Out-of-Pocket Costs Impact Neurologic Medication Adherence

THURSDAY, Feb. 20, 2020 — For patients with certain neurological conditions, increasing out-of-pocket medical costs is associated with lower medication adherence, according to a study published online Feb. 19 in Neurology.

Evan L. Reynolds, Ph.D., from the University of Michigan in Ann Arbor, and colleagues identified patients with incident neuropathy, dementia, or Parkinson disease (PD) using privately insured claims from 2001 to 2016. Patients who were prescribed medication with similar efficacy and tolerability and with differential out-of-pocket costs were selected. The authors examined the association between out-of-pocket costs and medication adherence, defined as the number of days supplied in the first six months.

Data were included for 52,249 patients with neuropathy on gabapentinoids, 5,246 patients with neuropathy on serotonin/norepinephrine reuptake inhibitors (SNRIs), 19,820 patients with dementia on cholinesterase inhibitors, and 3,130 patients with PD on dopamine agonists. The researchers found that for patients with neuropathy on gabapentinoids and patients with dementia, increasing out-of-pocket costs by $50 was associated with significantly lower medication adherence (adjusted incidence rate ratios [aIRRs], 0.91 [95 percent confidence interval (CI), 0.89 to 0.93] and 0.88 [95 percent CI, 0.86 to 0.91], respectively). There was no significant association noted for increased out-of-pocket costs with medication adherence for patients with neuropathy on SNRIs (aIRR, 0.97; 95 percent CI, 0.88 to 1.08) and patients with PD (aIRR, 0.90; 95 percent CI, 0.81 to 1.00). Compared with white patients, minority patients had lower adherence to gabapentinoids and cholinesterase inhibitors.

“Finding the medication with the lowest OOP (out-of-pocket) cost has the potential to increase medication adherence and ultimately improve patient care,” the authors write.

Several authors disclosed financial ties to the pharmaceutical, medical device, and other industries.

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