Department of Health Service Research, University of Texas MD Anderson Cancer Center, Houston.
University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla.
J Manag Care Spec Pharm. 2021 Dec;27(12):1750-1756. doi: 10.18553/jmcp.2021.27.12.1750.
Cancer survivors are at risk of financial hardships and cost-related medication nonadherence, particularly among those without adequate insurance coverage. To examine the association between cancer history and cost-related medication nonadherence, as well as the association between insurance coverage and nonadherence among Medicare beneficiaries. We used the 2013-2018 Medicare Current Beneficiary Survey Public Use File, a survey on the health, health service utilization, access to care, and satisfaction among a nationally representative sample of Medicare beneficiaries. Cost-related medication nonadherence was defined as often or sometimes reporting any of the following: (1) took smaller dose of medication, (2) skipped doses to make medication last, (3) delayed medication because of cost, and (4) not get medication because of cost. Logistic regression was used to estimate the odds ratio of cost-related nonadherence associated with cancer history, adjusting for survey year and sociodemographic characteristics of the respondents, including age, sex, race and ethnicity, highest grade completed, income level, marital status, and number of chronic conditions. We also included Medicare Part D, an interaction between Part D and the low-income subsidy, and Medicare Advantage in the model to examine the effect of insurance coverage on cost-related nonadherence. From 2013 to 2018, there were 12,492 cancer survivors and 53,262 respondents without a history of cancer in our sample, and 16.5% reported cost-related medication nonadherence. After adjusting for characteristics of the respondents, cancer survivors were more likely than those without a history of cancer to report cost-related medication nonadherence (adjusted OR = 1.10; 95% CI = 1.02-1.19). Having unsubsidized Part D-Part D without the low-income subsidy-was associated with a greater likelihood of reporting cost-related medication nonadherence (adjusted OR = 1.63, 95% CI = 1.49-1.78), while having subsidized Part D was not (adjusted OR = 0.96; 95% CI = 0.85-1.08). Finally, being on Medicare Advantage was associated with lower likelihood of reporting cost-related nonadherence compared with traditional fee-for-service Medicare (adjusted OR = 0.86; 95% CI = 0.80-0.92). Expanding the low-income subsidy and capping out-of-pocket drug expenditure can be effective policy options to reduce cost-sharing burden and cost-related nonadherence. For this study, Li was partially supported by a research grant from the National Cancer Institute (R01CA225647). The sponsor had no role in the design or implementation of the study, analysis or interpretation of the data, or drafting or approval the manuscript. The authors report no conflicts of interest.
癌症幸存者面临经济困难和与费用相关的药物不依从的风险，尤其是在那些没有足够保险覆盖的人群中。为了研究癌症史与与费用相关的药物不依从之间的关系，以及医疗保险受益人与保险覆盖范围与不依从之间的关系。我们使用了 2013-2018 年医疗保险当前受益人大调查公共使用文件，这是一项针对全国代表性医疗保险受益人群的健康、卫生服务利用、获得医疗保健和满意度的调查。与费用相关的药物不依从被定义为经常或有时报告以下任何一种情况：(1) 减少药物剂量，(2) 为了延长药物使用时间而跳过剂量，(3) 因费用而延迟用药，(4) 因费用而未获得药物。使用逻辑回归来估计与癌症史相关的与费用相关的不依从的比值比，同时调整调查年份和受访者的社会人口统计学特征，包括年龄、性别、种族和民族、最高学历、收入水平、婚姻状况和慢性疾病数量。我们还在模型中纳入了医疗保险 Part D、Part D 与低收入补贴之间的交互作用以及医疗保险优势，以研究保险覆盖范围对与费用相关的不依从的影响。在 2013 年至 2018 年期间，我们的样本中共有 12492 名癌症幸存者和 53262 名没有癌症史的受访者，其中 16.5%报告了与费用相关的药物不依从。在调整了受访者的特征后，癌症幸存者比没有癌症史的受访者更有可能报告与费用相关的药物不依从（调整后的比值比=1.10；95%置信区间=1.02-1.19）。未获得补贴的 Part D-没有低收入补贴的 Part D-与报告与费用相关的药物不依从的可能性更大相关（调整后的比值比=1.63；95%置信区间=1.49-1.78），而获得补贴的 Part D 则没有（调整后的比值比=0.96；95%置信区间=0.85-1.08）。最后，与传统的按服务收费的医疗保险相比，参加医疗保险优势计划与报告与费用相关的不依从的可能性较低相关（调整后的比值比=0.86；95%置信区间=0.80-0.92）。扩大低收入补贴和上限自付药物支出可以是减少费用分担负担和与费用相关的不依从的有效政策选择。在这项研究中，Li 部分得到了美国国立癌症研究所的研究资助（R01CA225647）。赞助商在研究的设计或实施、数据的分析或解释、或草案或批准手稿方面没有任何作用。作者报告没有利益冲突。
