Many Stroke Survivors Struggle to Afford Medications

LOS ANGELES – As the economy worsens and the cost of drugs rises, more and more stroke survivors are forced to cut back on a critical health ally – prescription medications.

The rate of medication nonadherence due to cost in stroke survivors increased from 9% in 2002 to almost 12% by 2009, Dr. Deborah A. Levine reported Feb. 10 at the International Stroke Conference.

Medicare Part D – the program introduced in 2006 to address this problem – isn’t helping stroke survivors very much, said Dr. Levine, of the University of Michigan. In fact, her study found that cost-related medication nonadherence was actually twice as high in Medicare Part D enrollees than it was in those who did not have the prescription benefit.

The clinical implications can be severe, she said, from increasing the risk of recurrent stroke or heart attack to neglecting treatment of pre-existing conditions. "The crucial message for physicians is that we need to ask our patients [every time we see them] if they can afford their medications, and if they can’t we need to drastically modify their medication regimen. Patients are not able to effectively prioritize which medications [would] give the biggest bang for the buck, so I work with them to prioritize the regimen to the essential ones that will have the highest value and health benefit, such as antihypertensives," Dr. Levine said at the meeting, which was sponsored by the American Heart Association.

The average stroke survivor takes 11 medications, a number that includes those taken before the stroke and those prescribed to prevent another stroke or heart attack. "In my clinic, patients are typically on four additional drugs after their stroke for things including stroke complications like seizure, chronic pain, and depression and those to prevent another cardiovascular event. These are in addition to their previous drugs, which are typically for things like hypertension, lipids, and diabetes. And many require multiple drugs to control these conditions to the target levels."

Even though many of the medications have generic forms, not all generics are cheap, she pointed out. And with so many needed, the cost can rise alarmingly. "Even if the copay is only $5 or $10 for each medication, that can be more than some of our patients can afford."

Dr. Levine and her colleagues examined data from the National Health Interview Survey from the years 2006-2009. The survey interviews community-dwelling adults and then extrapolates the results to the entire U.S. population.

She compared these recent data to those obtained for a similar study that examined rates of nonadherence based on the survey conducted from 1998 to 2002 (Arch. Neurol. 2007; 64:37-42).

In both surveys, the question assessing cost-related nonadherence was "During the past 12 months, was there any time when you needed prescription medicines but didn’t get them because you couldn’t afford them?"

According to the 2006-2009 survey, there were 5.3 million stroke survivors aged 45 years or older. Of these, 3.6 million were Medicare beneficiaries, and of these, 1.5 million participated in Medicare Part D. The overall proportion of those who reported nonadherence due to cost was 12% – significantly higher than the 8.6% rate found in the 1998-2002 survey.

The results also varied significantly by age and insurance status. In the earlier study, 18% of patients aged 45-54 years reported cost-related nonadherence, compared with 30% in the later study – a significant increase. The differences were not statistically significant among other age groups up to 75 years and older.

Insurance status also significantly affected the situation. In the 1998-2002 survey, 39% of the uninsured reported the problem, compared with 60% of the uninsured in 2006-2009.

"We were very surprised to find that Medicare Part D enrollees had a significantly greater frequency of nonadherence due to cost than did Medicare Part D nonenrollees," Dr. Levine said. In the most recent survey, 12% of enrollees reported nonadherence, compared with 6% of those who did not participate in the program. "Despite this federal program, medication is still unaffordable for many stroke survivors and this prevents the translation of some remarkable research and public health advances to many of our stroke patients," she said.

Potential solutions might include physician screening for medication underuse in stroke patients, particularly the young, uninsured, and Medicare Part D participants, Dr. Levine suggested. "The proposed national affordable health insurance program would be expected to improve cost-related medication nonadherence, medication access, and provide free medicines to prevent recurrent strokes and heart attacks."

The cause of this problem, at least for Medicare Part D enrollees, appears to be the "doughnut hole problem," Dr. Levine said. "The Medicare Part D doughnut hole means that after the program covering $2,500 in medical expenditures, a beneficiary will incur the cost of medications up to $5,000, when catastrophic coverage kicks in, after which Medicare Part D picks up the cost. The new national new health reforms proposed to close that by 2020."

Studies have shown that stroke survivors have a very high risk of both entering and leaving that hole in coverage, she added; survivors spend an average of $800 per month on medications. Because of this high monthly cost, stroke survivors are at a two- to threefold increased risk of severe financial burden, compared with those with other chronic illnesses, such as diabetes or cardiovascular disease.

"For our patients, the important message is that they need to take their medications to prevent a recurrent stroke or cardiovascular event," she said. "If they can’t get the medications due to cost, patients need to tell their doctor and enter a dialogue in order to solve the problem."

