Understanding & Addressing Cost Related Nonadherence to Medication

Faculty involved: Aimee James

Aimee James, PhD, MPH, and Marquita Lewis, PhD, discuss Dr. James' grant on affording medications.

Approximately half of all adults in the United States have a chronic health condition and many of those adults are prescribed medication for disease management. An estimated 20 to 60% of US adults do not adhere to their prescribed medication. Nonadherence can have significant negative health effects for the individual and contribute to increases in hospitalization, healthcare costs, and mortality. Adherence is a complex issue, but cost and affordability of medication is a common and critical barrier. Cost-related nonadherence (cost-coping) includes behaviors such as not filling or re-filling a prescription, filling some prescriptions but not others, intentionally skipping doses, or reducing the dose to save money, and is reported by an estimated 10-30% of adults. People who report cost-coping related to medication adherence also tend to report other cost-coping actions including reducing spending on food and utilities, borrowing money to afford medical care, or putting expenses on credit. While we know risk factors for cost-related nonadherence, we do not know how patients make choices about which bills to pay, which prescriptions to fill, and what to do when they cannot afford medication. We also do not know if or how healthcare providers address cost-related nonadherence. Our long- term objective is to deliver interventions to reduce cost-related nonadherence. Our short-term objective is to identify how patients and healthcare providers approach affordability and adherence and use those data to refine and pilot test an intervention promoting patient-provider discussion about cost, affordability, and adherence.

Many adults in the United States have been diagnosed with a chronic medical condition. An estimated 20 to 60% of US adults do not adhere to medication prescribed for their condition and the most common reason is cost and affordability of medication. Using mixed methods, our study will elucidate how patients and providers approach affordability and cost-related nonadherence. We will then test an intervention to increase conversations about medication cost and help patients make informed choices about their medication.

Select Publications:

Wells AA, Shon EJ, McGowan K, & James AS. Perspectives of Low-Income African-American Women Non-adherent to Mammography Screening: the Importance of Information, Behavioral Skills, and Motivation. J Cancer Educ. 2017 Jun;32(2):328-334. doi: 10.1007/s13187-015-0947-4.