• Posted May 22, 2023

1 in 5 U.S. Seniors Now Skip Meds Because of Cost

Many seniors skip or stretch prescription medications due to costs despite being insured by Medicare, a new U.S. study finds.

Roughly 20% of older adults reported taking less medication than prescribed or not taking medication because of cost, the researchers found.

"We also found that most respondents wanted to talk with their doctors about medication costs and would want their doctor to use tools to estimate their medication prices if they were available, " said lead researcher Stacie Dusetzina, a professor of health policy at Vanderbilt University in Nashville, Tenn.

For the study, Dusetzina and her colleagues surveyed more than 2,000 men and women age 65 and older, via phone and online.

Among those taking part in the survey, 20% said cost prevented them from adhering to their prescription drug regimens. Nearly 9% said they skimped on basic needs to afford their medications and nearly 5% said drug costs made them acquire debt.

Meanwhile, 89% said they were comfortable or neutral about being screened before a doctor visit for having a medication cost conversation and nearly 90% said they would like it if their doctor used a tool that would alert them to the cost of drugs.

Patients said they were concerned if prices were inaccurate, and would be extremely upset if actual medication prices were more than what their doctor estimated it would be. In fact, 80% said that if the costs were higher they would have to assess their decision to take the drug, the researchers found.

Most patients would also be upset if their doctor knew the price of a drug but didn't discuss it with them, Dusetzina's team noted.

The report was published online May 18 in JAMA Network Open.

"I wish I could say I was surprised, but the reality is this is the kind of finding that we've seen in other work, and it's the kind of finding that practicing clinicians see every day," said Dr. Adam Gaffney, who wasn't involved with the study. He's an assistant professor of medicine at Harvard Medical School in Boston and immediate past president of Physicians for a National Health Program, which advocates extending Medicare to everyone.

The high cost of drugs is primarily related to copays and out-of-pocket costs, he said.

"Copays, coinsurance, deductibles can be quite high, even if you have a Medicare Part D drug plan," Gaffney said. "I don't think this is a problem [of] just of the over-65 population. In fact, I think if you look at a privately insured population that was younger, you might have actually had the same adverse results."

Out-of-pocket costs can be particularly high for new drugs that are still patented, but they can also be high for some generic drugs, he noted, as drug prices have been steadily rising.

"We know that these price increases are reflected in what people are paying when they go to the pharmacy," Gaffney said. "We know that that often will lead patients either leave the prescription behind or not even fill it at all, or make other sacrifices."

Most doctors don't know the prices patients have to pay for drugs, he said.

"As a physician, you want to know what the out-of-pocket costs were ahead of time," Gaffney said. "You want to know what that meant for the patient. So, I think that sort of informational kind of infrastructure could have some benefits. But I think what that doesn't help you with is the fact that ultimately you want to be prescribing drugs that are best for the patient."

There are programs that patients can access that might lower out-of-pocket costs, Gaffney said. These include Medicare programs, private companies that may help lower costs on some generic drugs, and drug companies that often have special programs to make new drugs more affordable.

But solving the problem of high drug costs will ultimately need a cultural change that makes all drugs free, he said.

"Things can happen in the physician's office, but at the end of the day, what we need is systemic change," Gaffney said. "There is a growing appetite for really reforming the system because there's just something not civilized about having people go without necessary medications simply because they can't afford the copay."

More information

For more on drug costs, see the U.S. Congressional Budget Office.

SOURCES: Stacie Dusetzina, PhD, professor, health policy, Vanderbilt University, Nashville, Tenn.; Adam Gaffney, MD, assistant professor, medicine, Harvard Medical School, and immediate past president, Physicians for a National Health Program; JAMA Network Open, May 18, 2023, online