More than 10 percent of Americans delayed filling prescriptions, skipped doses or took less than the prescribed amount of a drug in an effort to reduce the cost of their medications, according to an analysis from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).

The survey also found that nearly 20 percent of people asked their doctor for less expensive options and 5 percent used alternative therapies to reduce prescription drug costs. However, for all three measures, the proportion of people using these cost-cutting strategies in 2017 fell compared with the percentages in 2013, which may be attributable to more people having health insurance.

Robin Cohen, PhD, and colleagues from the NCHS analyzed medication cost-reduction strategies using data from the 2013 to 2017 National Health Interview Survey (NHIS).

Around 70 percent of prescription medications carry out-of-pocket costs, averaging $30 for brand name drugs and $6 for generics, the study authors noted as background. While retail prescription drug spending accounted for 10 percent of total health expenditures in 2017, the growth in drug spending has slowed in recent years, they added.

NHIS is a nationally representative household survey of the United States population, excluding active duty military personnel and those in prisons, long-term care facilities or other institutions. Initial interviews are conducted in people’s homes, with follow-up information obtained by phone.

Participants were asked if they had been prescribed a medication by a doctor or other healthcare provider during the past 12 months. Those with prescriptions were asked the following questions. Those who answered the first three questions affirmatively were classified as not taking medication as prescribed. 

  1. You skipped medication doses to save money.
  2. You took less medicine to save money.
  3. You delayed filling a prescription to save money.
  4. You asked your doctor for a lower-cost medication to save money.
  5. You used alternative therapies to save money.

 In 2017, nearly 60 percent of adults ages 18 to 64 reported being prescribed medication during the past year. Participants were asked what type of insurance they had at the time of the interview, which may not have been in effect for the full year. Importantly, this analysis excluded seniors, who account for a large proportion of prescription medication use and are typically covered by Medicare.

Source: NCHS, National Health Interview Survey, 2017Courtesy of CDC NCHS

About one in 10 people with prescriptions (11.4 percent) said they did not take their medications as prescribed in 2017. This was more likely among women compared with men (12.7 versus 9.7 percent). Not surprisingly, uninsured people were much more likely to report not doing so than those with private insurance or Medicaid coverage (33.6, 8.4, and 12.5 percent, respectively). About the same proportion of people reported not taking drugs as prescribed in 2015 (11.1 percent), but the 2017 and 2015 figures reflect a significant decline from 2013 (14.9 percent).

About one in five respondents with prescriptions (19.5 percent) reported asking their provider for a lower-cost medication. Again, women were more likely to do so than men (22.0 versus 16.4 percent), and uninsured people were more than twice as likely to do so as those with private insurance or Medicaid (39.5 percent versus 18.0 and 15.7 percent, respectively). Here too, the latest figure was similar to the proportion in 2015 (19.8 percent), but these were significantly lower than 2013 figure (25.8 percent).

The proportion of people reporting use of alternative therapies was similar in 2017, 2015 and 2013 (5.4, 4.8 and 5.8 percent, respectively). In 2017, women were more likely to use alternative therapies than men (6.6 versus 3.9 percent), and uninsured people were more likely to do so than those with private insurance or Medicaid (13.9, 4.4 and 6.4 percent, respectively).

“Cost-saving strategies to reduce prescription drug costs may have implications for health status and have been associated with increased emergency room use and hospitalizations compared with adults who follow recommended pharmacotherapy,” the study authors concluded.

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