BOSTON – Eliminating copays on medications to control glucose, blood pressure, and cholesterol as a way to improve medication adherence can result in significant clinical improvements for uninsured low-income patients with chronic disease, including type 2 diabetes, reported John G. Ryan, Dr.P.H., director of research at the University of Miami Health System.
For this cross-sectional, single-site study, Dr. Ryan and his colleagues recruited 154 adults (mean age 55 years, 66% female, 55% black) from a university-affiliated, community outpatient clinic treating mostly uninsured adult patients. Average annual copays per patient were $458 before copays were waived, with a mean 58 prescriptions filled per year.
To qualify for the study, those who were enrolled had to have picked up at least two prescriptions to treat hypertension, diabetes, and/or high blood pressure.
The researchers took baseline hemoglobin A1c, cholesterol, and blood pressure information from electronic health records within 6 months before study onset. They also used pharmacy data to determine the proportion of days in which patients had medication on hand over the 12-month study period. Patients with medication for 80% of covered days were considered to be adherent.
The investigators then paired clinical data from baseline and 12 months with adherence measures.
In the subset of patients taking diabetes medications for whom HbA1c measures and paired adherence data were available (n = 47), just over half of diabetes patients were adherent over the course of a year – a proportion in keeping with published medication adherence rates in the general population of patients with type 2 diabetes, Dr. Ryan noted at the annual scientific sessions of the American Diabetes Association. Medication-adherent patients saw mean 6.67% HbA1c at follow-up, compared with 8.4% for those considered nonadherent (P = .003).
Dr. Ryan noted that the zero-pay study protocol originated as a service to patients before institutional review was sought and the study initiated. This limited the researchers’ ability to collect information from patients on other potential barriers to adherence, such as cognitive impairment and health literacy. The study design “addressed only one external barrier for medication nonadherence: personal finances,” he said. “I would have loved to have barraged these patients with a lot of different patient-oriented measures to try and understand what’s really going on,” he added.
Still, the findings suggest “that, in a minority population such as ours, characterized by poverty, lack of health insurance, with multimorbitity and sometimes severe multimorbidity, medication adherence improved chronic disease outcomes from access to prescription drugs,” Dr. Ryan said.
Many states, including Florida, have substantial numbers of adults with chronic disease who neither qualify for Medicaid under current state rules nor can afford insurance or copayments under the Affordable Care Act.
Dr. Ryan said he had not done a rigorous cost analysis but suspected that, for community clinics receiving funds to treat type 2 diabetes patients, “depending on the cut point of HbA1c, downriver you might see savings from deferring complications.”
Eliminating copays for uninsured patients “is something that a forward-looking public hospital might want to do if it can absorb short-term costs,” he said.
The study was funded by the University of Miami Health System. Dr. Ryan disclosed no conflicts of interest.