Dr. Levine and her colleagues did not report any financial disclosures.

LOS ANGELES – As the economy worsens and the cost of drugs rises, more and more stroke survivors are forced to cut back on a critical health ally – prescription medications.

The rate of medication nonadherence due to cost in stroke survivors increased from 9% in 2002 to almost 12% by 2009, Dr. Deborah A. Levine reported Feb. 10 at the International Stroke Conference.

Medicare Part D – the program introduced in 2006 to address this problem – isn’t helping stroke survivors very much, said Dr. Levine, of the University of Michigan. In fact, her study found that cost-related medication nonadherence was actually twice as high in Medicare Part D enrollees than it was in those who did not have the prescription benefit.

The clinical implications can be severe, she said, from increasing the risk of recurrent stroke or heart attack to neglecting treatment of pre-existing conditions. "The crucial message for physicians is that we need to ask our patients [every time we see them] if they can afford their medications, and if they can’t we need to drastically modify their medication regimen. Patients are not able to effectively prioritize which medications [would] give the biggest bang for the buck, so I work with them to prioritize the regimen to the essential ones that will have the highest value and health benefit, such as antihypertensives," Dr. Levine said at the meeting, which was sponsored by the American Heart Association.

The average stroke survivor takes 11 medications, a number that includes those taken before the stroke and those prescribed to prevent another stroke or heart attack. "In my clinic, patients are typically on four additional drugs after their stroke for things including stroke complications like seizure, chronic pain, and depression and those to prevent another cardiovascular event. These are in addition to their previous drugs, which are typically for things like hypertension, lipids, and diabetes. And many require multiple drugs to control these conditions to the target levels."

Even though many of the medications have generic forms, not all generics are cheap, she pointed out. And with so many needed, the cost can rise alarmingly. "Even if the copay is only $5 or $10 for each medication, that can be more than some of our patients can afford."

Dr. Levine and her colleagues examined data from the National Health Interview Survey from the years 2006-2009. The survey interviews community-dwelling adults and then extrapolates the results to the entire U.S. population.

She compared these recent data to those obtained for a similar study that examined rates of nonadherence based on the survey conducted from 1998 to 2002 (Arch. Neurol. 2007; 64:37-42).

In both surveys, the question assessing cost-related nonadherence was "During the past 12 months, was there any time when you needed prescription medicines but didn’t get them because you couldn’t afford them?"

According to the 2006-2009 survey, there were 5.3 million stroke survivors aged 45 years or older. Of these, 3.6 million were Medicare beneficiaries, and of these, 1.5 million participated in Medicare Part D. The overall proportion of those who reported nonadherence due to cost was 12% – significantly higher than the 8.6% rate found in the 1998-2002 survey.

The results also varied significantly by age and insurance status. In the earlier study, 18% of patients aged 45-54 years reported cost-related nonadherence, compared with 30% in the later study – a significant increase. The differences were not statistically significant among other age groups up to 75 years and older.

Insurance status also significantly affected the situation. In the 1998-2002 survey, 39% of the uninsured reported the problem, compared with 60% of the uninsured in 2006-2009.

"We were very surprised to find that Medicare Part D enrollees had a significantly greater frequency of nonadherence due to cost than did Medicare Part D nonenrollees," Dr. Levine said. In the most recent survey, 12% of enrollees reported nonadherence, compared with 6% of those who did not participate in the program. "Despite this federal program, medication is still unaffordable for many stroke survivors and this prevents the translation of some remarkable research and public health advances to many of our stroke patients," she said.

Potential solutions might include physician screening for medication underuse in stroke patients, particularly the young, uninsured, and Medicare Part D participants, Dr. Levine suggested. "The proposed national affordable health insurance program would be expected to improve cost-related medication nonadherence, medication access, and provide free medicines to prevent recurrent strokes and heart attacks."

The cause of this problem, at least for Medicare Part D enrollees, appears to be the "doughnut hole problem," Dr. Levine said. "The Medicare Part D doughnut hole means that after the program covering $2,500 in medical expenditures, a beneficiary will incur the cost of medications up to $5,000, when catastrophic coverage kicks in, after which Medicare Part D picks up the cost. The new national new health reforms proposed to close that by 2020."

Studies have shown that stroke survivors have a very high risk of both entering and leaving that hole in coverage, she added; survivors spend an average of $800 per month on medications. Because of this high monthly cost, stroke survivors are at a two- to threefold increased risk of severe financial burden, compared with those with other chronic illnesses, such as diabetes or cardiovascular disease.

"For our patients, the important message is that they need to take their medications to prevent a recurrent stroke or cardiovascular event," she said. "If they can’t get the medications due to cost, patients need to tell their doctor and enter a dialogue in order to solve the problem."

Dr. Levine and her colleagues did not report any financial disclosures.

