High out-of-pocket costs stop individuals correctly taking their essential heart disease medications

The results of a new study suggest that a significant proportion of individuals with heart disease do not take their essential cardiovascular disease medications as prescribed due to concerns over the high out-of-pocket costs associated with the drugs.

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New research, recently published in Circulation, demonstrates that one-eighth of individuals with common cardiovascular diseases delay taking their medications, delay filling prescriptions or take less than the prescribed doses of their essential medications due to concerns over associated, high, out-of-pocket drug costs.

Senior study author Khurram Nasir (Houston Methodist DeBakey Heart & Vascular Center; TX, USA) explained: “The out-of-pocket cost of medications is a huge issue for millions of high-risk patients with cardiovascular diseases such as heart attacks, stroke, angina and other conditions. When faced with the expenses of taking lifesaving medications as prescribed or not taking them because they are too costly, many choose not to take them.”

Medication non-compliance, due to out-of-pocket costs concerns, is common amongst individuals with cardiovascular disease and can be associated with higher healthcare costs down the line, due to the more intensive interventions required following disease progression, and increased rates of hospitalizations, emergency department visits and doctor appointments.

To determine the extent of the impact of healthcare costs on medication non-compliance of heart disease patients, a team of researchers lead by Rohan Khera (University of Texas Southwestern Medical Center; TX, USA) analyzed survey responses of 14,279 adults – with a mean age of 65 – who participated in the National Health Interview Survey from 2013–2017. All study participants had either confirmed coronary heart disease diagnoses, or had experienced heart-related chest pain, a heart attack or a stroke.

One-eighth of study participants – equivalent to 2.2 million individuals in the USA – attested to having not taken their essential medications as prescribed due to cost-related concerns.

Amongst study participants under the age of 65, medication non-compliance due to cost-related concerns was higher amongst persons from low-income families and individuals who lacked health insurance; more than 50% of uninsured study participants attested to not taking their medications as prescribed due to cost-related concerns.

Further, individuals who did not take their medications as prescribed, as a result of cost concerns, were nine times more likely to use alternative, non-prescription therapies, and 11 times more likely to request low-cost medications, compared with study participants who reported their therapy decisions not to be influenced by financial concerns.

Nasir commented: “Patients should not be afraid to speak with their health care provider if they are not able to afford a prescribed medication since there are many lower-cost generic drugs which might also be effective for their condition.”


Khera R, Valero-Elizondo J, Das SR et al. Cost-related medication nonadherence in adults with atherosclerotic cardiovascular disease in the United States, 2013 to 2017. Circulationdoi:org/10.1161/CIRCULATIONAHA.119.041974 (2019) (Epub ahead of print);



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Ilana Landau

Assistant Editor, Future Science Group

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