U.S. drug costs lead to lapsed treatment adherence, less viral suppression, more ER, hospital visits for people with HIV, study finds

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From 2016 to 2017, 14% of people living with HIV in the United States did something to save money on the out-of-pocket costs of their prescription medicine. Some asked their provider for a lower-priced medicine. Some bought their medicine from another country. Some used an alternative therapy. About half of them — 7 % of people living with HIV in the U.S. — however, saved money at the cost of taking their medicine as prescribed — skipping doses, cutting back on the amount taken, or putting off filling their prescriptions.

The cost of those measures in turn, of lowered likelihood of viral suppression, of more emergency room visits, or more hospitalizations was high — to patients’ health, to health systems and to goals of ending HIV as an epidemic in America, according to report in this week’s Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention.

The report notes that U.S. costs for prescription drugs exceed those of other high-income countries with patients here paying about 14% of those costs out of pocket. Across the U.S. population, the researchers note, cost-saving strategies are known to lead to lack of adherence to prescribed treatment regimens, increasing chances of illness, and among people living with HIV, of transmitting the virus. With telephone and face-to-face interviews as well as medical records, CDC researchers found that age, race, gender, housing need or time since HIV diagnosis did not play a role in the likelihood of cost-related treatment lapses. Having an income above the poverty level, however, did, possibly because of not having been deemed eligible for prescription medication assistance. Patients who said they needed but were not enrolled in the Ryan White AIDS Drug Assistance Program  — ADAP — were five times more likely to have resorted to a cost-saving strategy that included not taking their medicine as prescribed.

People whose cost-saving strategy included postponed prescriptions or skipped or smaller doses were 65% less likely to be virally suppressed on their last viral load test, 55% less likely to be virally suppressed on all viral load tests during the preceding year and less likely to be engaged in care, the researchers found.

While measures to improve adherence to treatment regimens among people living with HIV tend to focus on patients’ behaviors, the researchers note, measures to lower barriers to financial assistance for prescription drugs, including through expanded eligibility for Medicaid and ADAP, by increasing enrollment in the programs, might be more effective and more cost-saving overall.

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