Are Indie Pharmacy Users Rationing Their Drugs?

BY Courtney Huckabay

More consumers tend to avoid filling and taking prescription drugs, due to cost barriers, when faced with higher direct charges for medicines. This evidence is presented in the research article, Cost-​related non-​adherence to prescribed medicines among older adults: a cross-​sectional analysis of a survey in 11 developed countries, published in BMJ Open journal.

The purpose of the study was to assess the effects of direct patient costs on access to medicines in 11 developed countries in Europe, North America and Australasia. The researchers hypothesised that cost-​related access barriers would be higher in countries without universal coverage for pharmaceuticals (the USA and Canada) than in countries providing universal coverage of prescription drugs at little or no direct cost to patients (eg, the UK).

Further, because many of the health systems studied (including the USA and Canada) provide greater coverage of medication costs for persons over age 65, they hypothesised that access would be higher and cross-​national differences lower among that age group.

Independent pharmacies can counsel prescription fillers on the ramifications of not taking medications as prescribed. The latest AudienceSCAN study revealed 9.4% of U.S. adults get most prescriptions (for them or family) filled by an independent, locally owned pharmacy.

The researchers defined non-​adherence as: Self-​reported cost-​related non-​adherence (CRNA) in the form of either not filling a prescription or skipping doses within the past 12 months because of out-​of-​pocket costs.

Costs are a common and problematic cause of prescription non-​adherence, with studies showing that financial barriers to accessing necessary medications are correlated with worse health outcomes and increased use and cost of other health services.

The estimated prevalence of CRNA among all older adults varied from <3% in France, Norway, Sweden, Switzerland and the UK to 16.8% in the USA. Before adjusting for potential predictors of CRNA, the levels of CRNA in the USA, Canada and Australia were significantly higher than the reference country, the UK.

Independent pharmacists can educate the elderly and other customers with informative ads. According to AudienceSCAN research, 16.6% of Independent Pharmacy Users think of TV as the best source for health/​medical information.

In the logistic regression model with respondents of all ages and income levels from all countries, the adjusted odds of reporting CRNA were statistically significantly higher among people who were younger (age 54–65), of average or below-​average income and of poor health (results not shown in table). Sex was not a significant predictor of CRNA in the model. Controlling for age, sex, health status and household income, adults aged 55 and older in the USA were approximately six times more likely to report CRNA than adults aged 55 and older in the UK.

In contrast to other health systems, many residents of the USA and Canada do not have drug coverage. Americans and Canadians who do have private or public drug coverage face varying levels of deductibles, coinsurance or copayments. In some cases, this can include reference-​based reimbursement charges that stem from the dispensation of brand-​name drugs when generic alternatives are available; however, couponing by manufacturers is an attempt to reduce the burden of such charges for sponsoring brands. Consistent with the hypothesis that higher direct costs to patients are associated with increased likelihood of CRNA, the crude and adjusted odds of CRNA in the USA and Canada were significantly greater than the UK (and other comparator countries with universal coverage of medicines at little direct cost to patients).

60% of Independent Pharmacy Users took action after seeing television commercials, the AudienceSCAN study showed. TV spots can encourage customers to turn to their pharmacy for questions about drug costs and payment plans.

In summary, Americans are more than five times more likely to skip medication doses or not fill prescriptions due to cost than peers in the United Kingdom or Switzerland. U.S. patients are twice as likely as Canadians to avoid medicines due to cost. And, compared with health citizens in France, U.S. consumers are ten-​times more likely to be non-​adherent to prescription medications due to cost.

AudienceSCAN data is available as part of a subscription to AdMall for Agencies, or with the SalesFuel API. Media companies can access AudienceSCAN data through the AudienceSCAN Reports in AdMall.