Author Affiliation: Department of Family and Community Medicine, University of California, San Francisco.
Many clinicians have ordered a lipid panel for an elderly patient with
diabetes and coronary artery disease, only to find that the statin drug prescribed
6 weeks ago has failed to lower the patient's low-density lipoprotein cholesterol
level. "Are you taking your cholesterol pill every day?" the physician is
likely to ask. "I hate to tell you, doc, but I just couldn't afford that pill.
I never even bought it."
Recent studies indicate that lack of prescription drug coverage for
Medicare beneficiaries is associated with lower use of essential medications
and may lead to higher rates of adverse outcomes such as hospitalization and
nursing home placement.1,2 These
studies comprise a subset of the medical literature demonstrating that imposing
out-of-pocket costs on patients reduces use of medical services, especially
for low-income persons, with worsening of clinical processes or outcomes.
In the Rand Health Insurance Experiment, patients contributing to the cost
of their care had fewer ambulatory visits, fewer Papanicolaou tests, and higher
diastolic blood pressures (for people with hypertension) compared with the
free-care group, which had prescription drug coverage.3
In another survey, 37% of patients with uncontrolled hypertension reported
difficulty paying for their medications compared with 16% of those whose blood
pressure was controlled; the investigators concluded that pharmacy costs contributed
to inadequate hypertension control.4
Bodenheimer TS. Affordable Prescriptions for the Elderly. JAMA. 2001;286(14):1762–1763. doi:10.1001/jama.286.14.1762