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Title: Access and Cost-Related Nonadherence to Prescription Medications Among Lupus Patients and Controls: The Michigan Lupus Epidemiology and Surveillance Program.

Authors: Minhas, Deeba; Marder, Wendy; Harlow, Sioban; Hassett, Afton L; Zick, Suzanna M; Gordon, Caroline; Barbour, Kamil E; Helmick, Charles G; Wang, Lu; Lee, Jiha; Padda, Amrita; McCune, W Joseph; Somers, Emily C

Published In Arthritis Care Res (Hoboken), (2021 Nov)

Abstract: OBJECTIVE: Medication access and adherence are important determinants of health outcomes. We investigated factors associated with access and cost-related nonadherence to prescriptions in a population-based cohort of systemic lupus erythematosus (SLE) patients and controls. METHODS: Detailed sociodemographic and prescription data were collected by structured interview in 2014-2015 from participants in the Michigan Lupus Epidemiology and Surveillance (MILES) cohort. We compared access between cases and frequency-matched controls and examined associated factors in separate multivariable logistic regression models. RESULTS: A total of 654 participants (462 SLE patients, 192 controls) completed the baseline visit; 584 (89%) were female, 285 (44%) were Black, and the mean age was 53 years. SLE patients and controls reported similar frequencies of being unable to access prescribed medications (12.1% versus 9.4%, respectively; P was not significant). SLE patients were twice as likely as controls to report cost-related prescription nonadherence in the preceding 12 months to save money (21.7% versus 10.4%; P = 0.001) but were also more likely to ask their doctor for lower cost alternatives (23.8% versus 15.6%; P = 0.02). Disparities were found in association with income, race, and health insurance status, but the main findings persisted after adjusting for these and other variables in multivariable models. CONCLUSION: SLE patients were more likely than controls from the general population to report cost-related prescription nonadherence, including skipping doses, taking less medicine, and delaying filling prescriptions; yet, <1 in 4 patients asked providers for lower cost medications. Consideration of medication costs in patient decision-making could provide a meaningful avenue for improving access and adherence to medications.

PubMed ID: 32741110 Exiting the NIEHS site

MeSH Terms: Adult; Aged; Case-Control Studies; Cost Savings; Drug Costs*; Drug Substitution/economics; Female; Health Expenditures; Health Services Accessibility/economics*; Humans; Interviews as Topic; Lupus Erythematosus, Systemic/diagnosis; Lupus Erythematosus, Systemic/drug therapy*; Lupus Erythematosus, Systemic/economics*; Lupus Erythematosus, Systemic/epidemiology; Male; Medication Adherence*; Michigan/epidemiology; Middle Aged; Population Surveillance; Registries

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