High Cost, Barriers to Assistance Programs Contributing to Non-Adherence in Patients with HIV

Removing barriers to the Ryan White AIDS Drug Assistance Program (ADAP) and Medicaid and reducing private insurance medication costs may decrease cost-related nonadherence among patients with HIV infection and improve their health, according to the CDC’s Morbidity and Mortality report for December 13.

The report included population-based data on prescription drug cost-saving strategies among US patients with HIV. The CDC analyzed cross-sectional, nationally representative surveillance data on behaviors, medical care, and clinical outcomes among adult patients with HIV.

The report found a link between nonadherence due to prescription drug costs, reporting an unmet need for medications from the ADAP, having Medicaid coverage, and having private insurance. Patients who were nonadherent because of cost concerns were more likely to have visited an emergency department (ED), have been hospitalized, and not be virally suppressed.

The report was conducted by the Medical Monitoring Project, which used a 2-stage sample design of states and territories as well as patients with HIV infection. Data were collected from all 50 states using face-to-face or telephone interviews and medical record abstraction during June 2016-May 2017 from 3948 patients taking prescription drugs.

Patients taking prescription drugs were asked about their use of 6 cost-saving strategies over the past 12 months:

• Asking a doctor for a lower-cost medication
• Buying prescription drugs from another country
• Using alternative therapies
• Skipping doses
• Taking less medicine
• Delaying filling a prescription because of cost.

Overall, approximately 14% of US adult patients with HIV used any medication cost-saving strategy, including 7% who reported cost saving—related nonadherence. Among this group, 4% skipped doses, 4% took less medicine, and 6% delayed a prescription. In addition, 9% had asked a doctor for lower-cost medicine, 1% had bought drugs from another country, and 2% used alternative medicine. Cost–related nonadherence was not associated with age, race/ethnicity, gender, homelessness, or time since HIV diagnosis.

Nonadherence due to prescription drug costs was higher among persons with a disability (9%) than among those without disability (5%). Among those with health insurance, cost saving—related nonadherence was more likely among persons with private insurance (8%) than with those who did not have private insurance (6%). It was also less likely among those with Medicaid (5%) than among those who did not have Medicaid (8%).

Patients who had an unmet need for medications from ADAP were approximately 5 times as likely to be nonadherent because of cost (32%) than were those who received ADAP (7%). Nonadherence due to prescription drug costs was also associated with lower likelihood of HIV care engagement and higher numbers of ED visits and hospitalizations.

Due to the strong relationship between HIV infection and unsuppressed viral load, nonadherence among patients with HIV infection leads to increased morbidity, morality, and risk for HIV transmission. According to the report, addressing financial barriers to antiretroviral therapy adherence may improve levels of viral suppression.

Reference

• Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016—2017. CDC website. Published December 13, 2019. https://www.cdc.gov/mmwr/volumes/68/wr/mm6849ahtm?s_cid=mm6849a1_w. Accessed December 13, 2019.