.”

Some patients will not ask questions and doctors will assume they understand based on their behavior, Cook explained. This lowers the fill rates for prescriptions and accounts for about 10 percent of patients, he said.

Not taking medications as prescribed can have serious consequences.  If a person has diabetes, not treating the condition with appropriate medicine can cause damage to a person’s heart, blood vessels, eyes and kidneys, for instance. Cook warned starting a drug therapy and then stopping it – whether because of cost or another reason – can also cause serious harm.

It also greatly impacts health care costs. “It’s a multimillion-dollar problem in America,” Cook said.

For example, Cook said dialysis is already a huge problem in the United States. If people aren’t managing their diabetes properly now, over the long run we’ll become sicker as a nation, he said.  

In the study, skimping on medication over financial concerns was particularly prevalent among the poor and uninsured. The CDC report said 14 percent of adults aged 18-64 without insurance had not taken their medication as prescribed compared to 6 percent with insurance and 10 percent for those eligible for Medicaid.

Poor adults, or people with incomes below 139 percent of the poverty level, were the most likely Americans to skip on their medicine, according to the researchers.

The CDC researchers used data gathered from the2013 National Health Interview conducted by the U.S. Census Bureau. Americans spent $271.1 billion on prescription drugs in 2013, according to U.S. Centers for Medicare and Medicaid Services.

Cook said there are ways for doctors to get more engaged in patient health. Some of the change is behavioral such as a heightened awareness and communication with patients. Other methods involve patient engagement tools such as smartphone applications reminding patients about medications and follow-through by patient care coordinators.

Doctors too can stay informed on what deals have been struck between insurers and manufacturers of medicine in order to know what is effective and affordable to patients.

And patients should take responsibility for their own health care, Cook said. Consumers need to speak up, raise questions, call their doctors and mention if they encounter issues with affordability or access to medicine.    

How can you help lower your drug costs?

  • Ask your doctor whether there is a generic equivalent. Let your doctor know that cost as well as effectiveness of the medicine matters.
  • Ask your doctor if the pills can be safely split in half. The doctor would prescribe a double dose that could be easily cut in half at the score line.
  • Compare prices among drug stores, big box retailers and mail-order pharmacies. 
  • Check to see whether the pharmaceutical company offers help paying for the drug. Some major drug companies offer free medication to consumers who cannot afford the medication.
  • If eligible for Medicare, choose a plan that offers additional drug benefit for the gap coverage or “donut-hole.”




Published: 2/25/2015