High drug costs impact rates of adherence to prescription drugs among people with HIV, according to new findings published in MMWR, which showed that 14% of people with HIV used “prescription drug cost-saving strategies” in 2016 and 2017 and 7% did not adhere to their medication for cost-related reasons.
According to the authors of the report, compared with other high-income countries, the United States spends more per capita on prescription drugs, with patients paying 14% of the overall drug expenses in 2017. It is less clear how the cost of drugs impacts adherence among people with HIV, they said.
The Medical Monitoring Project (MMP) is a cross-sectional, nationally representative surveillance program developed by the CDC. In 2015, the agency expanded the MMP sampling method to include all persons diagnosed with HIV in the U.S., instead of only patients at who are receiving care.
Through MMP, the researchers analyzed data on behaviors, medical care and clinical outcomes of adults with HIV collected in face-to-face or telephone interviews and medical records between June 2016 and May 2017.
Study participants were asked about six cost-saving strategies:
-asking a doctor for a less expensive medication;
-buying prescription drugs from another country;
-using alternative therapies;
-taking less medicine; and
-delaying filling a prescription because of cost.
The researchers discovered that a cost-saving strategy was used by 14% of people with HIV (95% CI, 12%-15%), and 7% reported cost saving-related nonadherence (95% CI, 6%-8%). Among those classified as nonadherent, 4% skipped doses (95% CI, 3%-5%), 4% took less medicine than was prescribed (95% CI, 3%-5%) and 6% delayed filling a prescription (95% CI, 5%-7%). In terms of cost-saving strategies, 9% asked a doctor for a less expensive medication (95% CI, 7%-10%), 1% bought drugs from another country (95% CI, <1%-1%) and 2% used alternative medicine (95% CI, 2%-3%).
Factors associated with cost saving-related nonadherence included having private insurance, not being covered by Medicaid and having an unmet need for medication from the Ryan White AIDS Drug Assistance Program (ADAP), the researchers reported. According to the report, individuals who were nonadherent because of cost were more likely to have gone to the ED, been hospitalized and not be virally suppressed.
Although age, race/ethnicity, gender, homelessness or time since HIV diagnosis were not associated with cost saving-related nonadherence, household income above the poverty level was. For those with a disability, the rate of cost-related nonadherence was 9% compared with 5% among patients without a disability.
Cost-related nonadherence was also more common among people with private insurance (8%) compared with people without private insurance (6%). Similarly, such nonadherence was lower among people with Medicaid (5%) compared with people without Medicaid (8%). Additionally, people with HIV who received ADAP support had a nonadherence rate of 7% compared with a 32% rate among people who had an unmet need from ADAP.
The researchers noted that people who were nonadherent because of cost concerns were less likely to be virally suppressed at their last viral load test and at all tests during the past year compared with those without cost saving-related nonadherence.
“The prevalence of nonadherence due to prescription drug costs among persons with HIV infection was similar to that among the overall U.S. population and was associated with poorer clinical outcomes, including reduced viral suppression rates and suboptimal medical care utilization,” the researchers wrote. “Removing barriers to ADAP and Medicaid coverage, in addition to reducing medication costs for persons with private insurance, could help to decrease nonadherence related to cost concerns, which will contribute to improved health outcomes among persons with HIV infection and decrease HIV transmission.”