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October 2004, Vol 94, No. 10 | American Journal of Public Health 1782-1787
© 2004 American Public Health Association

RESEARCH AND PRACTICE

Cost-Related Medication Underuse Among Chronically III Adults: the Treatments People Forgo, How Often, and Who Is at Risk

John D. Piette, PhD, Michele Heisler, MD and Todd H. Wagner, PhD

John D. Piette and Michele Heisler are with the Center for Practice Management and Outcomes Research, Department of Veterans Affairs and the Department of Internal Medicine and Diabetes Research and Training Center, University of Michigan, Ann Arbor. Todd H. Wagner is with the Health Economics Resource Center, Department of Veterans Affairs and the Department of Health Research and Policy, Stanford University.

Correspondence: Requests for reprints should be sent to John D. Piette, Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, PO Box 130170, Ann Arbor, MI 48113–0170 (e-mail: jpiette{at}umich.edu).

Objectives. We sought information about the cost-related underuse of medications—which medications are underused, by whom, and how often.

Methods. Chronically ill adults were asked to identify how often they underused prescription medication for 16 health conditions because of the cost.

Results. Eighteen percent of respondents cut back on medication use owing to cost in the previous year, and 14% used less medication at least monthly. Although rates of underuse varied substantially across treatments, prescription coverage and out-of-pocket costs were determinants of underuse across medication types.

Conclusions. Many chronically ill adults frequently cut back on medications owing to cost. Patients are selective about the treatments they forgo. Out-of-pocket costs and inadequate prescription coverage may lead to adherence problems for many important medication types.




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