Nursing Notes

March 31, 2011

Many don’t take prescriptions because of cost

Here’s an article from Reuters that I read and scratched my head about.  As a nurse I have known that this is a major problem for many years.  I know that patients will take medication if it “works” ( ie.  they get better), they will take it if they feel they need it and it is not too much trouble to acquire, and they will take it if they can afford it.  So, what’s the deal with this study at this time?  With healthcare costs sky rocketing, it seems that someone in charge has finally seen the light.  Maybe we can prevent some of the catastrophic illnesses by starting earlier in the cycle and intervene at a time when medication alone may be able to prevent further bodily damage.  What a thought.

So, after a few minutes of head scratching, I realized that it is a good thing for someone to finally be looking at this issue in a quantitative and measurable way.  Maybe this is how we effect change in our system.

I know that my niece, the doctor, always chooses her medications to prescribe based on the $4.00 list at the local pharmacies so her patients can be sure to get the treatment they needed when they came to see her.  Maybe others should not be so influenced by the drug reps to prescribe the newest, most expensive drugs on the market.  Who knows?  Just my thoughts on this topic.  What are yours?

Please go to the site and read the entire article, then come back here to let me know what your thoughts are on this topic, won’t you?


By Alison McCook

NEW YORK | Wed Mar 30, 2011 11:52am EDT

NEW YORK (Reuters Health) – A significant portion of people – perhaps as many as one in five – don’t take drugs a doctor has prescribed because they can’t pay for them, according to a new survey of people visiting an emergency room.

“I think this is a wake-up call,” study author Dr. Karin Rhodes of the University of Pennsylvania told Reuters Health.

Among a group of more than 1500 people who volunteered to complete a questionnaire, more than 20 percent said they had previously not taken a prescribed drug on account of the price tag.

It’s an issue that many doctors aren’t aware of, noted Rhodes, and the system needs to address it. “Patients need to be asked ‘can you afford your medications?’ and they should get help to pay for them.”

A number of studies have shown that people with chronic health problems, including high blood pressure, diabetes and heart disease, commonly fail to take their medications as prescribed.

Other reports have shown similar rates of so-called “nonadherence,” although the actual estimate tends to vary depending on the exact questions researchers ask, according to Dr. Jae Kennedy of Washington State University, who did not participate in the current project.

One recent study found that 22 percent of prescriptions written for 75,000 Massachusetts patients were never filled. And in another, people were less likely to fill “dispense as written” prescriptions (See Reuters Health report, March 25, 2011).

Some people go to the trouble of filling the prescription, but never pick it up. Looking at information collected from 5 million Americans over 6 months, a study late last year showed that just over 3 percent never retrieve their prescriptions from the pharmacy, and were more likely to abandon expensive medications.

During the current study, 21 percent of the 1506 participants said they had previously not taken medications because of money concerns. Another 5 percent said they were worried they might not be able to pay for drugs.

The researchers, who published their results in the journal Academic Emergency Medicine, considered both groups to be “at risk” of nonadherence with future prescriptions.

Looking at the responses to other questions on the survey, Rhodes and her team found that people were more likely to be at risk of nonadherence if they had money issues – for instance, they worried about money, didn’t have enough food, reported housing problems, and had inadequate health insurance. But they were also more likely to be at risk of nonadherence if they smoked, used illegal drugs, or experienced domestic violence, as either the victim or perpetrator.

“I think (nonadherence) goes along with people who have difficult, disorganized lives,” said Rhodes.

Nonadherence has consequences, she added – one problem, if left untreated, will create others, such as when untreated high blood pressure hurts the kidneys. Research shows that people who don’t fill prescriptions or take medications as they’re prescribed are more likely to get sicker, and become hospitalized, said Kennedy in an e-mail.

“Nonadherence is a widespread and serious public health problem.”…..[read more]


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  1. Costs of prescription drugs has been and will continue to be a major concern for patients and prescribers. As a nurse, I see the consequences of failing to address prescription costs often. I volunteer at a local free clinic that sees adults with minor medical concerns. We had a gentleman who presented with a recurrent foot infection that had supposedly been treated with antibiotics a few weeks prior. On further questioning, I determined that the man had gone to fill the prescription he had been given for antibiotics and the cost was too high, so he opted not to fill it. Not surprisingly, the infection got worse, and the man was unable to walk when he returned to the clinic. Myself and the provider were able to get a prescription arranged that not only was therapeutic but affordable for the man. It was as simple as giving him two separate prescriptions for the same medication at two different strengths that equaled the correct dosage for his size. It turns out that giving him the same dosage in one pill was not on the $4 list, but the two separate pills were, so his total cost was only $8. I tell this story to illustrate that it can be quite simple in some cases to provide affordable prescriptions for patients. But, the first step is determining what financial concerns that patients have before they come back with problems. I see nurses as a vital player in assessing financial need and concern in patients. Often, it is a nurse that teaches patients about new medications, it makes sense for that nurse to ascertain whether the patient will be able to fill the prescription for the new medication. As you mention in your April 9th posting about preventing readmissions, we have to do better discharge planning. Determining if a patient can afford prescriptions will be a major step in preventing readmissions for similar problems.

    Comment by Karen — April 28, 2011 @ 1:29 am | Reply

    • Karen,

      Thanks for the informative comment. I wholeheartedly agree with you. As a psych nurse, I frequently see patients discharged and I know for a fact that they have no way to pay $900 a month for the new psychotropics. I worry about the effect for my patients of being medicated sporadically if at all. The older medications are not as wonderful and do have side effects, but if dosed appropriately and monitored, many of my patients could have productive lives and not go broke on medications. Nurses always know if their patients will be filling the prescriptions they leave with. Its something that you develop as a nurse. The problem is not with the nurses, but rather with the prescribing. I wish the physician would broach this subject with each patient before prescribing the “newest” or the “latest” drug. Thanks again for writing. Please feel free to respond again. I will look forward to hearing from you.


      Comment by Shirley — April 28, 2011 @ 2:15 am | Reply

  2. […] Many don’t take prescriptions because of cost ( […]

    Pingback by Fighting America’s ‘Other Drug Problem’: Researchers Find Key to Combating Medication Non-Adherence « Nursing Notes — May 26, 2011 @ 2:18 am | Reply

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