Patient Financial Responsibility a Problem for Heart Disease

December 02, 2019 - Nearly one in eight individuals nationwide with common heart diseases choose not to take their prescriptions, delayed filling prescriptions, or took a lower dose than prescribed because of patient financial responsibility concerns, according to a study in Circulation.

“The out-of-pocket cost of medications is a huge issue for millions of high-risk patients with cardiovascular disease such as heart attacks, stroke, angina, and other conditions. When faced with the expenses of taking life saving medications as prescribed or not taking them because they are too costly, many choose not to take them,” Kharram Nasir, MD, MPH, MSc, senior author of the study and chief of the division of cardiovascular prevention and wellness and co-director of the Center for Outcomes Research at Houston Methodist DeBakery Heart & Vascular Center in Texas said in a press release. 

Researchers reviewed National Health Interview Survey data from 2013 to 2017 of 14,279 adults who were previously diagnosed with coronary heart disease, heart-related chest pain, and a heart attack or stroke. The average age of the study participant was 65 years.

The study found that approximately 2.2 million individuals with common heart diseases had not taken their prescribed medications because of cost concerns. And younger female heart disease patients were more likely to skip doses.

Adults under 65 years were three times more likely to face medication non-compliance because of patient financial responsibility fears. About one in five of these study participants reported cost-related non-compliance, the study showed.

READ MORE: Patient Financial Responsibility Increased 12% from 2017 to 2018

One in four female patients under 65 years also did not take their prescribed medications because of cost concerns. The study also found that 30 percent of younger heart disease patients who came from low-income families and 53 percent without health insurance did not adhere to their medication treatment plan in order to save money.   

“While non-compliance has several causes, in recent years the rising share of health care costs paid directly by patients has become a concern. We wanted to understand the scope of medication non-compliance due to costs,” said Nasir. “Patients should not be afraid to speak with their health care provider if they are not able to afford a prescribed medication since there are many lower-cost generic drugs which might also be effective for their condition.” 

Specifically, non-compliant patients were 11 times more likely to request low-cost medication and nine times more likely to use alternative non-prescription therapies, compared to individuals who did not find cost to be an issue. 

“As health care providers, we should also consider advocating for changes in nation health policy, such as capping out-of-pocket expenses for low-income families,” Nasir stressed. “We also need to recognize that out-of-pocket medical costs may have a cumulative effect on a patient’s family who may also have difficulty paying for housing, transportation, and food. Health care providers can play an active role in working with our local health system and community financial assistance support programs to provide financial assistance and resources to those who need it the most.” 

According to a January 2019 report, one-quarter of patients are paying more for their medications than they did in 2018. Of those patients, 74 percent reported that they did not receive any warning of an increase in price of the specific drug, and 24 percent said that they may not be able to continue to pay for their future medications. 

READ MORE: Hospital Revenue from Patient Financial Responsibility Up 88%

Affordable healthcare and out-of-pocket costs have been a challenge for individuals for decades. As patients continue to struggle with affordability of needed drugs, medication adherence could continue to plummet. Providers should be taking an active role in addressing the issue of patient financial responsibility.

An extremely important step in medication adherence is trust between patient and provider, Stuart Goldberg, MD, a practicing oncologist, said in an interview with PatientEngagementHIT.com. He explained that he attempts to uncover any cost barriers of his patients by already assuming that they are struggling to make ends meet, as he understands medications can be unaffordable. “If a patient is ambivalent about drug costs, or says cost is not an issue, it is a red flag,” he said.

Goldberg goes on to explain that he talks with his patients about their current medications and tries to get a little more information from them, “like if they’re taking their pills and how they’re getting them where they’re getting them,” he explained.

Once a provider has discovered the root of the medication adherence barrier, they can look into cost assistance programs to help patients with their financial responsibility. Goldberg tends to lean towards generic alternatives or less intensive regimens to decrease costs.

By taking the challenge of affordability into his own hands, Goldberg shifts patients away from trying to fix the problem themselves in ways, which are not always effective in the long run and may even cause more problems down the road.

READ MORE: 28% of Adults Say Docs Discuss Patient Financial Responsibility

Much like Goldberg, David Weinstock, MD, a primary care provider at Massachusetts-based Grove Medical Associates directs his patients to pharmacies that are known for being more affordable and having lower rates. He will also prioritize medications based on how urgently the patient needs it. 

“If you don’t take the medicine, it doesn’t matter. You can pick the best treatment but if the patient doesn’t pick it up from the pharmacy because they can’t afford it, that doesn’t help the patient,” Goldberg said. “If the patient does pick it up and she doesn’t take the pill, that doesn’t help the patient either.”