Disparities in cost-related drug nonadherence under the Affordable Care Act

Wendy Yi Xu, Andrew Shooshtari, Jeah (Kyoungrae) Jung

Research output: Contribution to journalArticle

Abstract

Objective: The Affordable Care Act (ACA), implemented in 2014 in the USA, featured several policies relevant to patients’ out-of-pocket spending for prescription drugs. Our study examined how disparities in cost-related nonadherence (CRN) to prescription drugs changed by race, ethnicity and socioeconomic status after the ACA. Methods: We analysed a nationally representative sample of nonelderly adults aged 18–64 in the 2013–2017 National Health Interview Survey data. The first outcome measure captured individuals who could not afford needed prescription drugs in the past 12 months. Among participants who filled a prescription in the past year, three outcome measures included skipped medication doses, taking less medicine or delaying filling a prescription to save money during that time. Interactions between income, education, and race and ethnicity variables with the post-ACA indicator capture how the ACA affected socioeconomic and racial disparities in CRN, while linear probability regression models adjusted for patient characteristics, region indicators and year dummies. Key finding: Income-based disparities in CRNs narrowed after the ACA. Individuals with incomes below 138% federal poverty level (FPL) had larger reductions in the probability of being unable to afford prescription drugs (−3.83% points), skipping doses (−3.33% points), taking less medication (−3.17% points) or delaying medication fills to save money (−3.68% points) than those with income greater than 400% FPL. Several CRN measures declined more among Hispanics than among non-Hispanic white people. The ACA was also associated with greater CRN reductions among individuals with a high school education. Conclusion: The narrowed disparities in CRN suggest the ACA effectively improved prescription drug adherence by those vulnerable to healthcare cost burdens.

Original languageEnglish (US)
Pages (from-to)177-185
Number of pages9
JournalJournal of Pharmaceutical Health Services Research
Volume10
Issue number2
DOIs
StatePublished - Jun 1 2019

Fingerprint

Patient Protection and Affordable Care Act
Drug Costs
Prescription Drugs
Costs and Cost Analysis
Poverty
Prescriptions
Outcome Assessment (Health Care)
Education
Health Expenditures
Drugs
Costs
Health Surveys
Hispanic Americans
Social Class
Health Care Costs
Linear Models
Medicine
Prescription drugs
Interviews
Income

All Science Journal Classification (ASJC) codes

  • Economics, Econometrics and Finance (miscellaneous)
  • Pharmacology, Toxicology and Pharmaceutics (miscellaneous)

Cite this

@article{d0c12f0fe629488db95b8be354331121,
title = "Disparities in cost-related drug nonadherence under the Affordable Care Act",
abstract = "Objective: The Affordable Care Act (ACA), implemented in 2014 in the USA, featured several policies relevant to patients’ out-of-pocket spending for prescription drugs. Our study examined how disparities in cost-related nonadherence (CRN) to prescription drugs changed by race, ethnicity and socioeconomic status after the ACA. Methods: We analysed a nationally representative sample of nonelderly adults aged 18–64 in the 2013–2017 National Health Interview Survey data. The first outcome measure captured individuals who could not afford needed prescription drugs in the past 12 months. Among participants who filled a prescription in the past year, three outcome measures included skipped medication doses, taking less medicine or delaying filling a prescription to save money during that time. Interactions between income, education, and race and ethnicity variables with the post-ACA indicator capture how the ACA affected socioeconomic and racial disparities in CRN, while linear probability regression models adjusted for patient characteristics, region indicators and year dummies. Key finding: Income-based disparities in CRNs narrowed after the ACA. Individuals with incomes below 138{\%} federal poverty level (FPL) had larger reductions in the probability of being unable to afford prescription drugs (−3.83{\%} points), skipping doses (−3.33{\%} points), taking less medication (−3.17{\%} points) or delaying medication fills to save money (−3.68{\%} points) than those with income greater than 400{\%} FPL. Several CRN measures declined more among Hispanics than among non-Hispanic white people. The ACA was also associated with greater CRN reductions among individuals with a high school education. Conclusion: The narrowed disparities in CRN suggest the ACA effectively improved prescription drug adherence by those vulnerable to healthcare cost burdens.",
author = "Xu, {Wendy Yi} and Andrew Shooshtari and Jung, {Jeah (Kyoungrae)}",
year = "2019",
month = "6",
day = "1",
doi = "10.1111/jphs.12295",
language = "English (US)",
volume = "10",
pages = "177--185",
journal = "Journal of Pharmaceutical Health Services Research",
issn = "1759-8885",
publisher = "John Wiley and Sons Ltd",
number = "2",

}

Disparities in cost-related drug nonadherence under the Affordable Care Act. / Xu, Wendy Yi; Shooshtari, Andrew; Jung, Jeah (Kyoungrae).

