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Many nonelderly cancer survivors alter prescription drug use to save money
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Nearly one-third of nonelderly Americans recently diagnosed with cancer change their prescription drug use for financial reasons, according to an analysis published in Cancer.
“Specifically, nonelderly cancer survivors were more likely to skip medication, delay filling a prescription, ask their doctor for lower-cost medication, and use alternative therapies for financial reasons compared with nonelderly individuals without a cancer history,” Ahmedin Jemal, DVM, PhD, vice president of surveillance and health services research at the American Cancer Society, said in a press release.
The direct medical cost of a new cancer medication can routinely exceed $100,000 annually per patient. Due to rising deductibles, copayments, coinsurance and tiered drug formularies, an increasing portion of the cost of cancer medication is shifted to patients as out-of-pocket expenses.
Jemal and colleagues used 2001 and 2014 data from the National Health Interview Survey to compare changes in prescription drug use between cancer survivors (n = 8,931) and those without a cancer history (n = 126,287). Researchers also examined whether high private health insurance deductibles were associated with changes in prescription drug use for financial reasons among nonelderly cancer survivors, and whether changes in prescription drug use were linked to comorbid conditions.
Researchers stratified the study participants by age (nonelderly, 18 to 64 years; elderly, 65 years and older) and time since diagnosis (recently diagnosed, less than 2 years; previously diagnosed, 2 or more years). The final sample included recently diagnosed nonelderly (n = 686) and elderly survivors (n = 729), previously diagnosed nonelderly (n = 3,295) and elderly survivors (n = 4,230), and nonelderly (n = 76,096) and elderly (n = 16,989) individuals without a cancer history.
Annual deductibles of greater than or less than $1,200 per individual or $2,400 per family were used to determine whether individuals had high- or low-deductible plans. Among survivors, 41% who were recently diagnosed and 64% who were previously diagnosed were enrolled in high-deductible plans.
All participants responded to a survey in which they stated whether they had done any of the following in the past 12 months:
- skipped medication doses to save money;
- took less medication to save money;
- delayed filling a prescription to save money;
- asked their doctor for a lower cost medication to save money;
- bought prescription drugs from another country to save money; and
- used alternative therapies to save money.
Among nonelderly individuals, changes in prescription drug use for financial reasons occurred more frequently among recently diagnosed (31.6%) and previously diagnosed (27.9%) cancer survivors than among those without a cancer history (21.4%). Excess percentage changes for individual measures ranged from 3.5% to 9.9% among previously diagnosed survivors and from 2.6% to 2.7% among recently diagnosed survivors (P < .01).
Specifically, 25.8% of recently diagnosed nonelderly survivors and 21.9% of previously diagnosed nonelderly survivors reported asking for lower cost medication; 13.2% of recently diagnosed and 11.7% of previously diagnosed reported delaying filling a prescription; 9.9% of recently diagnosed and 9.3% of previously diagnosed reported taking less medication; 8.8% of previously diagnosed reported skipping medication doses; and 7.4% of previously diagnosed reported using alternative therapies.
Additionally, as the number of comorbid conditions increased from none to three or more, the adjusted percentages of those who reported any changes in prescription use rose from 24% to 51.2% among nonelderly survivors and from 11.8% to 28.3% among elderly survivors (P < .001 for both).
Nonelderly cancer survivors with high-deductible plans were more likely than those with low-deductible plans to ask their doctor for lower cost medication (32.2% vs. 22.5%; OR = 1.71; 95% CI, 1.32-2.22).
Elderly cancer survivors and those without a cancer history had comparable rates of changes in prescription drug use for financial reasons.
“Health care reforms addressing the financial burden of cancer among survivors, including the escalating cost of prescription drugs, should consider multiple comorbid conditions and high-deductible health plans, and the working poor,” Jemal said. “Our findings also have implications for doctor and patient communication about the financial burden of cancer when making treatment decisions, especially on the use of certain drugs that cost hundreds of thousands of dollars but with very small benefit compared with alternative and more affordable drugs.” – by Chuck Gormley
Disclosure: The researchers report no relevant financial disclosures.
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