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Running head: ACQUISITION AND ADHERENCE OF MEDICATIONS Page 1Prescription medications:
How patients acquire and adhere to medications they can’t afford? ACQUISITION AND ADHERENCE OF MEDICATIONS Page 2
Topic
Prescription medication costs are on the rise, leaving patients to struggle on how to
acquire and adhere to life-saving medications. The United States government fails to regulate
the prescription medication market, leaving patients risking their lives to access these drugs.
Patients with insurance or without insurance struggle to access affordable medications, which
causes patients to ration or skip doses of medications. Patients can access free online
prescription savings programs, but only if patients are aware and how to access these programs.
Even though these online prescription savings programs exist, there are many that are still not
affordable. Some patients have opted to travel outside the United States to access medication,
such as with insulin; a life saving medication required for type one diabetics who require insulin
to survive. Epi-pen a drug that is required for life-saving anaphylactic allergic reactions, the
company made headlines more than once about the astronomical inflation of this drug, due to
only kind on the market. Health care management will face challenges like this daily in helping
patients who struggle to afford medications and adhere to physician instructions. Health care
workers will need to help patients access medications by either getting these medications by
representatives of these drug companies, researching savings programs and or assistance
programs through the drug companies itself. Even after all those resources are accessed that still
will not guarantee these patients can access many medications.
Problem Statement
Prescription medication costs and acquisition and adherence of life-saving medications
has always been an issue; however, costs have been rising even higher causing patients to ration ACQUISITION AND ADHERENCE OF MEDICATIONS Page 3
medication doses. For many years, patients have debated about insurance costs and accessibility,
leaving out the factor of prescription medication costs. Every year insurance companies exclude
more medications from the formulary lists and add those medications to the exclusion list,
leaving patients stranded. If we continue to believe there is not an issue with medication
accessibility and affordability, we’ll never understand the larger question of why patients are not
adhering to physician orders. According to a study published in Health Policy, there is a direct
correlation between medication adherence and outcomes in management of patients with
diabetes and heart failure, (Gourzoulidisa, et al., 2017). The following study will address the gap
and barriers to adherence in patients’ health stemming from prescription medication costs. This
study will contain surveys to examine the barriers that patients face due to medication costs and
will incorporate the following research questions:
Should the government have to regulate the pharmaceutical companies?
Should patients have to choose between food, shelter or medications?
What can patients do to access life saving medications they cannot afford?
Literature Review
Medication costs; Cost and adherence
Prescription drug costs have risen rapidly, causing hardships for several Americans and
leaving people no choice to modify their medication dosage, quantity or omitting the drug itself
from their daily regimen, (Kennedy and Sclar, 2003). Research by Heisler, Piette and Wagner ACQUISITION AND ADHERENCE OF MEDICATIONS Page 4
(2008), conducted a study of adults 50 and over which the data showed a strong positive
association between copayments and cost related medication underuse. As published by
Kennedy and Wood, (2016), despite reforms many Americans are unable to afford to fill and
take their medications as prescribed. A polling data from a survey conducted by Kaiser Family
Foundation, which found that 72% of Americans feel that prescription costs are unreasonable,
(Kennedy and Wood, 2016). Patients are ashamed to admit they cannot afford medications and
rather resort to other options, such as cutting back on food and medications. Alexander and
Tseng, (2004), report that one in five did not fill medications due to cost and report medication
costs are a burden. A report from Center for Medicare and Medicaid Services reported that the
United States spent $333 billion on drug costs in 2017, which is more than a 40% increase in 10
years, (La-Viola, Sanchez and Snogna, 2019) . A study showed the relationship between co-
payments and cost-related underuse, which showed that more commonly patients reported taking
fewer medications or taking medications less frequently versus not filling medications, (Heisler,
Piette, Wagner, 2008). Including barriers to patients of drug prices which overall results in
negative health and an overall increase in costs of healthcare, (Snogna, La-Viola and Sanchez,
2019). Nonadherence of medications leads to higher medical costs overall for health systems
and insurance companies, a valid gap seen and a reason to further research this topic.
Medication costs; Government Regulations and Formularies
Humira, an injection used to treat psoriasis and arthritis, which is one of the many drugs
that range from double or even triple cost in the United States versus other countries, (Kliff, ACQUISITION AND ADHERENCE OF MEDICATIONS Page 5
2018). Humira in the United Kingdom costs $1362, Switzerland $822, United States $2669, the
same drug varies drastically across country lines, (Cliff, 2018). The differences vary due to the
United States does not have any system or regulation in place to negotiate prices of drugs when
they come out, (Kliff, 2018). Other countries use a government agency to negotiate an
appropriate price with the pharmaceutical companies, (Kliff, 2018). According to the article,
Shouldn’t the U.S Government do more to regulate high drug prices; states that if the United
States adopted European-style price controls on drugs from 1986 to 2004, that it would have
produced 117 fewer new medicine compounds. According to Alexander and Tseng, (2004),
doctors are often trained to prescribe new and better medications versus using the more
affordable medication to fit a patient’s budget. Drug manufactures have consolidated and
merged together, which caused an increase in cost of generic medications, (Snoga, La-Viola and
Sanchez,2019). The new commissioner of the FDA is working on a program to use the FDA to
help establish a program to lower cost of medications including the brand name pharmaceutical
companies from “gaming the system” and allowing more generic medication costs affordable,
(Zuckerman, 2017). Zuckerman (2017), provides an example of a drug called Deflazacort, that
was not yet approved by the FDA in the United States that varied from $1000-$2000 for year
supply, once FDA approved the cost in the US was $89,000 per year, a 6000% increase.
