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About one in eight adults suffering from a high-risk heart problem say financial strain has caused them to skip taking their meds, delay filling a prescription, or take a lower dose than prescribed, the researchers said.
Those not yet old enough to go on Medicare were most strongly affected, said senior researcher Dr. Khurram Nasir. He is chief of cardiovascular prevention and wellness at Houston Methodist Hospital in Texas.
Cost-related medication noncompliance was as much as three times more common in people under 65 years old, the study authors found.
"Elderly patients covered by Medicare have a higher burden of disease, and they are less likely to be actively employed," Nasir said. "Still, they had two to three times lower risk of being noncompliant due to cost."
The results bolster the argument that a public insurance option such as Medicare-for-All could promote better health among Americans, he added.
"Our study suggests the current for-profit private insurance system is failing to protect at lot of people from financial risk," Nasir said.
Skipping prescribed blood pressure meds, cholesterol-lowering drugs and other therapies is a risky financial tactic that increases patients' chances of developing heart failure or suffering a heart attack or stroke, Nasir explained.
Dr. Benjamin Hirsh is director of preventive cardiology with Northwell Health Sandra Atlas Bass Heart Hospital, in Manhasset, N.Y. He noted that "heart disease is rising at an alarming rate, and policymakers and stakeholders are needed to curb this epidemic by addressing problems related to affordability of medications."
To see how widespread the practice has become, Nasir and his colleagues analyzed responses from more than 14,000 people who took part in the annual federally funded National Health Interview Survey between 2013 and 2017. All had previously been diagnosed with heart disease, heart-related chest pain, heart attack or stroke.
Nearly one in five people under 65 reported that a financial squeeze had kept them from taking their heart medications as directed, the findings showed.
People without health insurance were least likely to be able to afford their drugs, with more than half saying they'd had to skip doses or delay prescriptions.
But significant percentages of working-age adults with health coverage also reported not taking their heart meds as directed, including 21% of people on Medicaid or other public insurance, and nearly 15% of those with private insurance.
Low-income adults were twice as likely to save costs by skipping medications as people with middle-to-high income levels, 30% compared to 15%.
The South has the most working-age folks struggling with drug costs (25%), followed by the Midwest (21%), the West (18%) and the Northeast (15%), according to the report.
People suffering from two or more chronic diseases had a harder time keeping up with their medication costs, with about 28% reporting noncompliance compared with 20% for those with one chronic illness, and 14% for heart patients with no chronic condition.
There is some evidence that people are doing their best to take the drugs their doctors prescribe, however.
"One in three of individuals who were noncompliant actively requested their physicians to help them find cheaper alternatives," Nasir said.
People not taking medications as prescribed due to cost concerns were 11 times more likely to request low-cost medication and nine times more likely to use alternative, nonprescription therapies, compared to people who could afford their meds, the study authors said.
Heart patients who find themselves skipping doses to save money should talk with their doctor, who can switch them to more affordable alternative meds, and might even be able to steer them toward financial-assistance programs, said Nasir and Dr. Satjit Bhusri, a cardiologist with Lenox Hill Hospital in New York City.
"Affordability, by using generic-brand medicines and support from outside aid, is the best weapon against noncompliance due to cost," Bhusri said.
"Efforts directed towards educating patients and stakeholders, and team-based strategies to reduce medication costs will be necessary to reduce heart disease and curb unsustainable health care expenditures," Hirsh said.
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