Copayment assistance and adherence to prescription medication among patients with cancer.
57 Background: The relationship between prescription medication adherence and copay assistance is understudied and directly impacts quality of care. Methods: We conducted a cross-sectional survey study assessing patient-reported failure to take medication as prescribed (nonadherence) and application for copay assistance. Participants were enrolled between 6/2010-5/2011 from the HealthWell Foundation (a copay assistance program) and Duke Cancer Center. Eligible patients were adults receiving treatment for a solid malignancy. Nonadherence was defined as taking a less than prescribed amount of medication, not filling or partially filling a prescription, or taking medications prescribed for someone else. Adherence and receipt of copay assistance were not linked to a specific drug. Logistic regression assessed the association between medication nonadherence, copay assistance application, and financial burden. Results: Among 258 participants, 75% applied for copay assistance. 38% (n=99) reported nonadherence with medications due to cost. Compared to adherent participants, nonadherent participants were more likely to: ask their doctor for a less expensive medication than prescribed (p<0.001); reduce spending on basics like food or clothing to pay for medication (p<0.001); purchase an over-the-counter drug to replace a more costly prescription (p<0.001); borrow/use credit to pay for medications (p<0.001); and talk with doctors about treatment-related costs (p=0.014). In adjusted analyses applying for copay assistance did not change odds of nonadherence. Having a prescription drug plan (OR 6.56, 95% CI 1.69-25.53) and utilizing coping strategies (OR 2.72, 95% CI 2.03-3.65) increased odds of nonadherence; older age (OR 0.93, 95% 0.88-0.98) decreased odds of nonadherence. Conclusions: Medication nonadherence due to cost was prevalent among cancer patients whether or not they applied for copay assistance. To afford medications cancer patients adapted their lifestyles and altered their care. Future research should investigate whether underinsured patients have timely access to copay assistance programs and whether copay assistance impacts the quality of care.
Zullig, LL; Peppercorn, JM; Schrag, D; Taylor, DH; Zhong, X; Samsa, G; Abernethy, AP; Zafar, Y
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