Drug Affordability a Barrier to Access for Many Americans

SPOKANE, Wash. — A national study published in the April issue of “Clinical Therapeutics” suggests that a growing proportion of Americans are unable to pay for medications they are prescribed and that medication costs are not just a problem for elderly patients. People with low incomes, poor health, high levels of medical care use, and no health insurance are at particularly high risk of cost-associated prescription noncompliance.

Using data from the Centers for Disease Control’s National Health Interview Survey (NHIS), authors Jae Kennedy, Joseph Coyne and David Sclar — all faculty in the department of health policy and administration at Washington State University Spokane — estimate that the number of Americans unable to take their medications as prescribed due to cost grew from 12.6 million in 1997 to 16.6 million in 2002 (the most recent data available).

Prescription drug costs have risen rapidly since the mid-1990s, and the growing inability of patients to pay for medications has important consequences for population health and health system costs. Prescription noncompliance is related to higher levels of emergency department admissions, hospital admissions and readmissions and mortality rates. Failure to take prescribed medications can have serious health consequences for the patient and substantial economic consequences for society.

An estimated 16.6 million Americans reported being unable to purchase a prescribed medication in 2002. The authors note, “This number has political significance as well as statistical significance. Moreover, if this prescription noncompliance leads to adverse health outcomes and higher health service costs, then the economic effect could be substantial.”

The proportion of Medicare recipients who could not afford to fill one or more prescriptions rose rapidly over the study period from 4 percent in 1997 to 7 percent in 2002. “The recently passed Medicare Prescription Drug, Improvement and Modernization Act is intended to address the problem of drug coverage for Medicare beneficiaries, and we will certainly be keeping a close eye on these rates in the period after these program changes are fully implemented,” said lead author Kennedy.

However, the problem of drug affordability extends beyond the Medicare program. The authors note, “Even the most comprehensive Congressional measures to expand Medicare coverage will have little effect on the problem of prescription drug access in the general population, simply because Medicare beneficiaries made up only 14.6 percent of those who could not afford a prescription. Indeed, such efforts may draw scarce health resources from higher-need populations such as the uninsured (who comprised an estimated 14 percent of the population but represented 42.2 percent of those who could not afford to fill a prescription).”

Kennedy, has published previously on drug costs as barriers to access and on difficulties with emergency room access. Coyne is a professor and the director of the Center for International Health Services Research and Policy, recently established at WSU. Sclar holds the Boeing Distinguished Professorship in Health Policy at WSU Spokane, is the Boehringer Ingelheim Scholar in Pharmaceutical Economics and is director of the Pharmacoeconomics and Pharmacoepidemiology Research Unit in WSU’s College of Pharmacy.

Web sites:

·         Department of health policy and administration Web site: www.hpa.spokane.wsu.edu

·         WSU Spokane: www.spokane.wsu.edu

·         Clinical Therapeutics: www.clinicaltherapeutics.com (follow link to “Current Issue” and accept terms in order to access the article as a PDF)

·         Drug Costs a Barrier to Prescription Compliance for People with Disabilities: News release on previous research by Kennedy published in the American Journal of Public Health: https://wsunews.wsu.edu/detail.asp?StoryID=3139 (July 8, 2002)

·         WSU Researcher Finds Emergency Care Access Barriers in National Study: News release on research by Kennedy published in “Annals of Emergency Medicine”: https://wsunews.wsu.edu/detail.asp?StoryID=4557