In: Journal of Pharmaceutical Health Services Research, Vol. 10, No. 2, 01.06.2019, p. 177-185.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Disparities in cost-related drug nonadherence under the Affordable Care Act

AU - Xu, Wendy Yi

AU - Shooshtari, Andrew

AU - Jung, Jeah (Kyoungrae)

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objective: The Affordable Care Act (ACA), implemented in 2014 in the USA, featured several policies relevant to patients’ out-of-pocket spending for prescription drugs. Our study examined how disparities in cost-related nonadherence (CRN) to prescription drugs changed by race, ethnicity and socioeconomic status after the ACA. Methods: We analysed a nationally representative sample of nonelderly adults aged 18–64 in the 2013–2017 National Health Interview Survey data. The first outcome measure captured individuals who could not afford needed prescription drugs in the past 12 months. Among participants who filled a prescription in the past year, three outcome measures included skipped medication doses, taking less medicine or delaying filling a prescription to save money during that time. Interactions between income, education, and race and ethnicity variables with the post-ACA indicator capture how the ACA affected socioeconomic and racial disparities in CRN, while linear probability regression models adjusted for patient characteristics, region indicators and year dummies. Key finding: Income-based disparities in CRNs narrowed after the ACA. Individuals with incomes below 138% federal poverty level (FPL) had larger reductions in the probability of being unable to afford prescription drugs (−3.83% points), skipping doses (−3.33% points), taking less medication (−3.17% points) or delaying medication fills to save money (−3.68% points) than those with income greater than 400% FPL. Several CRN measures declined more among Hispanics than among non-Hispanic white people. The ACA was also associated with greater CRN reductions among individuals with a high school education. Conclusion: The narrowed disparities in CRN suggest the ACA effectively improved prescription drug adherence by those vulnerable to healthcare cost burdens.

AB - Objective: The Affordable Care Act (ACA), implemented in 2014 in the USA, featured several policies relevant to patients’ out-of-pocket spending for prescription drugs. Our study examined how disparities in cost-related nonadherence (CRN) to prescription drugs changed by race, ethnicity and socioeconomic status after the ACA. Methods: We analysed a nationally representative sample of nonelderly adults aged 18–64 in the 2013–2017 National Health Interview Survey data. The first outcome measure captured individuals who could not afford needed prescription drugs in the past 12 months. Among participants who filled a prescription in the past year, three outcome measures included skipped medication doses, taking less medicine or delaying filling a prescription to save money during that time. Interactions between income, education, and race and ethnicity variables with the post-ACA indicator capture how the ACA affected socioeconomic and racial disparities in CRN, while linear probability regression models adjusted for patient characteristics, region indicators and year dummies. Key finding: Income-based disparities in CRNs narrowed after the ACA. Individuals with incomes below 138% federal poverty level (FPL) had larger reductions in the probability of being unable to afford prescription drugs (−3.83% points), skipping doses (−3.33% points), taking less medication (−3.17% points) or delaying medication fills to save money (−3.68% points) than those with income greater than 400% FPL. Several CRN measures declined more among Hispanics than among non-Hispanic white people. The ACA was also associated with greater CRN reductions among individuals with a high school education. Conclusion: The narrowed disparities in CRN suggest the ACA effectively improved prescription drug adherence by those vulnerable to healthcare cost burdens.

UR - http://www.scopus.com/inward/record.url?scp=85064716302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064716302&partnerID=8YFLogxK

U2 - 10.1111/jphs.12295

DO - 10.1111/jphs.12295

M3 - Article

AN - SCOPUS:85064716302

VL - 10

SP - 177

EP - 185

JO - Journal of Pharmaceutical Health Services Research

JF - Journal of Pharmaceutical Health Services Research

SN - 1759-8885

IS - 2

ER -