LOS ANGELES -- Some stroke survivors skip prescribed medications because the cost is too high -- a situation that may be worsening, particularly among young and uninsured patients, researchers found.
According to a national survey of stroke survivors conducted from 2006 to 2009, 30 percent of those ages 45 to 54 and 60 percent of those who were uninsured reported that they were nonadherent because they could not afford to buy the medication, according to Dr. Deborah Levine of the University of Michigan in Ann Arbor.
Both figures were greater than those reported in a similar survey conducted from 1998 to 2002, when cost-related nonadherence was 18 percent among those 45 to 54 and 39 percent among the uninsured, Levine reported at the American Stroke Association's International Stroke Conference here.
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Surprisingly, Medicare beneficiaries with Part D prescription drug coverage -- implemented in 2006 -- had a higher rate of cost-related nonadherence than those who did not have Part D (12 percent versus 6 percent).
That difference, however, was no longer significant after accounting for sociodemographics, neurological disability due to stroke, health status, comorbidities, and private health insurance coverage. That fact indicates that Part D does not resolve the problem of cost-related nonadherence, Levine said.
"Despite federal and local programs, medication is still unaffordable for many stroke survivors," Levine said at a press briefing. "The bottom line is that medication nonadherence due to cost prevents the translation of remarkable research and public health advances to our stroke patients."
But solutions exist, she said, including clinician screening for cost-related medication underuse in stroke survivors, the use of lower-cost medications, the provision of affordable health insurance and prescription drug coverage for uninsured stroke survivors, and free medications to prevent recurrent stroke as is currently being studied for survivors of acute heart attack.
Levine noted that stroke survivors require an average of 11 different medications to prevent recurrent stroke and to treat related conditions, such as diabetes, chronic pain, seizure and depression.
Prioritizing is Key
Because many patients cannot afford all of these medications, even with assistance, Levine said that she does help prioritize meds so patients can purchase those that will have the greatest impact, like blood pressuring-lowering drugs.
"For clinicians, the important message is we need to ask our patients if they can afford their medications and for those who can't, we need to drastically modify their medication regimen," she said.
Levine and her colleagues examined data on 2,656 stroke survivors ages 45 and older who responded to the National Health Interview Survey from 2006 to 2009. Those patients represented 5.3 million stroke survivors nationwide, 3.6 million of whom were Medicare beneficiaries.
Patients who responded affirmatively to a question about not getting prescription medications within the past year because of cost were considered to be nonadherent because of cost.
Overall, the rate of cost-related nonadherence was 11 percent in 2006-2009, up from 8.6 percent in the 1998 to 2002 study data.
Although the rate increased significantly in younger stroke survivors between the two study periods, it remained steady in the older age groups (4 percent to 8 percent).
There were some limitations of the study, including the use of self-reported stroke history and potential unmeasured confounding from provider characteristics, stroke variables, and medication-taking attitudes and behavior.