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Even after a serious cardiac event some patients are rationing drugs due to cost. Getty Images
  • Many people with heart disease report not taking their medications as prescribed because of concerns about cost.
  • A new study found that 1 in 8 people who have a heart condition are rationing or avoiding their medications.
  • This can actually cost more in the long run if they end up back in the hospital.

One in eight people who’ve had a heart attack or other cardiovascular condition don’t take their medications as prescribed, new research shows.

In the new study, researchers found that people saved money on prescription drugs by skipping doses, delaying refills, or taking less than the prescribed dose.

This kind of cost-related rationing of medication can dramatically increase a person’s risk of having another heart attack, stroke, or other cardiovascular event.

Medication rationing or avoidance can even cost a patient more money, since it can lead to higher healthcare costs down the road if people end up at the emergency room or hospitalized, or need more frequent doctor’s appointments.

Dr. Deborah Levine, MPH, a general internist and researcher at the University of Michigan’s Institute for Healthcare Policy and Innovation, said these results confirm what’s been seen in earlier studies, including her 2018 study of stroke survivors.

“Many Americans are struggling to afford their medications, and in many cases forgoing their medications or rationing them,” said Levine, who wasn’t involved in the new study. “As a result, they’re experiencing preventable health complications.”

In the study, researchers from Yale University and other institutions looked at information on U.S. adults from the National Health Interview Survey for 2013 to 2017.

The study was published November 25 in the American Heart Association’s journal Circulation.

The researchers focused on 14,279 people who had experienced coronary heart disease, heart-related chest pain, heart attack, and stroke.

One out of eight people reported not taking their medications as prescribed because of cost concerns.

Based on this, the researchers estimate that each year 2.2 million heart disease patients in the United States skip or cut back on their prescription drugs to save money.

Cost-related medication nonadherence was 3 times higher among people under 65, compared to older adults covered by Medicare.

Among those under age 65, some groups were more likely to not take their medications as prescribed because of cost — women, people with a low income, and those without health insurance.

Researchers also found that over a quarter of people asked their doctor for a lower-cost medication. Four percent reported using an alternative nonprescription therapy to treat their condition.

People who didn’t take their medications as prescribed because of cost were more likely to use these two cost-saving strategies.

For people who’ve had a heart attack, stroke, or other cardiovascular event, keeping up with their medications may mean taking several pills a day.

A 2006 study found that survivors of stroke take on average 11 different medications, although it ranged from 3 to 27.

But this grueling regimen can help keep them healthy longer.

“People who already have had a cardiovascular event are at high risk for having another one,” said Levine. “Up to 80 percent or more of second cardiovascular events can be prevented by controlling blood pressure, cholesterol, and diabetes, and by taking an aspirin or stronger blood thinner.”

Medication adherence can also reduce healthcare costs because people are less likely to be hospitalized or need additional doctor’s visits.

Cost, though, is just one reason why people don’t take their medications as prescribed.

Julie Cooper, PharmD, an associate professor of cardiology clinical sciences at High Point University in North Carolina, who wasn’t involved in the new research, said other factors include a person’s social support, living situation, or health literacy skills.

A lack of trust in the healthcare system or being unable to get to a pharmacy can also play a role.

Having health insurance can help people afford their medications, but it’s only part of the solution.

“Our [2018] study and others have shown that while insurance helps make medications more affordable and reduces out-of-pocket costs for patients, it will not solve the problem,” said Levine.

“Even patients with insurance find it difficult to afford medications,” she added.

This is partially due to rising out-of-pocket costs — not just for medications, but also for insurance deductibles and copays, and inpatient visits.

Older adults tend to have higher out-of-pocket costs for medications, because they often have more chronic conditions to treat. But in the new study, this group had better adherence than younger adults.

“Some find the high rate of cost-related medication nonadherence in younger Americans to be surprising,” said Cooper.

But she pointed out that many younger people are uninsured, while all older adults are eligible for Medicare.

In 2017, 27.4 percent of non-elderly were uninsured, according to the Kaiser Family Foundation.

As a result, younger Americans are “at high risk for new onset cardiovascular disease,” said Cooper.

Some studies have found that if patients are provided beneficial medications for no or low cost it can improve adherence and lead to lower healthcare costs.

But it’s unlikely that widespread drug pricing reform is coming soon.

In the meantime, Cooper offers these tips for people who are struggling to pay for their medications:

  • Ask your doctor or pharmacist about using a less expensive generic or brand-name medication.
  • If you don’t have insurance, compare prices at pharmacies, including online ones.
  • Check out medication assistance programs that offer discounted or free prescription drugs.
  • Look for programs in your community or through your local health system that support people who are uninsured or underinsured.