Cost of asthma medication commonly behind nonadherence in adults
Key takeaways:
- In 2011, 23.2% of adults with asthma experienced cost-related medication nonadherence vs. 13.1% in 2022.
- The likelihood for asthma attacks was heightened with vs. without this type of nonadherence.
Asthma medication nonadherence due to cost has decreased over recent years but still impacted around one in six adults, according to results published in Thorax.
“Asthma can be effectively managed with medication, but nonadherence to medication continues to be a health concern,” Chung-Hsuen Wu, PhD, professor in the department of clinical pharmacy at Taipei Medical University, told Healio. “Although many factors contribute to medication nonadherence, cost is a main reason for it.”
In this observational study, Wu and colleagues assessed 30,793 U.S. adults with asthma from the 2011 to 2022 National Health Interview Survey to uncover how many adults report medication nonadherence due to cost and how this factor impacts the odds for asthma attacks and asthma-related ED visits.
Researchers classified three actions as fitting under the definition of cost-related nonadherence to medications, and the most-reported act was delaying refilling medications to save money (15.1%). The second most-reported action was taking less medication to save money (12.4%), followed by skipping medication doses to save money (11.6%).
Reports of medication nonadherence due to cost were recorded for 17.8% of the total cohort, according to the study.
In 2011, researchers observed 23.2% of adults with asthma experiencing cost-related medication nonadherence, but this proportion went down in 2022 to 13.1%.
Focusing on cost as the reason for asthma medication nonadherence, researchers reported that this was true for “approximately every one in six adults.”
According to the study, some significant (P < .01) links emerged between patient demographics/comorbidities and cost-related medication nonadherence. The following characteristics had higher proportions of patients reporting nonadherence as a result of costs:
- 41- to 60-year-olds and 18- to 40-year-olds vs. those aged older than 60 years (21.5% and 18.7% vs. 11.9%);
- women vs. men (19.5% vs. 14.4%);
- non-Hispanic Black and Hispanic individuals vs. non-Hispanic white individuals (20.3% and 20.1% vs. 17.1%);
- South, Midwest and West vs. Northeast region residence (20.6%, 18.9% and 16.7% vs. 12.9%);
- less than a high school education vs. a high school education and higher (19.4% vs. 17.6%; P = .05);
- without vs. with health insurance (45.2% vs. 15.5%);
- family income of 100% to less than 200% of the federal poverty level (25.8% vs. less than 100%, 23.2% vs. 200% to less than 400%, 20.7% vs. 400% or higher, 8.8%);
- current and former smoking status vs. non-smoker status (27.6% and 17.1% vs. 15.2%);
- poor vs. good perceived health status (30.4% vs. 16.5%);
- single/living alone vs. married/living with partner (18.7% vs. 17%); and
- at least two comorbidities (20.3% vs. one comorbidity, 16.4% and no comorbidities, 14.3%).
“Cost-related medication nonadherence remains a concern for patients with certain characteristics such as those with low income and without insurance coverage,” Wu told Healio. “Notably, the near-poor population (income between 100% and 200% of the poverty level) is identified as the most vulnerable group for experiencing cost-related nonadherence.”
Notably, researchers found that most of the above characteristics also appeared as factors linked to elevated odds for cost-related medication nonadherence in an adjusted multivariable logistic regression model.
In a set of nine comorbidities, the one with the highest proportion of adults reporting cost-related asthma medication nonadherence was liver disease at 28.8%, according to the study. Comorbidities following closely behind included kidney disease (26.8%), diabetes mellitus (23.7%) and COPD (23.5%).
Following covariate and survey year adjustment, researchers observed heightened odds for asthma attacks with vs. without cost-related medication nonadherence (adjusted OR = 1.95; 95% CI, 1.78-2.13).
Similarly, the likelihood for asthma-related ED visits was elevated among adults with vs. without medication nonadherence due to cost (aOR = 1.63; 95% CI, 1.44-1.84).
“Health care professionals should consider not only treatment effects but also patients’ economic conditions when prescribing medication for patients with asthma,” Wu told Healio.
Reference:
- Cost stops 1 in 6 US adults with asthma from taking meds as prescribed, study suggests. https://www.eurekalert.org/news-releases/1067055. Published Dec. 9, 2024. Accessed Dec. 9, 2024.
Perspective
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I was actually surprised by the results of this study because the weighted prevalence of cost-related medication nonadherence significantly decreased between 2011 and 2022. However, the authors offered a few reasons for this decrease, and I would agree with them. I would also add that the cost of inhaled medications has almost doubled between 2011 to 2022. Some payers and pharmacy benefit managers have invested in navigator programs or digital apps to reduce costs associated with nonadherence, increased use of telemedicine and technological advancements that may have influenced cost-related medication nonadherence. Also, the patient’s perception of their asthma control may influence medication use. I also found the geographic impact on the cost-related medication nonadherence prevalence of interest.
The presence of cost-related medication nonadherence is similar to my own experience, and we also find that people who do not qualify for Medicaid or have health insurance with a high deductible experience barriers to care and some medication assistance programs. We also find patients are not aware of the medication assistance programs or the process to get qualified. This may require a patient navigator to walk them through this process.
There are several ways doctors can use these findings to improve care.
For one, don’t assume to know why patients may not be adherent.
Learn what patients are experiencing by asking questions similar to the three in the study and listening to the responses. Another question to ask early on is “What is the largest obstacle to using your medication?” If cost-related medication nonadherence is part of the answer, make sure patients are aware of medication assistance programs. Allergy & Asthma Network (AAN) has two webpages that could help: "What to do if I can’t afford my medication" and “Why was my prescription denied by insurance?”
Set expectations for prescriptions with the patient by sharing that the prior authorization process will take time and provide medication samples, if possible, with inhaler education to place the patient on the right path.
Consider offering patient education in the native language of the patient.
Evaluate inhaler technique and provide feedback at every visit.
Plan ahead of time with the medical team to learn more about the adherence of each patient.
Address confusion about the eligibility to participate in inhaler price cap programs, which in turn may reduce the drug cost and increase adherence.
Share information about health savings plans and how to use them, especially if a person has a high-deductible health plan.
Participate in shared decision-making with the patient to determine patient preferences for medication or medication devices that may lead to improved patient adherence.
Recognizing the geographical region of the HCP practice and patient residency may benefit from asthma self-management education via telehealth.
Moving forward, there are several possible directions for further research. Because these three questions are specific to this survey, consider incorporating these questions specific to asthma in models of care to examine real-world evidence generation.
We also need an understanding of the patient's perspectives about medication adherence, patient education research around cost-related medication nonadherence and patient-centered outcomes research.
Additionally, researchers could consider disease management and medication applications with patient navigators to promote drug adherence and asthma control. AAN offers the Trusted Messenger asthma coaching program for people diagnosed with asthma.
I also wonder if there are research opportunities that include payers and pharmacy benefit managers (PBMs) focused on cost-related medication nonadherence, which could be beneficial.
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