More on Patient Engagement

High out-of-pocket costs can make medications out of reach for millions of Americans with cardiovascular disease

Non-compliance has several causes, but recent years have seen patients assuming a greater share of healthcare costs, likely fanning the flame.

Jeff Lagasse, Associate Editor

One in eight adults with common heart diseases and stroke skip taking medications, delay filling prescriptions or take lower doses than prescribed because of concerns about cost, according to new research in the American Heart Association journal Circulation.

Not taking pills at the dose or the interval prescribed -- called medication non-compliance -- is a known problem for people with cardiovascular disease. It often means they need more expensive care later because they become sicker and are more likely to need care in an emergency room, be hospitalized or have more frequent doctor's appointments.

Non-compliance has several causes, but recent years have seen patients assuming a greater share of healthcare costs, which is likely fanning the flame.

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The investigators analyzed survey responses from 14,279 adults (average age 65, 44% female) who took part in the National Health Interview Survey between 2013 and 2017. All had previously been diagnosed with coronary heart disease, heart-related chest pain, a heart attack or a stroke.

In addition to the one in eight who had skipped medications due to cost concerns, the survey found that cost-related medication non-compliance was three times more common in people under 65, with nearly one in five reporting it.

Among those under 65, one in four women, one in three patients from low-income families and more than half of patients without health insurance reported not taking their medications as prescribed in order to save money.

People who did not take medications as prescribed due to cost concerns were 11 times more likely to request low-cost medication, and nine times more likely to use alternative, non-prescription therapies, compared to people who reported that financial concerns did not impact their decision.

The study did not examine the specific medications patients were prescribed and which were more likely to result in cost-related non-compliance.


Patients have been vocal about their desire for upfront pricing, with 85% of those polled in a recent HealthPocket survey saying healthcare costs are too high in general, and 51% saying they've avoided medical care due to a lack of ability to pay.

Just this week, a Wolters Kluwer report broke down Americans' ongoing struggles with medical costs by age group, finding that millennials are twice as likely as baby boomers to forego medical care due to cost.

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Twitter: @JELagasse

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