The high price of co-payments impacts medication compliance


Yesterday, I told you that 40% of women aren't being screened regularly for mammograms. Today, we look at how many more women aren't filling their proven life-extending prescriptions. At least this time, we know why. A higher prescription co-payment, especially among older women, is associated with both early discontinuation and incomplete use of adjuvant aromatase inhibitor therapy, a life-saving therapy for women with hormone-sensitive, early-stage breast cancer. Dawn L. Hershman, MD, associate professor of medicine and epidemiology and co-director of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center at Columbia University, told us that previous research has identified several factors affecting compliance, such as age, severity of side effects and belief that the medication is useful. This time, Hershman and her colleagues looked at the impact of prescription co-payments on hormone therapy use. Working with the Medco Research Institute, the investigators used anonymous patient information to target women older than 50 years who were prescribed aromatase inhibitors for early-stage breast cancer. "We looked at two different factors: women who discontinued use altogether or had no subsequent refills and those that did not refill their prescription on time or did not take the medication at least 80 percent of the time," said Hershman.Results showed that of the 8,110 women aged 50 to 65 years, 21.1 percent stopped taking the medication, and of those who properly continued with their regimen, 10.3 percent didn't take the medication as directed over the two-year period. In the older population of 65 years and up, almost 25 percent stopped taking the medication, and of those who continued, 8.9 percent were non-adherent. Co-payments were categorized as less than $30, between $30 and $89.99, and $90 or more. The 90-day co-payments ranged from $0 to $893.49. In the 65 and older group, women were more likely to discontinue medication use if they fell in the co-payment categories above $30. However, it was not until the co-payment reached $90 that the 64 and younger age group was more likely to discontinue use or not take it as prescribed. Additionally, the study results showed that women whose prescriptions came from a primary care doctor or women who were prescribed many other medications were also more likely to stop taking the medications or not take them as prescribed. I am an awful "pill taker." In fact, I have to put my vitamins next to the daily arthritis medication I give my dog so I'll remember to take it. I am the poster child for the millions of us who take "medication vacations." For me, it's not so much about cost as it is about placing the care of others before myself--a bad habit I am trying to break. Cost, however, is a huge issue for many of us who are all too familiar with the mounting costs associated with aging. I've seen my own parents struggle with high co-pays and, in their opinion, the limited rate of return with regard to my dad's Alzheimer's medications.What an awful choice to have to make.

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