School of Pharmacy, Northeastern University.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston.
Med Care. 2021 Jan;59(1):13-21. doi: 10.1097/MLR.0000000000001458.
Unaffordability of medications is a barrier to effective treatment. Cost-related nonadherence (CRN) is a crucial, widely used measure of medications access.
Our study examines the current national prevalence of and risk factors for CRN (eg, not filling, skipping or reducing doses) and companion measures in the US Medicare population.
Survey-weighted analyses included logistic regression and trends 2006-2016.
Main analyses used the 2016 Medicare Current Beneficiary Survey. Our study sample of 12,625 represented 56 million community-dwelling beneficiaries.
Additional outcome measures were spending less on other necessities in order to pay for medicines and use of drug cost reduction strategies such as requesting generics.
In 2016, 34.5% of enrollees under 65 years with disability and 14.4% of those 65 years and older did not take their medications as prescribed due to high costs; 19.4% and 4.7%, respectively, experienced going without other essentials to pay for medicines. Near-poor older beneficiaries with incomes $15-25K had 50% higher odds of CRN (vs. >$50K), but beneficiaries with incomes <$15K, more likely to be eligible for the Part D Low-Income Subsidy, did not have significantly higher risk. Three indicators of worse health (general health status, functional limits, and count of conditions) were all independently associated with higher risk of CRN.
Changes in the risk profile for CRN since Part D reflect the effectiveness of targeted policies. The persistent prevalence of CRN and associated risks for sicker people in Medicare demonstrate the consequences of high cost-sharing for prescription fills.
药物费用负担过高是影响治疗效果的一大障碍。与费用相关的不依从性（CRN）是评估药物可及性的重要指标，应用广泛。
本研究旨在调查美国 Medicare 人群中 CRN（例如，未取药、漏服或减剂量）及其相关指标的现况及其危险因素。
采用问卷调查加权分析，包括逻辑回归和 2006-2016 年的趋势分析。
主要分析采用 2016 年 Medicare 现居受益人调查数据。本研究的样本量为 12625 人，代表了 5600 万社区居住的受益人。
其他生活必需品支出减少以支付药品费用，以及使用药物费用减免策略（例如要求使用仿制药）。
2016 年，14.4%的 65 岁及以上残疾受益人和 34.5%的 65 岁以下残疾受益人为了支付药品费用而未按处方服药；19.4%和 4.7%的人分别表示为了支付药品费用而减少了其他生活必需品的支出。收入在 15000-25000 美元的接近贫困的老年受益人的 CRN 风险比（OR）比收入超过 50000 美元的老年受益人大 50%，但收入低于 15000 美元、更有可能有资格获得 Part D 低收入补贴的受益人的风险没有显著增加。健康状况较差的三个指标（总体健康状况、功能限制和疾病数量）均与 CRN 风险增加独立相关。
自 Part D 以来，CRN 风险状况的变化反映了有针对性政策的有效性。 Medicare 中 CRN 的持续高发生率以及与更严重疾病相关的风险表明，高共付额对处方药的影响。
