by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
December 17, 2019
Beer L, et al. Nonadherence to Any Prescribed Medication Due to Costs among Adults with HIV Infection — United States, 2016–2017. MMWR Morb Mortal Wkly Rep 2019; 68:1129–1133. DOI:http://dx.doi.org/10.15585/mmwr.mm6849a1
The U.S. spends more per capita on prescription drugs than other high-income countries, and in 2017 patients paid 14% of their drug cost out of pocket. It is known that drug costs limit access to medications and thus results in non-adherence by patients. This study from the CDC used data from their Medical Monitoring Project (MMP) and included 3,948 patients with HIV who were taking prescription medications including, but not limited to, antiretrovirals. Persons interviewed at clinical sites participating in the MMP were queried regarding their use of six cost-saving strategies over the past year: 1) asking their doctor for a less expensive medication, 2) skipping doses, 3) taking less medicine, 4) delaying getting a drug refilled due to cost, 5) purchasing their drug from another country, or 6) using alternative therapies. During 2016–2017, 14% of these individuals reported using a cost-saving strategy for their prescription medications and 7% had cost saving–related nonadherence. Three factors were identified as being associated with drug costs and subsequent nonadherence. These included: having an unmet need for medications from ADAP programs, not having Medicaid coverage, and being covered by a private insurance plan. Patients who were non-adherent due to drug costs were more likely to NOT be virally suppressed, more likely to have required a visit to the emergency department and more likely to have been hospitalized. Reducing barriers to ADAP and Medicaid coverage, in addition to reducing medication costs for persons with private insurance, might help decrease nonadherence due to cost concerns. This could also help improve viral suppression rates and other health outcomes among persons with HIV disease.
In this study, nonadherence to any prescription medication (due to costs) was associated with lack of engagement in care as well as lack of both recent and sustained HIV viral suppression. Addressing financial barriers at every office visit is extremely important if we are to keep our patients virally suppressed and decrease HIV transmission risk. I believe most providers do a good job with adherence counseling, but all members of the patient care team should discuss drug access issues at every visit. I would encourage readers to link to the issue of MMWR cited above, read the full report and share this information with colleagues including nursing, pharmacy and case management staff.
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