The hidden cost of medications

From the Archives of Internal Medicine, comes this story:

About one-third of chronically ill adults who underuse medications because of the costs associated with buying the drugs, never tell their health care practitioners . . .

The underuse of essential medications, including cholesterol-lowering medications, heart medications, asthma medications and antipsychotics, has been associated with increased emergency department visits, nursing home admissions, acute psychiatric hospitalizations, and a decrease in self-reported health status, according to the article.

Of respondents who did not tell a clinician, 66 percent reported that they had not been asked about their ability to pay for prescriptions. Seventy two percent of patients who talked with their clinicians about medication costs found the conversations to be helpful. However, 31 percent said their medications were never changed to a generic or less expensive replacement. Also, only 30 percent of patients were informed of programs that help pay drug costs, and fewer people were told where to purchase less expensive medication (28 percent).

We already know that the cost of prescription medication is a huge problem today. One of the causes of this problem happens to be one of the greatest strengths of modern medicine – as studies come out heralding new medications to treat chronic illness, more patients will have burgeoning “laundry-lists” of drugs. Take a heart attack – once this happens, you are immediately placed on several lifelong prescription medications: an anti-platelet agent (aspirin or Plavix), a cholesterol-lowering agent (i.e. Lipitor), an ace-inhibitor (i.e. Zestril or lisinopril), a beta-blocker (i.e. metoprolol or atenolol), and maybe a long-acting nitrate (i.e. Imdur). That’s the potential of five lifelong medications instantly. Since many people with heart disease also have diabetes (increasing the number of medications by sometimes three drugs), that only increases the burden.

This survey underscores the importance of compliance when taking these medications. The mortality-lowering benefit only comes into play when patients take their medications. If they aren’t, it is important to ask why. If cost is an issue, measures should be taken to address this. In most cases, there are generic equivalents – especially with antibiotics and the treatment of hypertension. With non-compliance increasing hospital and emergency room use, the price paid when prescription medication isn’t taken hurts both patients and physicians.