LOS ANGELES – As the economy worsens and the cost of drugs rises, more and more stroke survivors are forced to cut back on a critical health ally – prescription medications.

The rate of medication nonadherence due to cost in stroke survivors increased from 9% in 2002 to almost 12% by 2009, Dr. Deborah A. Levine reported Feb. 10 at the International Stroke Conference.

Medicare Part D – the program introduced in 2006 to address this problem – isn’t helping stroke survivors very much, said Dr. Levine, of the University of Michigan. In fact, her study found that cost-related medication nonadherence was actually twice as high in Medicare Part D enrollees than it was in those who did not have the prescription benefit.

The clinical implications can be severe, she said, from increasing the risk of recurrent stroke or heart attack to neglecting treatment of pre-existing conditions. "The crucial message for physicians is that we need to ask our patients [every time we see them] if they can afford their medications, and if they can’t we need to drastically modify their medication regimen. Patients are not able to effectively prioritize which medications [would] give the biggest bang for the buck, so I work with them to prioritize the regimen to the essential ones that will have the highest value and health benefit, such as antihypertensives," Dr. Levine said at the meeting, which was sponsored by the American Heart Association.

The average stroke survivor takes 11 medications, a number that includes those taken before the stroke and those prescribed to prevent another stroke or heart attack. "In my clinic, patients are typically on four additional drugs after their stroke for things including stroke complications like seizure, chronic pain, and depression and those to prevent another cardiovascular event. These are in addition to their previous drugs, which are typically for things like hypertension, lipids, and diabetes. And many require multiple drugs to control these conditions to the target levels."

Even though many of the medications have generic forms, not all generics are cheap, she pointed out. And with so many needed, the cost can rise alarmingly. "Even if the copay is only $5 or $10 for each medication, that can be more than some of our patients can afford."

Dr. Levine and her colleagues examined data from the National Health Interview Survey from the years 2006-2009. The survey interviews community-dwelling adults and then extrapolates the results to the entire U.S. population.

She compared these recent data to those obtained for a similar study that examined rates of nonadherence based on the survey conducted from 1998 to 2002 (Arch. Neurol. 2007; 64:37-42).

In both surveys, the question assessing cost-related nonadherence was "During the past 12 months, was there any time when you needed prescription medicines but didn’t get them because you couldn’t afford them?"

According to the 2006-2009 survey, there were 5.3 million stroke survivors aged 45 years or older. Of these, 3.6 million were Medicare beneficiaries, and of these, 1.5 million participated in Medicare Part D. The overall proportion of those who reported nonadherence due to cost was 12% – significantly higher than the 8.6% rate found in the 1998-2002 survey.

The results also varied significantly by age and insurance status. In the earlier study, 18% of patients aged 45-54 years reported cost-related nonadherence, compared with 30% in the later study – a significant increase. The differences were not statistically significant among other age groups up to 75 years and older.

Insurance status also significantly affected the situation. In the 1998-2002 survey, 39% of the uninsured reported the problem, compared with 60% of the uninsured in 2006-2009.

"We were very surprised to find that Medicare Part D enrollees had a significantly greater frequency of nonadherence due to cost than did Medicare Part D nonenrollees," Dr. Levine said. In the most recent survey, 12% of enrollees reported nonadherence, compared with 6% of those who did not participate in the program. "Despite this federal program, medication is still unaffordable for many stroke survivors and this prevents the translation of some remarkable research and public health advances to many of our stroke patients," she said.

Potential solutions might include physician screening for medication underuse in stroke patients, particularly the young, uninsured, and Medicare Part D participants, Dr. Levine suggested. "The proposed national affordable health insurance program would be expected to improve cost-related medication nonadherence, medication access, and provide free medicines to prevent recurrent strokes and heart attacks."

The cause of this problem, at least for Medicare Part D enrollees, appears to be the "doughnut hole problem," Dr. Levine said. "The Medicare Part D doughnut hole means that after the program covering $2,500 in medical expenditures, a beneficiary will incur the cost of medications up to $5,000, when catastrophic coverage kicks in, after which Medicare Part D picks up the cost. The new national new health reforms proposed to close that by 2020."

Studies have shown that stroke survivors have a very high risk of both entering and leaving that hole in coverage, she added; survivors spend an average of $800 per month on medications. Because of this high monthly cost, stroke survivors are at a two- to threefold increased risk of severe financial burden, compared with those with other chronic illnesses, such as diabetes or cardiovascular disease.

"For our patients, the important message is that they need to take their medications to prevent a recurrent stroke or cardiovascular event," she said. "If they can’t get the medications due to cost, patients need to tell their doctor and enter a dialogue in order to solve the problem."

Dr. Levine and her colleagues did not report any financial disclosures.