The United States spends more per capita on prescription drugs than other countries, and one-fifth of this cost is paid out-of-pocket by patients. Cost-saving strategies, including nonadherence to medications due to cost concerns, have been documented among U.S. adults, which can affect morbidity and, in the case of persons living with HIV, transmission. However, population-based data for persons with HIV are lacking.
The Medical Monitoring Project (MMP) is a surveillance system that collects interview and medical record data from a probability sample of adults with diagnosed HIV in the United States. Using weighted data collected 6/2015-5/2016 from 3560 persons taking prescription drugs, we examined the prevalence of 6 strategies used to reduce prescription drug costs, including 3 involving nonadherence (skipping doses, taking less medicine, delaying filling a prescription). Because nonadherence can affect health and transmission, we compared the prevalence of cost-saving related nonadherence by sociodemographic groups, and clinical outcomes among those who did and did not report cost-saving related nonadherence. We used prevalence ratios with predicted marginal means to evaluate significant (P<0.01) differences between groups.
In all, 13% of persons reported using any cost-saving strategy and 8% reported any cost-saving related nonadherence; 8% asked a doctor for lower cost medicine, 1% bought drugs from another country, 2% used alternative medicine, 4% skipped doses, 4% took less medicine, and 6% delayed a prescription. Cost-saving related nonadherence was not associated with age, gender, race/ethnicity, poverty, or homelessness. Cost-saving related nonadherence was significantly higher among persons with a disability, private insurance, and unmet need for medications from the Ryan White AIDS Drug Assistance Program (ADAP), and lower among persons with Medicaid (Table). Persons reporting cost-saving related nonadherence were less likely to be virally suppressed and engaged in care, and more likely to have visited an emergency room or been hospitalized more than once.
Persons with diagnosed HIV in the United States used various strategies to reduce prescriptions drug costs. Cost-saving related nonadherence was relatively low, but was associated with poorer clinical outcomes. Increasing access to ADAP and Medicaid coverage may help to decrease nonadherence due to cost concerns among persons with diagnosed HIV.