Another example of medication costs in the US called Sovaldi, which treats Hepatitis C, in 2013
cost $84,000 for a 12-week course and in Canada same drug costs $55,000 and in Egypt costs
only $900, (Zuckerman, 2017). Scullin, Hogg, Luo, Scott, McElnay (2011), presented with
integrated medicines management to follow patients during a 12-month period that demonstrated ACQUISITION AND ADHERENCE OF MEDICATIONS Page 6
quality improvements in a targeted group. During this trial of services of medication
management system showed a reduced stay and reduced readmission rates, (Scullin, Hogg, Luo,
Scott, McElnay, 2011), this study would not be a valid research to further validate for this one
particular topic that was done, due to more focus was on inpatient medications versus outpatient
as this study focused on. According to Li and Shane (2017), consolidation of manufacturers of
typically low-cost generic medications are also driving the drug expenditures higher, which is
happening every day and is valid reasons to further research the FDA process and formularies.
Preexisting Conditions as it relates to medication costs
High costs of medications, patients must choose between food, shelter and prescriptions.
Patients with chronic conditions and disabled adults struggle to afford multiple medications for
their health conditions. Shaw (2016), performed a four-year prospective study with two waves of
survey and chart-based data collection with four qualitative methods. The study including
different races of patients who have diabetes and/or hypertension through interviews. This
research also brought out a causal relationship that suffered between patients and health care
providers, due to restrictions on medication formularies and costs. Some patients that were
interviews stated they must pick and choose what medications they can fill that month depending
on costs. Analyzation of a NHIS survey of a cross-sectional study of non-institutionalized
patients on the United States to determine the relationship between food instability and cost-
related medication underuse, (Herman and Afulani, 2015). Studies have shown that patients
have reported cutting back on medications to afford food costs. According to Heisler, Wagner & ACQUISITION AND ADHERENCE OF MEDICATIONS Page 7
Piette, (2005), a national study was performed on 4,055 adults taking medications for one or
more medication conditions, which separated by categories such as cutting back on necessities,
increasing debt, and underuse of medications. There was direct relationship to socio-
demographic characteristics between medication adherence and cost factors and cutting
necessities or increasing debt or underuse of medications, (Heisler, Wagner & Piette, 2005). The
study shows factors related to adverse health effects and medication adherence, (Heisler, Wagner
& Piette, 2005). Kennedy and Erb, (2002), performed a study which showed that 1.3 million
adults with disabilities did not take their medications as prescribed due to cost and more than half
reported direct correlating health problems. Srinivasan & Pooler, (2018), performed a study to
determine if there is a direct correlation between adults 60 and older who received SNAP
benefits and cost of medications. This study breaks down the aspects that receiving such funds of
SNAP gave more access to patients affording their medications by being given benefits to
purchase food. Kennedy and Erb, (2002), study suggest that increasing access to SNAP benefits
may allow older adults to be able to afford their medications better. Patients with chronic
conditions and disabilities are more suspectable to underlying disadvantages and barriers to
affording medications, which still has many unanswered questions to how patients acquire these
medications and is a valid reason to warrant further research. ACQUISITION AND ADHERENCE OF MEDICATIONS Page 8
References
Shouldn't the U.S. Government do more to regulate high drug prices? (2017, February 23).
Retrieved from https://www.drugcostfacts.org/drug-pricing-regulations .
Alexander, G. C., & Tseng, C. W. (2004). Six strategies to identify and assist patients burdened
by out-of-pocket prescription costs. Cleveland Clinic journal of medicine , 71 (5), 433-437.
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https://pdfs.semanticscholar.org/bb0e/3eb2acff71dc335e42a3677cfdad539703f9.pdf
Gourzoulidisa, G., Kourlaba, G., Stafylas, P., Giamouzis, G., Parissis, J., & Nikolaos
Maniadakis, N. (2017, February 28). Association between copayment, medication adherence
and outcomes in the management of patients with diabetes and heart failure. Retrieved from
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Heisler, M., Wagner, T. H., & Piette, J. D. (2005). Patient Strategies to Cope with High
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