Medication adherence refers, simply enough, to the extent to which a patient continues their course of medication until the end. Failing to finish your meds is one of the most common reasons for failure in treatment and, ultimately, the persistence of your medical condition and potentially greater costs somewhere down the line. The reason medications are not always adhered to by patients can be a somewhat puzzling one, and there are many factors which, in any given case, could potentially be at work. Of the things that medication adherence is intimately related to, however, is the how much the actual medication costs. And the in U.S., where prescription medication typically costs 2.5 times as much as the average across other developed nations, it costs a lot.
A recent study published in the medical journal Circulation found that one in eight American patients suffering from Atherosclerotic Cardiovascular Disease (ASCVD) did not “adhere” (which means completing the full course) to their medication because of the cost. This is perhaps an effect of high American drug prices that is given less attention than some of the more obvious. Not that patients do not receive the medication they need, but that they run out of money and stop taking it.
“We see this almost every day in the clinic I work in,” Lisa Cillessen, an assistant professor at the University of Missouri-Kansas City School of Pharmacy, told Pharmacy Today, “A lot of patients just simply don’t pick up their medications because of the cost, and even if they are able to pick them up, they stretch them out.” Cillessen’s institution is one which focuses on low-income patients and her anecdotal evidence reveals another aspect of this phenomenon – that patients take their medication less often in order to cut costs. This amounts, of course, to totally sub-optimal treatment that would seem to affect the poorest the hardest.
Relationship to Health Insurance
Although the Circulation study seems to suggest that patients experiencing this struggle are those who perhaps do not have insurance (or sub-standard insurance), there is evidence to suggest that this is a phenomenon which affects fully insured Americans as well. In 2020, NPR, the Harvard T.H. Chan School of Public Health and the Robert Wood Johnson Foundation conducted a survey of patients with insurance plans typical of most Americans. The findings were similarly damning, and it was revealed that insurance plans very often do not cover the medication that patients need, or only cover sub-standard generic versions of the medicines required.
The majority of Americans may have insurance, which is supposed to include prescription drugs, but the survey also found that over one third of American adults (across all income groups) have seen their insurance fail to cover their prescriptions.
There does exist several touted solutions for this problem of cost-related medicine adherence. The use of Canadian online pharmacies such as Canada Pharmacy is certainly one, with more and more Americans filling prescriptions in this way.
Medicare can also help in the cases where patients are eligible for it. Unfortunately, this excludes many younger patients, who are not covered. In those over sixty-five however, there is evidence to suggest that access to Medicare had a positive effect on the incidences of cost-related non-adherence.
Ultimately, medications have specific course times for a very specific reason. Nobody is keeping patients on meds longer than is necessary – they simply take that long to work. But until the American systems sees some more fundamental change, it does not look like this problem is going away any time soon.